The Missing RxLink: Veteran Prescription use in Private Sector Community Pharmacies
Katie J. Suda PharmD MS
October 2019 -
The lack of access to non-VA pharmacy data is particularly problematic for opioids, where dual pharmacy use is common and associated with unsafe prescribing including high opioid dosage and overlap with benzodiazepines (BZD). While non-VA Rxs for opioids can be identified at the point-of-care through state prescription drug monitoring programs (PDMPs), PDMP data are only available for the prior 6 months, are not imbedded within the electronic health record or integrated into clinical decision support, and have not been widely available for research. Access to up-to-date non-VA opioid and related pain medications would fill a critical gap for research and clinical care. The first step to resolve this gap is to create a database linkage between VA data and a national private sector Rx database. Thus, the purpose of this Phase I planning grant is to establish a new VA partnership with an external partner (IQVIA) where infrastructure will be built to create a database linkage between VA data and IQVIA’s real-time Rx database (Xponent®). Xponent contains 92% of all outpatient Rxs dispensed in the U.S. and is updated weekly. The long-term goal for Phase II is to evaluate cross-system Rx use, including therapeutic duplication and Rx overlap across- and within-pharmacy sources. The IQVIA data can also provide an indirect measure of non-VA provider use because provider names, geographic location, provider type and specialty are available variables in Xponent. This VA-IQVIA data linkage (“RxLink”) will identify processes to close the gap in our knowledge of Veterans’ medication use in the private sector.
Linking IQVIA data to VA data will provide new information about Veterans’ Rx use. This will be particularly valuable for younger Veterans, where little is known about their use of non-VA Rxs due to use of employer sponsored insurance and for Veterans paying cash for Rx. These data will be transformative for studying multiple issues regarding Rx use, dual use, adherence, and care fragmentation.
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