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BACKGROUND/RATIONALE:
In February 2002, the VA increased medication copayments from $2 to $7 per 30-day supply. It is important to examine how this copayment increase affected veterans who are dependent upon medications to manage their chronic conditions.
OBJECTIVE(S):
The purpose of this study was to examine: (1) the effect the VA’s medication copayment increase on changes in medication use by veterans with diabetes and/or hypertension, (2) the effects of medication changes on VA utilization and costs by veterans with diabetes, veterans with hypertension and veterans with both conditions and (3) the effects of medication changes on intermediate health outcomes (e.g., HbA1c, blood pressure, LDL).
METHODS:
We extracted patient data from VA national databases at the Austin Automation Center and from VistA files at each of four sites. We estimated the effects of copayment increase on medication changes, the effect of medication changes on health care utilization changes, and the effect of medication changes on intermediate health outcomes. Our final sample included 28,363 veterans with diabetes and/or hypertension treated at VAMCs in Ann Arbor, Hines, Little Rock and Seattle.
FINDINGS/RESULTS:
We found a secular trend toward decreased medication adherence through time for all veterans regardless of copayment status after the copayment was increased. Among veterans on anti-hypertensive medications, there was a significant adverse effect of the copayment increase on medication adherence for veterans who were required to pay medication copayments. For veterans with hypertension and hyperlipidemia, there was no significant effect of the copayment increase on adherence to statins. There was no significant effect of the copayment increase on adherence to anti-glycemic medications for patients with diabetes or on adherence to statins for patients with diabetes and hyperlipidemia.
We were unable to measure the impacts of the copayment increase and medication non-adherence on blood pressure due to lack of data for this measure. It appears as though greater adherence is associated with improved glycemic control and cholesterol control, but the relationship between the copayment increase and disease control is unclear.
There was a significant indirect effect of the copayment increase on health care utilization and expenditures for all patients who paid medication copayments: patients with diabetes on anti-glycemic medications, patients with hypertension on anti-hypertensive medications, and diabetes and/or hypertension patients with hyperlipidemia on statins.
IMPACT:
This project demonstrates that a $5 increase in medication copayments (from $2 to $7) was sufficiently large to induce non-adherence to anti-hypertensive medications but not large enough to affect adherence to anti-glycemic medications or statins. Before undertaking additional medication copayment increases, VA must understand how its medication copayment policies affect veterans who rely upon medication management for their chronic conditions.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Prevention, Quality of Care
Keywords:
Cardiovasc’r disease, Diabetes, Risk factors
MeSH Terms:
none
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