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Author List:
Stroupe KT (Midwest Center for Health Services and Policy Research)
Smith B (Midwest Center for Health Services and Policy Research)
Lee TA (Midwest Center for Health Services and Policy Research)
Durazo-Arvizu R (Northwestern Feinberg School of Medicine)
Cao L (Northwestern Feinberg School of Medicine)
Nydam T (Midwest Center for Health Services and Policy Research)
Objectives:
In February 2002, VA raised the medication copay from $2 to $7 per 30-day prescription. Veterans were subject to the copay depending on their VA Priority Category: Priority 1 (no copay), Priorities 2-6 (copay for non-service connected medications), and Priorities >=7 (copay for all medications). We examined changes in medication acquisition from VA following the copay increase among these groups.
Methods:
Our cohort was a 5% random sample of male VA users in fiscal year 2001. We excluded veterans who were new users of VA or who died during the study period, resulting in 140,213 veterans. Pharmacy data came from the VA Pharmacy Benefit Management Group. To exclude medications for acute conditions, we included only medications with at least one 30-day prescription. We compared the number of 30-day prescriptions during the one-year periods before and after the copay increase, using t-tests and multivariable count models that controlled for demographic factors and comorbidities. We compared all chronic medications, high-cost (medications costing > $7/30-day supply), low-cost (medications costing <= $7/30-day supply), over-the-counter (OTC), generic, prescription-only, and brand medications.
Results:
Following the copay increase, medication acquisition increased for Priority 1 veterans. However, the number of 30-day prescriptions of all chronic medications fell 4% for Priorities 2-6 (52.5 versus 50.4; p < 0.001) and 7% for Priorities >=7 (45.3 before versus 42.2 after; p < 0.001). The number of low-cost medications fell 13% for Priorities 2-6 and 25% for Priorities >=7; however, the number of high-cost medications fell only 2% for Priorities 2-6 and 4% for Priorities >=7. There were relatively greater reductions in OTC and generic medications, which tend to be lower cost, than prescription-only and brand medications. These trends remained in multivariable count models
Implications:
The number of prescriptions fell following the copay increase among veterans subject to the copay. The copay increase had relatively larger impacts on low-cost, OTC, and generic medications.
Impacts:
The change in copay policy had a relatively larger impact on acquisition of lower-cost medications, which might indicate that veterans were substituting medications from non-VA sources. Additional research is needed to determine the impact on subsequent non-VA medication acquisition and health outcomes.
