Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website
HSRD Conference Logo



2023 HSR&D/QUERI National Conference Abstract

Printable View

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.