The association of medicare drug coverage with use of evidence-based medications in the Veterans Health Administration

Michael L. Johnson, Laura A. Petersen, Raji Sundaravaradan, Margaret M Byrne, Jennifer C. Hasche, Nora I. Osemene, Iris I. Wei, Robert O. Morgan

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Veterans with Medicare managed-care plans have access to pharmacy benefits outside the Veterans Health Administration (VA), but how this coverage affects use of medications for specific disease conditions within the VA is unclear. OBJECTIVE: To examine patterns of pharmacotherapy among patients with diabetes mellitus, ischemic heart disease, and chronic heart failure enrolled in fee-for-service (FFS) or managed-care (HMO) plans and to test whether pharmacy benefit coverage within Medicare is associated with the receipt of evidence-based medications in the VA. METHODS: A retrospective analysis of veterans dually enrolled in the VA and Medicare healthcare systems was conducted. We used VA and Medicare administrative data from 2002 in multivariable logistic regression analysis to determine the unique association of enrollment in Medicare FFS or managedcare plans on the use of medications, after adjusting for sociodemographic, geographic, and patient clinical factors. RESULTS: A total of 369,697 enrollees met inclusion criteria for diabetes, ischemic heart disease, or chronic heart failure. Among patients with diabetes, adjusted odds ratios (ORs) of receiving angiotensin-converting enzyme (ACE) inhibitors and oral hypoglycemics in the FFS group were, respectively, 0.86 and 0.80 (p < 0.001). Among patients with ischemic heart disease, FFS patients were generally less likely to receive β-blockers, antianginals, and statins. Among patients with chronic heart failure, adjusted ORs of receiving ACE inhibitors, angiotensin-receptor blockers, and statins in the FFS group were, respectively, 0.90, 0.78, and 0.79 (all p < 0.05). There were few systematic differences within HMO coverage levels. CONCLUSIONS: FFS-enrolled veterans were generally less likely to be receiving condition-related medications from the VA, compared with HMO-enrolled veterans with lower levels of prescription drug coverage. Pharmacy prescription coverage within Medicare affects the use of evidence-based medications for specific disease conditions in the VA.

Original languageEnglish
Pages (from-to)1565-1575
Number of pages11
JournalAnnals of Pharmacotherapy
Volume43
Issue number10
DOIs
StatePublished - Oct 1 2009

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Veterans Health
United States Department of Veterans Affairs
Fee-for-Service Plans
Medicare
Veterans
Health Maintenance Organizations
Pharmaceutical Preparations
Myocardial Ischemia
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Heart Failure
Managed Care Programs
Angiotensin-Converting Enzyme Inhibitors
Odds Ratio
Prescription Drugs
Angiotensin Receptor Antagonists
Hypoglycemic Agents
Prescriptions
Diabetes Mellitus
Logistic Models
Regression Analysis

Keywords

  • Managed care
  • Medicare
  • Pharmacy
  • Veterans

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Johnson, M. L., Petersen, L. A., Sundaravaradan, R., Byrne, M. M., Hasche, J. C., Osemene, N. I., ... Morgan, R. O. (2009). The association of medicare drug coverage with use of evidence-based medications in the Veterans Health Administration. Annals of Pharmacotherapy, 43(10), 1565-1575. https://doi.org/10.1345/aph.1L606

The association of medicare drug coverage with use of evidence-based medications in the Veterans Health Administration. / Johnson, Michael L.; Petersen, Laura A.; Sundaravaradan, Raji; Byrne, Margaret M; Hasche, Jennifer C.; Osemene, Nora I.; Wei, Iris I.; Morgan, Robert O.

In: Annals of Pharmacotherapy, Vol. 43, No. 10, 01.10.2009, p. 1565-1575.

Research output: Contribution to journalArticle

Johnson, ML, Petersen, LA, Sundaravaradan, R, Byrne, MM, Hasche, JC, Osemene, NI, Wei, II & Morgan, RO 2009, 'The association of medicare drug coverage with use of evidence-based medications in the Veterans Health Administration', Annals of Pharmacotherapy, vol. 43, no. 10, pp. 1565-1575. https://doi.org/10.1345/aph.1L606
Johnson, Michael L. ; Petersen, Laura A. ; Sundaravaradan, Raji ; Byrne, Margaret M ; Hasche, Jennifer C. ; Osemene, Nora I. ; Wei, Iris I. ; Morgan, Robert O. / The association of medicare drug coverage with use of evidence-based medications in the Veterans Health Administration. In: Annals of Pharmacotherapy. 2009 ; Vol. 43, No. 10. pp. 1565-1575.
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