Impact of the VA Medication Copayment Redesign

项目背景/理由：使用退伍军人事务部（VA）医疗保健的退伍军人 设施往往有更多的慢性病比一般人口，这往往 需要长期药物治疗。适当的药物管理对于 防止对这些退伍军人的健康造成不良影响。目前的政策可能导致 某些药物的VA共付额高于非VA零售药店， 这可能会鼓励使用非VA药房。有更多的用药记录 一个以上的医疗保健系统增加了记录不完整的风险，这可能导致 非预期不良反应。此外，药物共付额可能与 降低药物依从性。因此，VA将在2月改为3级系统 2017年（1、2和3级药物每30天供应分别为5美元、8美元和11美元），以及 退伍军人每年必须支付的药物共同支付额将有700美元的上限。的 VA预计，对于大多数退伍军人，这些新的共同负担金额将导致较低的出- 口袋费用，这将鼓励更多的坚持处方药，并将减少 当退伍军人使用多个药房时，会导致分散的护理风险。理解 共同负担费用变化的影响对决策和规划至关重要。 项目目标：本研究的目标是：1）确定共同负担的影响 患者使用VA药房的变化; 2）检查共付额变化对 患者用药依从性、用药成本和临床结局; 3）评估 患者报告的药物管理经验的共同负担变化;以及4）评估 共同负担费用变化对提供者报告的处方实践的影响， 经验 项目方法：我们将使用混合方法，最大限度地利用 VA提供的可用数据，以检查共同负担费用的变化是否影响了 来自VA药房的药物（目标1）、药物依从性（目标2）和退伍军人， 提供者经验和决策（目标3和4）。因为， 共同负担的重组将取决于退伍军人的决策（例如，从何处获得 药物）和提供者的处方实践（例如，他们是否会将患者转到第1层 药物），我们将进行调查和半结构化访谈，以检查患者和 提供者在共付额变化及其实施方面的经验。

Project background/rationale: Veterans using Department of Veterans Affairs (VA) healthcare facilities tend to have more chronic diseases than the general population, which frequently require chronic pharmacologic treatment. Appropriate medication management is important to prevent untoward health effects for these Veterans. VA's current policies may result in copayments that are higher in VA for certain medications than in non-VA retail pharmacies, which could encourage use of non-VA pharmacies. Having medication records across more than one healthcare system increases the risk that records will be incomplete, which can lead to unintended adverse reactions. Additionally, medication copayments may be associated with reduced medication adherence. Consequently, VA will change to a 3-tiered system in February 2017 ($5, $8, and $11 per 30-day supply for Tier 1, 2 and 3 medications, respectively), and there will be a cap on annual medication copayments that Veterans have to pay of $700. The VA anticipates that for most Veterans, these new copayment amounts will result in lower out-of- pocket costs, which will encourage greater adherence to prescribed medications and will reduce the risk of fragmented care that results when Veterans use multiple pharmacies. Understanding the impact of the copayment change will be crucial for policymaking and planning. Project objectives: The aims of this study are to 1) determine the impact of the copayment change on patient use of VA pharmacies; 2) examine the impact of the copayment change on patient medication adherence, medication costs, and clinical outcomes; 3) assess the impact of the copayment change on patient-reported medication management experiences; and 4) assess the impact of the copayment change on provider-reported prescribing practices and experiences. Project methods: We will use a mixed methods approach that takes maximum advantage of available data from VA to examine whether the copayment change impacted receipt of medications from VA pharmacies (Aim 1), medication adherence (Aim 2), and Veteran and provider experiences and decision making (Aims 3 and 4). Because the implications of the copayment restructuring will depend on Veterans' decision making (e.g., where to obtain medications) and on providers' prescribing practices (e.g., whether they switch patients to Tier 1 medications), we will conduct surveys and semi-structured interviews to examine patient and provider experiences with the copayment change and its implementation.