Dual use of VA and Part D Prescription Drug Benefits Associated with Potentially Unsafe Medication Prescribing among Veterans
Veterans 65 years and older with prescription drug benefits from VA are almost universally eligible for Medicare Part D. Previous work shows that dual VA-Part D prescription drug use is a risk factor for potentially unsafe medication (PUM) exposure in Veterans with dementia and opioid users. Thus, this study evaluated the association of dual prescription use through VA and Part D (vs. VA-only use) with the prevalence of PUM exposure in a national cohort of dually-eligible older Veterans. Using VA and Medicare data, investigators identified 279,940 Veterans (68 years and older) who were continuously enrolled in VA and Part D and received at least one medication through VA in 2015 – placing them into a dual-user group (n=52,839) or VA-only group (n=227,101). Investigators examined four PUM measures: 1) any prescription for a Healthcare Effectiveness Data and Information Set high-risk medication in the elderly (PUM-HEDIS); 2) exposure to prescriptions with an anticholinergic cognitive burden score of at least 3 (PUM-ACB); 3) any overlapping days of exposure to drug combinations with high risk for severe interactions; and 4) a composite measure of any type of PUM exposure.
- Dual use of VA and Part D prescription drug benefits was associated with an almost 2-fold increase in the odds of exposure to any PUM compared with VA-only use and more than 3 times the odds of exposure to severe drug-drug interactions.
- PUM exposure was lowest among VA-only users, and PUM exposure peaked in Veterans receiving prescriptions in near-equal proportions (50/50) from VA and Part D.
- To mitigate the potential risks associated with unsafe medication prescribing, policies intended to expand access to non-VA providers must ensure patient information is shared and integrated into routine practice for all patients seeking care across multiple healthcare systems. Further, it is possible that the safety risks found in this study of Veterans may extend to all patients who receive prescriptions across disconnected healthcare providers or systems.
- In a JAMA Internal Medicine Invited Commentary by David Shulkin, MD, former VA Secretary, he states that “the MISSION Act will likely dramatically increase the number of Veterans getting at least some of their care from the private sector.” In addition, he states that “An effective integrated system of care for Veterans will require comprehensive care coordination and improved interoperability of data across clinical settings.”
This study was partly funded by HSR&D. Drs. J. Thorpe and C. Thorpe and Ms. Schleiden are part of HSR&D’s Center for Health Equity Research & Promotion.
Thorpe J, Thorpe C, Schleiden L, et al. Association between Dual Use of Department of Veterans Affairs and Medicare Part D Drug Benefits and Potentially Unsafe Prescribing. JAMA Internal Medicine. Research Letter. E-published on July 22, 2019.