Hasche JC (Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center ), Kuebeler MK
(Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center ), Daw CN
(Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center ), Byrne MM
(University of Miami, Miami, FL), Petersen LA
(Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine )
To examine the dynamics and clinical characteristics of patients who used the VHA primarily for pharmacy services from FY03-FY06, and to assess the impact of such users on costs to the system.
We identified veterans who used the VHA primarily for pharmacy services in each of FY03-FY06. These veterans met the following criteria in a single fiscal year: 1) no inpatient use, 2) two or fewer primary care visits and four or fewer visit days, 3) pharmacy costs at least one-half of annual VA costs. We examined demographic and clinical characteristics of these veterans, as well as utilization patterns and costs.
In FY03-FY06, we identified 14.1%-15.2% of VHA outpatients as principally pharmacy users; we did not observe a drop in FY06 associated with the inception of Medicare Part D. Of the FY03 cohort, 58.9% met the criteria in at least two years, and 34% in at least three years of the study. These users are older (FY06 mean(sd) age 70.0(12.7) v. 62.6(14.5) years), and twice as likely to be Priority 8 veterans (FY06 44.5% v. 22.1%, p < 0.001) when compared to typical outpatient users. Their FY06 median pharmacy and total costs were $663 and $971 respectively, compared with $476 and $2,125 for typical outpatient users. These high intensity pharmacy users were much less likely to have common outpatient conditions such as musculoskeletal/connective disorders (28.3% v 49.7%), substance abuse (6.8% v 17.2%), and mental health disorders (14.4% v. 29.2%), and slightly more likely to have heart related conditions (70.3 to 66.3% in FY06) (all comparisons p < 0.001).
In each of FY03-FY06, nearly 15% of VHA outpatients relied primarily on the pharmacy service; a substantial portion of these patients did so in multiple years. The FY06 total cost of these patients to the VA was $727M ($556 pharmacy), or 2.4% of the total VHA appropriation.
In an era of rising medication costs, the VA continues to be an important source for pharmacy benefits for our veterans, including those with limited access to VA services. This assessment does not appear to be changing despite implementation of Medicare Part D.