Center for Health Equity Research and Promotion

CHERP Investigator Walid Gellad, MD, MPH, led a study of VA Pharmacy use in the first year of the Veterans Choice Program.

CITATION:

Gellad W, Cunningham F, Good C, et al. Pharmacy Use in the First Year of the Veterans Choice Program: A Mixed Methods Evaluation. Medical Care. February 17, 2017; Epub ahead of print. This article is part of a special supplement focusing on the Veterans Access, Choice and Accountability Act.

 

BACKGROUND:

A key goal for the Choice Act is to increase access to care for Veterans. The Veterans Choice Program (VCP), which is part of the new law, includes providing care outside VA for Veterans who live more than 40 miles from a VA facility – or who are unable to schedule an appointment with a VA healthcare provider within 30 days. Another aspect of care that changed was prescribing: VCP patients may receive prescriptions from providers who are not employed by VA and not integrated into VA’s electronic medical record. CHERP Investigator Walid Gellad, MD, MPH, led this study, with Co-Investigators Chester B. Good, MD, MPH, FACP, and Fran Cunningham, PharmD, seeking to describe pharmaceutical use during the first year of the VCP and to understand barriers and facilitators for VA pharmacists to dispensing medications under the VCP. Dr. Gellad and his collaborators worked with VA’s Pharmacy Benefits Management Service (PBM) to develop a research-ready database of VCP prescriptions written by non-VA providers but dispensed through VA pharmacies, identifying 17,346 Veterans who received 56,426 VCP prescriptions from November 7, 2014 to November 7, 2015. Investigators also interviewed VA pharmacists (n=27), focusing on VA formulary management and experiences dispensing opioid and hepatitis C virus (HCV) medications to Veterans through the VCP.

FINDINGS:  

• A majority of VCP pharmacy spending in the first year was for HCV medications, which accounted for only 5% of prescriptions but 90% of costs. However, in 2015, VA experienced greater than expected demand for HCV medications, which exceeded available funding, thus some patients obtained medications through the VCP. The impact of HCV medications on the VCP should be short-lived given broadened availability in VA in 2016.
• Topical eye drops and opioids represented the most commonly dispensed prescriptions: 16% and 9% of all prescriptions, respectively.
• Most prescriptions dispensed (93%) were for formulary agents, but substantial efforts were required from VA pharmacists to work with non-VA providers to use formulary drugs.
• Challenges related to obtaining medications from VA pharmacies through VCP included requiring controlled substance prescriptions to be hand-delivered, a lack of access to lab data required to safely dispense medications, and substantial time required by pharmacists to communicate with non-VA providers.

 

IMPLICATIONS:  

• Safe use of opioids, efficient management of non-formulary medications, and unintended new barriers to access created by the VCP must be addressed, in addition to robust ongoing evaluations to identify new cost, quality, and safety concerns.

 

LIMITATIONS:  

• This study represents findings from the first year of VCP and may not represent continued use.

 

AUTHOR/FUNDING INFORMATION:

This study was funded by VA HSR&D’s Quality Enhancement Research Initiative (VCA 15-245). Drs. Gellad, Cunningham, and Good are part of HSR&D’s Center for Health Equity Research & Promotion (CHERP), Pittsburgh and Philadelphia, PA.