title: Erectile Dysfunction Medication Use in Veterans Eligible for Medicare Part D.
abstract: BACKGROUND
  Erectile dysfunction (ED) medications are therapeutically effective and associated with satisfaction. Medicare Part D included ED medications on the formulary during 2006 and inadvertently in 2007-2008.
  
  
  OBJECTIVE
  To characterize phosphodiesterase-5 inhibitor (PDE-5) medication use among veterans who were dually eligible for Veterans Affairs (VA) and Medicare Part D benefits.
  
  
  METHODS
  Veterans aged > 66 years who received PDE-5 inhibitors between 2005 and 2009 were included. Veterans were categorized by PDE-5 inhibitor claims: VA-only, Part D-only, or dual users of VA and Part D-reimbursed pharmacies. T-tests and chi-square tests were applied as appropriate.
  
  
  RESULTS
  From 2005 to 2009, the majority (85.2%) of veterans used VA benefits exclusively for their PDE-5 inhibitors; 11.4% used Medicare Part D exclusively; and 3.4% were dual users. The Part D-only group was older, more frequently not black, had a VA copay, and had a higher income (P < 0.03). The VA group was more likely to have comorbidities, smoke, and have a history of substance abuse (P < 0.001). With the inception of Medicare Part D in 2006, the number of patients filling prescriptions for PDE-5 inhibitors (-68%) and total number of PDE-5 inhibitor 30-day equivalents dispensed (-86.7%) from the VA decreased. Part D prescriptions increased through 2006 (full coverage period) and 2007 (accidental partial coverage) and decreased in 2008. While Part D accounted for only 10% of PDE-5 inhibitor 30-day equivalents, it equaled 29.2% of dispensed tablets. In October 2007, VA PDE-5 inhibitor use returned to 2005 levels.
  
  
  CONCLUSIONS
  Implementation of Medicare Part D reduced VA PDE-5 inhibitor acquisition. However, after removal of PDE-5 inhibitors from the Part D formulary, use of VA pharmacies for PDE-5 inhibitors resumed. Medication policies outside the VA can affect medication use. Veterans with access to non-VA health care may obtain medications from the private sector because of VA restrictions. This may be especially true for nonformulary and lifestyle medications.
  
  
  BACKGROUND
  The authors received funding support for this research project from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service as grant IIR 07-165-2. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or Health Services Research and Development Service. Study concept and design were contributed by Smith and Stroupe, assisted by the other authors. Huo, Bailey, and Stroupe took the lead in data collection, assisted by the other authors. Data interpretation was performed by Spencer and Suda, along with Smith and Stroupe and assisted by Huo and Bailey. The manuscript was primarily written by Spencer and Suda, with assistance from the other authors, and revised by Spencer, along with the other authors.
authors.affiliation: 1 College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Samantha H
authors.initials: SH
authors.lastname: Spencer
authors.affiliation: 2 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, and College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Katie J
authors.initials: KJ
authors.lastname: Suda
authors.affiliation: 3 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Smith
authors.affiliation: 4 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois.
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Huo
authors.affiliation: 5 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, and Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Lauren
authors.initials: L
authors.lastname: Bailey
authors.affiliation: 6 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, and Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004608:Eligibility Determination / Q000379:methods / Q000639:trends*; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000639:trends*; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends*; D014728:Veterans
chemical_list: D058986:Phosphodiesterase 5 Inhibitors