title: Pharmacy Use in the First Year of the Veterans Choice Program: A Mixed-methods Evaluation.
abstract: The Veterans Choice Program (VCP) was created to ensure timely access to health care in the Department of Veterans Affairs (VA). Under this program, medications may be ordered by select non-VA clinicians to be dispensed by VA pharmacies, creating new challenges in ensuring medication safety.
  
  
  
  To examine pharmaceutical use during the first year of the VCP and to understand barriers and facilitators for VA pharmacists to dispensing medications under the VCP.
  
  
  
  Mixed-methods evaluation.
  
  
  
  We captured all prescriptions dispensed through the VCP and described the demographics of VCP users and their medications. We also conducted semistructured interviews of VA pharmacists, focusing on VA formulary management and experiences dispensing opioid and hepatitis C (HCV) medications. Codebook development and coding followed iterative qualitative methods.
  
  
  
  Overall, 17,346 Veterans received 56,426 VCP prescriptions from November 7, 2014 through November 7, 2015. The total medication cost was $27 million, 90% of which was for only 2772 HCV prescriptions. Topical eye drops and opioids represented the most commonly dispensed prescriptions (15.6% and 9.2% of all prescriptions, respectively). Pharmacists reported numerous challenges to dispensing VCP medications, including time required to contact non-VA clinicians about formulary issues, requiring controlled substance prescriptions to be hand delivered to VA pharmacies, and lack of access to laboratory data required to safely dispense medications.
  
  
  
  HCV-related medication costs predominated the first year of VCP, but this is likely to change going forward. The safe use of opioids, efficient management of nonformulary medications, and unintended new barriers to access created by the VCP must be addressed.
authors.affiliation: *Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System †Department of Medicine, School of Medicine ‡Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, PA §Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, IL ∥Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA ¶Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Center of Innovation, Veterans Health Administration Salt Lake City, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Walid F
authors.initials: WF
authors.lastname: Gellad
authors.forename: Francesca E
authors.initials: FE
authors.lastname: Cunningham
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.forename: Brandi
authors.initials: B
authors.lastname: Bair
authors.forename: KatieLynn
authors.initials: K
authors.lastname: Roman
authors.forename: Susan L
authors.initials: SL
authors.lastname: Zickmund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002755:Choice Behavior; D005260:Female; D006078:Government Programs; D006526:Hepatitis C / Q000188:drug therapy; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid