Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, US Department of Veterans Affairs, Hines, IL, and Department of Public Health Sciences, Loyola University Chicago, Maywood, IL.
Independent Consultant, Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Coxsackie, NY.
J Manag Care Spec Pharm. 2021 Aug;27(8):983-994. doi: 10.18553/jmcp.2021.27.8.983.
The availability of Medicare Part D pharmacy coverage may increase veterans' options for obtaining medications outside of the Department of Veterans Affairs (VA) pharmacies. However, availability of Part D coverage raises the potential that veterans may be receiving similar medications from VA and non-VA pharmacies. The VA's personal health record portal, My HealtheVet, allows veterans to self-enter the non-VA medications that they obtained from community-based pharmacies, including those reimbursed by Medicare Part D. The Blue Button medication view feature of My HealtheVet allows veterans to view and download their VA and self-entered non-VA medication history. To examine whether the use by veterans of the Blue Button feature of My HealtheVet was associated with less acquisition of similar medications from VA and community-based pharmacies reimbursed by Medicare Part D. This study included a national sample of veterans who were new My HealtheVet users during fiscal year 2013 (October 1, 2012-September 30, 2013) and who used the Blue Button medication view feature of My HealtheVet at least once (users). We compared these veterans with a random sample of veterans who were not registered to use My HealtheVet (nonusers). From these groups, we identified veterans who were enrolled in Part D. We used multiple logistic regression analysis to assess the association of Blue Button medication view use with obtaining medications from the same drug classes (with overlap of 7 or more days) from VA and Part D-reimbursed pharmacies. There were 7,973 My HealtheVet medication view users and 65,985 nonusers. During a 12-month period, medication view users received more 30-day supplies of medications (one 90-day supply equals three 30-day supplies) than nonusers, on average (152.1 vs 71.3, < 0.001). A larger percentage of users than nonusers obtained medications from VA and Part D-reimbursed pharmacies with overlapping days supply from the same drug classes (30% vs 23%, < 0.001). However, for veterans who obtained greater numbers of 30-day supplies (82 or more), a significantly smaller percentage of users than nonusers obtained overlapping medications from VA and Part D-reimbursed pharmacies. Moreover, controlling for the total number of 30-day supplies that veterans received, the odds of obtaining medications from VA and Part D-reimbursed pharmacies with days supply that overlapped by at least 7 days for the same drug classes was 18% lower for users than nonusers (=0.002). Veterans who used the Blue Button medication view feature of My HealtheVet obtained a larger number of 30-day supplies of medications from VA pharmacies than nonusers. For veterans who obtained a larger number of 30-day supplies of medications, use of the Blue Button medication view feature of My HealtheVet was associated with less overlap in days supply of medication from the same drug class from VA and Part D-reimbursed pharmacies. This study was funded by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service project IIR 14-041-2. The sponsor provided funding but was not involved in the development of the manuscript. 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 the Health Services Research and Development Service. All authors are employed in some capacity with the Department of Veterans Affairs and have no conflicts of interest to disclose.
医疗保险 Part D 药房覆盖范围的提供可能会增加退伍军人在退伍军人事务部 (VA) 药房外获得药物的选择。然而，Part D 覆盖范围的提供增加了退伍军人可能从 VA 和非 VA 药房获得类似药物的可能性。VA 的个人健康记录门户 My HealtheVet 允许退伍军人自行输入他们从社区药房获得的非 VA 药物，包括由 Medicare Part D 报销的药物。My HealtheVet 的蓝色按钮药物查看功能允许退伍军人查看和下载他们的 VA 和自行输入的非 VA 药物史。为了研究退伍军人是否使用 My HealtheVet 的蓝色按钮功能与从 VA 和 Medicare Part D 报销的社区药房获得类似药物的重叠天数减少有关。这项研究包括了在 2013 财年（2012 年 10 月 1 日至 2013 年 9 月 30 日）期间首次使用 My HealtheVet 的全国性退伍军人样本，以及至少使用过一次 My HealtheVet 蓝色按钮药物查看功能的退伍军人（用户）。我们将这些退伍军人与未注册使用 My HealtheVet 的随机退伍军人样本（非用户）进行了比较。从这些群体中，我们确定了参加 Part D 的退伍军人。我们使用多变量逻辑回归分析来评估蓝色按钮药物查看使用与从 VA 和 Part D 报销的药房获得相同药物类别的药物（重叠 7 天或以上）之间的关联。有 7973 名 My HealtheVet 药物查看用户和 65985 名非用户。在 12 个月期间，药物查看用户平均收到的药物 30 天供应量（一个 90 天供应量等于三个 30 天供应量）多于非用户（152.1 比 71.3，<0.001）。与非用户相比，更多的用户从 VA 和 Medicare Part D 报销的药房获得具有相同药物类别重叠天数供应的药物（30%比 23%，<0.001）。然而，对于获得 82 或更多 30 天供应量的退伍军人来说，与非用户相比，使用蓝色按钮药物查看功能的用户从 VA 和 Medicare Part D 报销的药房获得重叠药物的比例明显较小。此外，控制退伍军人收到的 30 天供应量总数，使用蓝色按钮药物查看功能的退伍军人从 VA 和 Medicare Part D 报销的药房获得相同药物类别的药物重叠天数至少 7 天的可能性比非用户低 18%（=0.002）。使用 My HealtheVet 蓝色按钮药物查看功能的退伍军人从 VA 药房获得的 30 天供应量的药物数量多于非用户。对于获得大量 30 天供应量的药物的退伍军人来说，使用 My HealtheVet 的蓝色按钮药物查看功能与从 VA 和 Part D 报销的药房获得相同药物类别的药物重叠天数减少有关。本研究由退伍军人事务部、研究与发展办公室、卫生服务研究与发展服务项目 IIR 14-041-2 资助。赞助商提供了资金，但没有参与手稿的编写。本文所表达的观点是作者的观点，不一定代表退伍军人事务部或卫生服务研究与发展服务的观点。所有作者都以某种身份受雇于退伍军人事务部，没有利益冲突需要披露。
