Center for Health Equity Research and Promotion
CHERP Research and Accomplishments
VA provides Veterans efficient, low cost care for diabetes
Data Shows Prescribing in VA for Diabetes is More Efficient than in Medicare, with Substantial Cost Implications
Diabetes is a common, chronic condition with high medication use and a wide range of available therapies. A national study of 1.5 million medical records, led by Walid Gellad, MD, MPH, of the VA Center for Health Equity Research and Promotion (CHERP), demonstrates that VA care for Veterans with diabetes is more efficient and lower cost than Medicare.
• Higher cost brand name drugs: Diabetes patients on Medicare Part D are 2-3 times more likely to be prescribed brand name drugs than comparable patients receiving care within the VA, at an added national cost of about $1 billion a year. Medication choice plays a large role in spending because brand-name drugs cost substantially more than generics. The researchers analyzed health records for 1,061,095 Medicare Part D beneficiaries and 510,485 Veterans aged 65 years or older with diabetes to compare overall and regional rates of brand-name drug use. Of the 4 medication groups commonly used by patients with diabetes, Medicare beneficiaries were more than twice as likely as VA patients to use brand-name drugs.
• Single formulary: Medicare contracts with more than 1,000 private insurance companies, each using a distinct formulary and cost-sharing arrangement for prescribing drugs. The VA uses a single formulary, and all Veterans have the same cost sharing arrangement.
• Patterns of medication use: The researchers estimated Medicare could have saved more than $1 billion in 2008 if the patterns of medication use for patients with diabetes had mirrored those of the VA. These changes depend on clinicians changing their prescribing behavior.
• Generics as effective as brand-name drugs: Since strong evidence shows similar effectiveness of generic vs. brand-name drugs among the diabetes drug classes included in the study, switching to generics would improve efficiency without harming quality of care or access to effective medicines.
Dr. Gellad was invited to present these results to analysts at the Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare program.
Gellad WF, Donohue JM, Zhao X, Mor MK, Thorpe CT, Smith J, Good CB, Fine MJ, Morden NE.
Brand-name prescription drug use among Veterans Affairs and Medicare Part D patients with diabetes: a national cohort comparison. Annals of Internal Medicine. 2013 Jul 16; 159(2):105-14.
