Effect of increased copayments on pharmacy use in the Department of Veterans Affairs.
OBJECTIVE
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.
Center for Management of Complex Chronic Care, Hines VA Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA. kevin.stroupe@va.gov
Kevin T
KT
Stroupe
Bridget M
BM
Smith
Todd A
TA
Lee
Elizabeth
E
Tarlov
Ramon
R
Durazo-Arvizu
Zhiping
Z
Huo
Tammy
T
Barnett
Lishan
L
Cao
Muriel
M
Burk
Francesca
F
Cunningham
Denise M
DM
Hynes
Kevin B
KB
Weiss
D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D003157:Community Pharmacy Services / Q000191:economics* / Q000706:statistics & numerical data; D003669:Deductibles and Coinsurance / Q000191:economics* / Q000706:statistics & numerical data; D004363:Drug Utilization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011306:Prescription Fees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics* / Q000706:statistics & numerical data