1 College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
2 Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, and College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
J Manag Care Spec Pharm. 2016 Jul;22(7):818-24. doi: 10.18553/jmcp.2016.22.7.818.
Erectile dysfunction (ED) medications are therapeutically effective and associated with satisfaction. Medicare Part D included ED medications on the formulary during 2006 and inadvertently in 2007-2008.
To characterize phosphodiesterase-5 inhibitor (PDE-5) medication use among veterans who were dually eligible for Veterans Affairs (VA) and Medicare Part D benefits.
Veterans aged > 66 years who received PDE-5 inhibitors between 2005 and 2009 were included. Veterans were categorized by PDE-5 inhibitor claims: VA-only, Part D-only, or dual users of VA and Part D-reimbursed pharmacies. T-tests and chi-square tests were applied as appropriate.
From 2005 to 2009, the majority (85.2%) of veterans used VA benefits exclusively for their PDE-5 inhibitors; 11.4% used Medicare Part D exclusively; and 3.4% were dual users. The Part D-only group was older, more frequently not black, had a VA copay, and had a higher income (P < 0.03). The VA group was more likely to have comorbidities, smoke, and have a history of substance abuse (P < 0.001). With the inception of Medicare Part D in 2006, the number of patients filling prescriptions for PDE-5 inhibitors (-68%) and total number of PDE-5 inhibitor 30-day equivalents dispensed (-86.7%) from the VA decreased. Part D prescriptions increased through 2006 (full coverage period) and 2007 (accidental partial coverage) and decreased in 2008. While Part D accounted for only 10% of PDE-5 inhibitor 30-day equivalents, it equaled 29.2% of dispensed tablets. In October 2007, VA PDE-5 inhibitor use returned to 2005 levels.
Implementation of Medicare Part D reduced VA PDE-5 inhibitor acquisition. However, after removal of PDE-5 inhibitors from the Part D formulary, use of VA pharmacies for PDE-5 inhibitors resumed. Medication policies outside the VA can affect medication use. Veterans with access to non-VA health care may obtain medications from the private sector because of VA restrictions. This may be especially true for nonformulary and lifestyle medications.
The authors received funding support for this research project from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service as grant IIR 07-165-2. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or Health Services Research and Development Service. Study concept and design were contributed by Smith and Stroupe, assisted by the other authors. Huo, Bailey, and Stroupe took the lead in data collection, assisted by the other authors. Data interpretation was performed by Spencer and Suda, along with Smith and Stroupe and assisted by Huo and Bailey. The manuscript was primarily written by Spencer and Suda, with assistance from the other authors, and revised by Spencer, along with the other authors.
勃起功能障碍（ED）药物具有治疗效果，并能带来满意度。医疗保险 Part D 于 2006 年将 ED 药物纳入目录，在 2007-2008 年期间无意中也纳入了这些药物。
描述同时符合退伍军人事务部（VA）和医疗保险 Part D 福利资格的退伍军人中使用磷酸二酯酶-5 抑制剂（PDE-5）药物的情况。
纳入在 2005 年至 2009 年间使用 PDE-5 抑制剂的年龄>66 岁的退伍军人。根据 PDE-5 抑制剂的索赔情况对退伍军人进行分类：仅 VA、仅 Part D 或同时使用 VA 和 Part D 报销药房的退伍军人。适用 t 检验和卡方检验。
从 2005 年到 2009 年，大多数（85.2%）退伍军人仅使用 VA 福利来获得他们的 PDE-5 抑制剂；11.4%仅使用医疗保险 Part D；3.4%的人同时使用 VA 和 Part D。仅 Part D 组年龄较大，较少为黑人，有 VA 共付额，收入较高（P<0.03）。VA 组更可能患有合并症、吸烟和有药物滥用史（P<0.001）。随着医疗保险 Part D 于 2006 年的推出，退伍军人使用 PDE-5 抑制剂处方的数量（减少 68%）和从 VA 分发的 PDE-5 抑制剂 30 天等效剂量（减少 86.7%）减少。Part D 处方在 2006 年（全面覆盖期）和 2007 年（意外部分覆盖期）增加，并在 2008 年减少。尽管 Part D 仅占 PDE-5 抑制剂 30 天等效剂量的 10%，但它相当于分发片剂的 29.2%。2007 年 10 月，VA 的 PDE-5 抑制剂使用恢复到 2005 年的水平。
医疗保险 Part D 的实施减少了 VA PDE-5 抑制剂的获取。然而，在将 PDE-5 抑制剂从 Part D 目录中删除后，VA 药房再次开始使用 PDE-5 抑制剂。VA 以外的药物政策可能会影响药物的使用。有机会获得非 VA 医疗保健的退伍军人可能会因为 VA 的限制而从私营部门获得药物。对于非处方和生活方式药物尤其如此。
作者的这项研究项目得到了退伍军人事务部、退伍军人健康管理局、卫生服务研究与发展服务部的资助，资助号为 IIR 07-165-2。本文观点仅代表作者，不一定代表退伍军人事务部或卫生服务研究与发展服务部。研究概念和设计由 Smith 和 Stroupe 提出，其他作者协助。 Huo、Bailey 和 Stroupe 主导数据收集，其他作者协助。Spencer 和 Suda 对数据进行了解释，Smith 和 Stroupe 以及 Huo 和 Bailey 协助。Spencer 和 Suda 主要撰写了这份手稿，其他作者协助，并由 Spencer 与其他作者共同修订。
