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Substantial Portion of Elderly Veterans Receive Medications from Medicare Part D-Reimbursed Pharmacies - Either Alone or in Conjunction with VA Pharmacies

Stroupe KT, Smith BM, Bailey LA. Substantial Portion of Elderly Veterans Receive Medications from Medicare Part D-Reimbursed Pharmacies - Either Alone or in Conjunction with VA Pharmacies: Briefing before the VHA Senior Leadership (included the VA Under Secretary for Health, Deputy Under Secretaries and Chiefs); 2016 Apr 13; Washington, DC.


BACKGROUND: In 2007, the Centers for Medicare and Medicaid Services estimated that approximately 27% of Veterans enrolled in VA healthcare also were enrolled in Medicare Part D. Given the sizable proportion of the elderly U.S. population who are Veterans, it is important for clinicians and policymakers, both in the VA and in the private sector, to understand the impact of Medicare Part D on Veterans' medication use. For example, the availability of Part D coverage may increase Veterans' options for obtaining medications by making it easier for them to obtain prescription medications not on VA's formulary. However, the availability of Part D coverage may be one factor that contributes to increasing the complexity of Veterans' medication management. Therefore, this study examined patterns of medication acquisition from VA and Part D-reimbursed pharmacies following the implementation of Part D. Using VA data, investigators identified all female Veterans and a random 10% sample of male Veterans who were > 65 years old as of January 2004. Using both VA and Medicare data for Veterans in this cohort that were alive through December 2009 (n = 145,899), they examined their medication acquisition in 2009. Other measures included patient characteristics and healthcare utilization. FINDINGS: -Nearly one-third of VA healthcare users received medications from Part D-reimbursed pharmacies, either alone or in combination with VA pharmacies: 21% (n = 29,952) from Part D-reimbursed pharmacies only, and 10% (n = 14,401) from both VA and Part D-reimbursed pharmacies. -Veterans who lived in rural areas, were not black, had VA medication copayments, or were dual or Medicare-only outpatient users were more likely to be dual (i.e., both VA and Part D) pharmacy users or Part D-reimbursed only pharmacy users. -Among dual pharmacy users, more than half of the Veterans received medications from the same drug class from both VA and Part D-reimbursed pharmacies for which the days' supplies that overlapped was more than seven days. IMPLICATIONS: -Results highlight the clinical importance of assessing medications from VA and non-VA sources. At particular risk for suboptimal medication reconciliation are those Veterans who receive care within VA only or both VA and Medicare outpatient clinics, but who solely obtain their medications from non-VA pharmacies. LIMITATIONS: -Investigators only examined non-VA pharmacy data for Veterans enrolled in Part D. Thus results provide a lower estimate of the percentage of Veterans who were enrolled in Medicare managed care plans due to incomplete data.

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