Session number: 1062
Abstract title: Do enrollees come to VA just for Pharmacy?
Author(s):
SC Zhu - Center for Health Quality, Outcomes, & Economic Reasearch, Department of Health Services, Boston University School of Public Health
JA Gardner - Center for Health Quality, Outcomes, & Economic Reasearch
W West - Center for Health Quality, Outcomes, & Economic Reasearch
AM Hendricks - Center for Health Quality, Outcomes, & Economic Reasearch, Department of Health Services, Boston University School of Public Health
Objectives: To determine what proportion of patient come to VA primarily for pharmacy services and to estimate their annual pharmacy costs.
Methods: For the patients (n=525160) using VA care in FY1998 at six study sites for the ‘Evaluation of VA Cost Study’ or in VISN 1 & 2, we applied three alternative definitions to identify those who were “primarily pharmacy users” (PPU). PPU were defined as having no inpatient utilization but at least some pharmacy cost during FY98 and: (1) No more than 4 outpatient visits; or (2) Non-pharmacy cost less than $800; or (3) Pharmacy costs over $100 and comprising at least 33% of annual VA costs. Sub-samples of patients with diabetes or Parkinson’s Disease were analyzed.
Results: In FY1998, PPUs were 12.7% of VA patients by the outpatient visit definition (1), 8.8% by the non-pharmacy cost definition (2), and 6.9% by the pharmacy cost definition (3). Under definition (1), PPUs’ average pharmacy cost was $679 compared with $273 (p<.0001) for all other patients; this was 22.9% of total PPUs’ cost, not significantly different from all others at 23.0% (p=0.5846). For the non-pharmacy cost definition (2), PPUs’ average pharmacy cost was $393 compared to $305 for all others (p<.0001); this was 35.5% of total cost, compared to 17.0% (p<.0001) for others. For the pharmacy costs definition (3), PPUs’ average pharmacy cost was $1206 compared with all others at $244 (p<.0001); this was 53.8% of total cost, significantly higher than others (12.7%, p<.0001 ). For diabetes patients (n=66,789), we found a similar PPU distribution for each of the three definitions.
Conclusions: Depending on the definition we applied, there were about 7-13% of VA patients who appear to come to VA primarily for pharmacy. Their average pharmacy costs are $88-962 more than for other patients.
Impact statement: The VA pharmacy benefit is sufficiently important for a significant share of VA patients that they come to VA primarily for that services. Depending on the definition, the amount of pharmacy costs of these patients average between $400 to $1200. This could change if Medicare adds a drug benefit.