title: Problems due to medication costs among VA and non-VA patients with chronic illnesses.
abstract: OBJECTIVE
  To compare rates of cost-related medication underuse and other problems due to medication costs among Department of Veterans Affairs (VA) patients with rates among patients with Medicaid, private health insurance, Medicare, and no insurance coverage.
  
  
  METHODS
  Nationwide survey.
  
  
  METHODS
  A total of 4055 chronically ill patients completed an online questionnaire regarding cost-related adherence problems for medications used to treat 16 chronic illnesses. Respondents also reported whether they cut back on necessities due to medication costs, increased their debt burden to pay for prescriptions, and worried about how they would pay for their medications.
  
  
  RESULTS
  Rates of cost-related medication underuse were lower among VA patients (12%) than among patients with Medicaid (25%; P =.0004), Medicare (22%; P =.001), or no insurance (35%; P < .0001). In multivariate analyses, patients with Medicare or no insurance coverage were more likely than VA patients to forego medication at least once per month due to cost (adjusted odds ratios of 3.4 and 3.9; both P < or = .001). Patients with Medicare or no insurance coverage also were more likely than VA patients to forego basic needs to pay medication costs, borrow money to pay for their treatments, and worry frequently about how they would pay for their medication.
  
  
  CONCLUSIONS
  The VA's prescription benefits may prevent problems due to medication costs. Studies assessing the impact of VA prescription coverage on health outcomes and service use will be needed to evaluate the cost-effectiveness of VA drug benefit policies.
authors.affiliation: Department of Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, MI 48113-0170, USA. jpiette@umich.edu
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D005382:Financing, Personal; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics; D006787:Hospitals, Veterans / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D006278:Medicare; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011306:Prescription Fees; D012646:Self Administration / Q000191:economics*; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*