Pharmacy use by dual-eligible non-elderly veterans with private healthcare insurance.
BACKGROUND
Utilization of private sector healthcare services among dual enrolled veterans with private healthcare insurance plans (PHIP) has not been well-characterized. Concurrent use of Veterans Health Administration (VHA) and non-VHA pharmacies may increase risk for adverse outcomes. Thus, the objectives of this study were to determine the extent to which dual VHA-PHIP enrollees obtain medications through VHA and non-VHA pharmacies and to characterize medications obtained through non-VHA pharmacies.


METHODS
This observational study used merged administrative data from VHA and a predominant regional PHIP to select veterans < 65 years of age, residing in two Midwestern US states, and simultaneously enrolled in both VHA and the PHIP during fiscal years (FY) 2001-2010. Primary outcome measures included counts of prescriptions dispensed from VHA and non-VHA pharmacies, and frequencies of medications dispensed by non-VHA pharmacies based on PHIP claims.


RESULTS
Of 5783 veterans who filled ≥ 1 prescription in FY10, 2935 (50.8 %) used non-VHA pharmacies exclusively, 1165 (20.2 %) used VHA pharmacies exclusively and 1683 (29.1 %) were dual users. Health services utilization was higher for dual users compared to exclusive users of either VHA or non-VHA pharmacies across multiple measures, including total prescriptions, outpatient encounters, and inpatient admissions. The most common medications dispensed by non-VHA pharmacies, by proportion of veterans treated, were hydrocodone (20.9 %), amoxicillin (18.5 %), simvastatin (17.5 %), azithromycin (17.4 %), and lisinopril (15.1 %). Antidepressants comprised 3 of 10 most common medications dispensed by VHA, but none of the most common medications dispensed to exclusive non-VHA pharmacy users.


CONCLUSIONS
Our findings align with VHA-Medicare dual enrolled veterans where only a minority of veterans used VHA services exclusively. Younger veterans relied disproportionately on VHA for mental health medications.
Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System (Mailstop 152), 601 Hwy 6 West, Iowa City, IA, 52246, USA. Brian.Lund@va.gov.|Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA. Brian.Lund@va.gov.
Brian C
BC
Lund
Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System (Mailstop 152), 601 Hwy 6 West, Iowa City, IA, 52246, USA.|Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52242, USA.
Mary E
ME
Charlton
Veterans Rural Health Resource Center - Eastern Region, White River Junction VA Medical Center, White River Junction, VT, 05009, USA.|Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH, 03755, USA.
Alan N
AN
West
Access to care; Drugs; Health insurance; Veterans
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