Boston—The Veterans Health Administration (VHA) might get a bad rap—deserved or not—for care issues, but it excels in making sure its beneficiaries follow their prescription-drug regimens, according to a new study.

The report in Health Affairs points out that high out-of-pocket drug spending worsens adherence and outcomes, especially for patients who are poor, chronically ill, or members of minority groups.

The VHA system, however, provides drugs at minimal cost, which could reduce cost-related medication nonadherence, according to a Harvard Medical School–led study.

Researchers used data for 2013–2017 from the National Health Interview Survey to evaluate the association of VHA coverage with nonadherence. “Although people with VHA coverage were older and in worse health and had lower incomes than those with other coverage, VHA patients had lower rates of cost-related medication nonadherence: 6.1 percent versus 10.9 percent for non-VHA patients, an adjusted 5.9-percentage-point difference,” the authors wrote.

In fact, they add, reductions in nonadherence were especially notable in patients with chronic illnesses who had VHA coverage. Also notable, according to the report, was the reduction in racial/ethnic and socioeconomic disparities in nonadherence.

“The VHA pharmacy benefit is a model for reform to address the crisis in prescription drug affordability,” the study maintains.

Background information in the article describes how the Department of Veterans’ Affairs buys drugs at relatively low cost by using a combination of regulations, bargaining with drug companies to reduce wholesale prices, and utilizing a national formulary. The result is the ability to provide drugs to veterans with low—or no—patient copays.

The 6.1% of VHA enrollees who reported that costs caused them to go without any medication in the course of a year was much lower than the 10.9% of non-VA patients in the same situation, according to the authors, who add that the differences were even larger among patients with serious conditions such as heart disease (6.1% vs. 14.4%) and chronic lung disease (6.4% vs. 19.9%).

“We face a crisis in drug affordability,” noted senior author Danny McCormick, MD, MPH, associate professor of medicine at Harvard Medical School and a primary care physician. “High copays and deductibles are forcing patients to skip their medications—even for serious illnesses like heart disease or lung disease—putting their health, and even their life at risk. The VA shows that there is a better way.”

Previous studies suggest that drug costs would be lower for Medicare if it were allowed to negotiate prices directly with drug companies and use a national formulary—in other words, was more similar to the VA.

“Today, we have better drugs—more ways to help our patients—than ever before. But these drugs offer no help to patients who can’t afford to take them,” points out lead author Adam Gaffney, MD MPH, a pulmonary and critical care physician at Harvard Medical School. “By reforming how we pay for prescription medications, we can improve health outcomes, while bringing our drug spending in line with that of other rich nations.”

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