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Effect of increased copayments on pharmacy use in the Department of Veterans Affairs.

Stroupe KT, Smith BM, Lee TA, Tarlov E, Durazo-Arvizu R, Huo Z, Barnett T, Cao L, Burk M, Cunningham F, Hynes DM, Weiss KB. Effect of increased copayments on pharmacy use in the Department of Veterans Affairs. Medical care. 2007 Nov 1; 45(11):1090-7.

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OBJECTIVES: In February 2002, the Department of Veterans Affairs (VA) raised medication copayments from $2 to $7 per 30-day supply of medication for certain veteran groups. We examined the impact of the copayment increase on medication acquisition from VA. METHODS: This was a retrospective cohort study using data from national VA databases from February 2001 through February 2003. We took a random sample of over 5% of male VA users in 2001. Of 149,107 veterans sampled, 19,504 (13%) had copayments for no drugs, 101,410 (68%) had copayments for some drugs, and 28,193 (19%) had copayments for all drugs. We used multivariable count models to examine changes in the number of 30-day medication supplies after the increase. RESULTS: After the copayment increase, veterans subject to copayments for all drugs received 8% fewer 30-day supplies of medication annually relative to veterans with no copayments (P < 0.001). The effect of the copayment increased as the number of different medications veterans received increased. Among veterans subject to copayments for all drugs, acquisition of lower-cost drugs fell by 36%, higher-cost medications fell by 6%, over-the-counter medications fell by 40%, and prescription-only medications fell by 4% relative to veterans with no drug copayments. CONCLUSIONS: The number of medications veterans obtained from VA decreased after the copayment increase. There were relatively larger impacts on veterans with higher medication use and on lower-cost and over-the-counter medications.

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