Substantial Portion of Elderly Veterans Receive Medications from Medicare Part D-Reimbursed Pharmacies – Either Alone or in Conjunction with VA Pharmacies
BACKGROUND:
In 2007, the Centers for Medicare & Medicaid Services estimated that approximately 27% of Veterans enrolled in VA healthcare also were enrolled in Medicare Part D. Given the sizable proportion of the elderly U.S. population who are Veterans, it is important for clinicians and policymakers, both in VA and in the private sector, to understand the impact of Medicare Part D on Veterans' medication use. Because the availability of Part D coverage may increase Veterans' options for obtaining medications by making it easier for them to obtain prescription medications not on VA's formulary, the availability of Part D coverage may be one factor that contributes to increasing the complexity of Veterans' medication management. Therefore, this study examined patterns of medication acquisition from VA and Part D-reimbursed pharmacies following the implementation of Part D. Using VA data, investigators identified all female Veterans and a random 10% sample of male Veterans who were >65 years old as of January 2004. Using both VA and Medicare data for Veterans in this cohort that were alive through December 2009 (n=145,899), they examined their medication acquisition in 2009. Other measures included patient characteristics and healthcare utilization.
FINDINGS:
- Nearly one-third of VA healthcare users received medications from Part D-reimbursed pharmacies, either alone or in combination with VA pharmacies: 21% (n=29,952) from Part D-reimbursed pharmacies only, and 10% (n=14,401) from both VA and Part D-reimbursed pharmacies.
- Veterans who lived in rural areas, were not black, had VA medication copayments, or were dual or Medicare-only outpatient users were more likely to be dual (i.e., both VA and Part D) pharmacy users or Part D-reimbursed only pharmacy users compared to other Veterans.
- Among dual pharmacy users, more than half of the Veterans received medications from the same drug class from both VA and Part D-reimbursed pharmacies that overlapped by more than seven days.
IMPLICATIONS:
- Results highlight the clinical importance of assessing medications from VA and non-VA sources. At particular risk for suboptimal medication reconciliation are those Veterans who receive care within VA only or from both VA and Medicare outpatient clinics, but who solely obtain their medications from non-VA pharmacies.
LIMITATIONS:
- Investigators only examined non-VA pharmacy data for Veterans enrolled in Part D. Thus, results provide a lower estimate of the percentage of Veterans who were dual VA and non-VA pharmacy users.
- Only data from 2009 were analyzed; it's unclear whether current data would reveal similar trends.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 07-165). Drs. Stroupe and Smith, and Ms. Bailey are part of HSR&D's Center of Innovation for Complex Chronic Healthcare (CINCCH) in Hines, IL.
Stroupe K, Smith B, Bailey L, et al. Medication Acquisition by Veterans Dually Eligible for VA and Medicare Part D Pharmacy Benefits. American Journal of Health-System Pharmacy. February 1, 2017;74(3):140-150.
