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2023 HSR&D/QUERI National Conference Abstract

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4130 — Survey on the Impact of VA Medication Copayment Restructuring on Veteran Cost of Medications and Use of Non-VA Pharmacies

Lead/Presenter: Kevin Stroupe,  COIN - Hines
All Authors: Stroupe KT (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, IL), Etingen B (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, IL) Hogan TP (Center for Healthcare Organization and Implementation Research (CHOIR), Bedford and Boston, MA) Gonzalez B (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, IL) Evans CT (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, IL) Suda KJ (Center for Health Equity Research & Promotion (CHERP), Pittsburgh and Philadelphia, PA) Huo Z (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, IL) Ippolito D (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, IL) Burk M (VA Pharmacy Benefits Management) Cunningham F (VA Pharmacy Benefits Management) Smith BM (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines, IL)

Objectives:
In February 2017, VA restructured their outpatient medication copayment system. Previously, VA charged non-exempt Veterans either $8 or $9 for each 30-day or less supply of medication. Under the restructured system, VA created 3 medication tiers similar to the private sector distinguished, in part, by whether the medications are available from multiple or single sources. Restructured copayments per 30-day supply are based on their medication tier classification: $5, $8, and $11 per 30-day supply for tier 1-3 medications, respectively. VA also lowered the cap on annual medication copayments for Veterans from $960 to $700. This study utilized a survey to assess the impact of the copayment restructuring on Veterans’ medication costs and use of non-VA pharmacies.

Methods:
We conducted a national cross-sectional survey of Veterans in 2018 to understand their perspectives about the VA’s copayment restructuring. We invited a random sample of 10,000 Veterans with chronic conditions treated with medications (i.e., diabetes, hypertension, hyperlipidemia, depression, benign prostatic hyperplasia, or rheumatoid arthritis) who utilized VA services between 2/1/2015-1/31/2017 to complete the survey by mail. We received responses from 2,884 Veterans (29% response rate). We compared survey responses between Veterans with (vs. without) VA medication copayments using Chi-square tests. Analyses were weighted to account for sample design and non-response.

Results:
After weighting, the sample was 8% female, 17% Black, and 58% married with a mean age of 66 years. Over 71% had an annual household income of < = $35,000, and 23% had a bachelor’s degree or higher. Just under half of our sample (42%) had VA copayments for at least 1 medication, and 39% received medications from non-VA pharmacies in 2018. A larger portion of Veterans with (vs. without) VA copayments who obtained non-VA medications reported obtaining them to save money (39% vs. 12%, p < 0.001). Regarding medication use in 2018, a larger portion of Veterans with (vs. without) VA copayments reported that due to the copayment restructuring they obtained medications from VA they previously obtained outside VA (10% vs. 8%, p < 0.001) or obtained medications outside VA they previously obtained from VA (8% vs. 3%, p < 0.001). Veterans with (vs. without) VA copayments reported that the copayment restructuring helped control prescription costs (29% vs. 15%, p < 0.001) and that monthly medication costs were much lower after the copayment restructuring (20% vs. 9%, p < 0.001). However, even with the copayment restructuring, a larger portion of Veterans with (vs. without) VA copayments reported that medication costs are still a significant burden (19% vs. 4%, p < 0.001); they worried about being able to pay for prescriptions (31% vs. 12%, p < 0.001); and they spent less on utilities and other basic needs to have enough money for prescriptions (18% vs. 5%, p < 0.001).

Implications:
A substantial portion of Veterans (20-30%) with medically treated chronic conditions reported that the VA copayment restructuring decreased their medication financial burden. However, even with the copayment restructuring, a portion of Veterans continue to worry about the costs of medications and make tradeoffs between medications and other needs.

Impacts:
VA could consider additional copayment reforms targeting those facing the greatest burden from medication costs.