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Publication Briefs

Study Examines Erectile Dysfunction Medication Use among Veterans Eligible for Medicare Part D

BACKGROUND: In erectile dysfunction (ED) treatment guidelines, the oral phosphodiesterase-5 inhibitors (PDE-5) – including sildenafil, vardenafil, and tadalafil – are considered first-line therapy for ED. Veterans who use PDE-5 inhibitors for ED are limited to four doses per month through VA pharmacy benefits. However, Medicare Part D included ED medications on the formulary during 2006, and then inadvertently in 2007 and 2008. Although data exist for the use of PDE-5 inhibitors at the population level, limited information exists on the use of PDE-5 inhibitors by Veterans who are dually using VA and private sector healthcare. This retrospective cohort study determined PDE-5 medication use among Veterans who were dually eligible for VA and Medicare Part D benefits. Investigators identified a random 10% sample of male Veterans (n=24,745) who used VA healthcare, were aged 66 or older, and had received at least one prescription for a PDE-5 inhibitor between January 2005 and December 2009. Veterans were categorized by PDE-5 inhibitor claims: VA-only (85%), Part D-only (11%), or dual users of VA and Part D-reimbursed pharmacies (3%). Demographics and insurance copayment status also were examined.


  • During the period when PDE-5 inhibitors were allowed on the Medicare Part D formulary, PDE-5 inhibitor prescriptions from VA pharmacies decreased, while PDE-5 inhibitor fills from Medicare-reimbursed pharmacies increased. However, this trend reversed after PDE-5 inhibitors were removed from the Part D formulary.
  • Vardenafil and sildenafil represented 55% and 43% of all prescriptions, respectively. In 2006, after vardenafil was classified as the preferred PDE-5 inhibitor for the VA, the number of sildenafil prescriptions dispensed by VA decreased significantly – from 53,511 prescriptions in 2005 to 6,583 prescriptions in 2006.


  • VA formulary restrictions can increase the likelihood that Veterans who have access to non-VA healthcare obtain medications from the private sector. Since use of non-VA pharmacies may be unknown to VA providers, these Veterans may be at higher risk of adverse events or drug interactions. This is especially a concern for lifestyle drugs, such as those used for ED.


  • Databases used to capture prescription fills were not able to capture any prescriptions that were paid for with cash in the private sector.
  • A chart review was not performed to detect whether Veterans reported outside use of ED medications, which would have helped describe whether VA providers were aware of dual users, and medical records were only availble for Veterans who received VA care.
  • Data may not reflect more recent trends in Medicare Part D use especially in the wake of the Affordable Care Act.

This study was funded by HSR&D (IIR 07-165). Drs. Suda, Smith, Huo, Bailey, and Stroupe are part of HSR&D's Center of Innovation for Complex Chronic Healthcare (CINCCH) in Hines, IL.

PubMed Logo Spencer S, Suda K, Smith B, Huo Z, Bailey L, and Stroupe K. Erectile Dysfunction Medication Use in Veterans Eligible for Medicare Part D. Journal of Managed Care & Specialty Pharmacy. July 2016;22(7):818-824.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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