Impact of the VA Medication Copayment Redesign

项目背景/理由：退伍军人使用退伍军人事务部(VA)医疗保健 设施往往比普通人群有更多的慢性病，这经常 需要长期药物治疗。适当的用药管理对 防止对这些退伍军人造成不利的健康影响。退伍军人管理局目前的政策可能会导致 某些药物的VA含量高于非VA零售药店的共付金， 这可能会鼓励使用非退伍军人管理局的药房。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 意外的不良反应。此外，药物共同支付可能与 降低服药依从性。因此，退伍军人管理局将在2月改为3级系统 2017年(每30天供应1、2和3级药物分别为5美元、8美元和11美元)，以及 退伍军人必须支付的年度药物共同支付上限为700美元。这个 退伍军人管理局预计，对于大多数退伍军人来说，这些新的共同赔付金额将导致较低的退伍军人 口袋费用，这将鼓励更多地遵守处方药，并将减少 当退伍军人使用多家药店时，导致护理分散的风险。理解 共同支付变化的影响将对政策制定和规划至关重要。 项目目标：本研究的目的是：1)确定共同支付的影响 患者使用退伍军人管理局药房的变化；2)检查共同支付变化对 患者用药依从性、用药成本和临床结果；3)评估 患者报告的用药管理经验的共同支付变化；4)评估 共同支付变化对提供者报告的处方实践的影响以及 经历。 项目方法：我们将使用混合方法方法，最大限度地利用 来自退伍军人管理局的可用数据，以检查共同支付更改是否影响 退伍军人管理局药房的药物(目标1)、服药依从性(目标2)、退伍军人和 提供商经验和决策(目标3和4)。因为这一事件的影响 共同支付重组将取决于退伍军人的决策(例如，从哪里获得 药物)和提供者的处方做法(例如，他们是否将患者转到第1级 药物)，我们将进行调查和半结构化访谈，以检查患者和 提供商对共同支付变更及其实施的体验。

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.