Excess Medication Supply Potentially High among Veterans Using VA Healthcare
BACKGROUND:
Medication excess and oversupply can result from therapeutic duplications. Prescriptions may get duplicated for several reasons, some of which may be intentional or rational (i.e., two different formulations of the same drug); however, unintentional therapeutic duplications may lead to potentially unsafe situations and may reflect inefficient use of limited healthcare resources (i.e., patients' possession of excess medication). This retrospective study sought to determine the prevalence of potential medication excess in the VA healthcare system – and to identify associated medication-, patient-, and system-level factors. Using VA data, investigators identified 4,687,453 Veterans who received one or more prescription medications dispensed by a VA pharmacy in FY2014. The primary outcome of "medication excess" was defined for each patient as the number of excess days' worth of medications for all overlap episodes – concurrently dispensed medications with the same name for >10 days. Investigators also determined the frequency with which prescriptions were supplied by a VA-based Consolidated Mail Outpatient Pharmacy (CMOP) as compared to the local VA facility, as well as those supplied for >90 days. Additional covariates that were assessed included co-pay status, patient demographics and medical comorbidities, as well as VA healthcare utilization.
FINDINGS:
- Medication excess was high among VA healthcare users in this study, with nearly two-thirds of patients (64%) experiencing at least one duplicative medication. Medication excess was more likely for Veterans with multiple prescribing providers or with higher comorbidity scores. Conversely, having a co-pay for medications was associated with lower rates of medication excess [a majority of patients (69%) did not have a co-pay].
- Patients that had a combination of filling locations (CMOP or local pharmacy) and/or durations supplied had higher medication excess than those who had prescriptions from a single location or with uniform durations.
IMPLICATIONS:
- As systems such as mail-order pharmacies and 90-day supply are increasingly implemented to reduce costs and improve medication adherence, it is important to recognize the potential for systems-level inefficiencies and inappropriate prescribing. Further efforts should be made to develop and implement strategies and systems (i.e., synchronized dispensing – refilling all prescriptions at the same time) that foster the appropriate and safe use of medications.
LIMITATIONS:
- Investigators were unable to determine whether Veterans took the extra medications rather than saved them for future need; however, having the excess supply available still exposes them to the potential of a medication overdose and harm.
AUTHOR/FUNDING INFORMATION:
Dr. Linsky was supported by an HSR&D Career Development Award. Drs. Linsky, Simon, and Rosen, and Ms. Stolzmann are part of HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA
Linsky A, Stolzmann K, Simon S, Cabral H, and Rosen A. Patient Possession of Excess Medication Supply in the VA: A Retrospective Database Study. Medical Care. November 2019;57(11):898-904.
