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The American Journal of Managed Care May 2018
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Characteristics and Medication Use of Veterans in Medicare Advantage Plans
Talar W. Markossian, PhD, MPH; Katie J. Suda, PharmD, MS; Lauren Abderhalden, MS; Zhiping Huo, MS; Bridget M. Smith, PhD; and Kevin T. Stroupe, PhD
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Characteristics and Medication Use of Veterans in Medicare Advantage Plans

Talar W. Markossian, PhD, MPH; Katie J. Suda, PharmD, MS; Lauren Abderhalden, MS; Zhiping Huo, MS; Bridget M. Smith, PhD; and Kevin T. Stroupe, PhD
Veterans enrolled in Medicare Advantage plans differed from fee-for-service sector enrollees in several demographic, geographic, and clinical characteristics and in patterns of medication use.
Statistical Analyses

Demographic, geographic, and medication use differences between veterans who obtained Medicare in the FFS sector and those who were enrolled in an MA plan in 2008-2009 were assessed by descriptive and bivariate statistics, including t tests and χ2 tests. We compared the number of 30-day supplies, the number of medication classes, and the most frequently occurring drug classes from VA or Part D–reimbursed pharmacies by Medicare FFS or MA plan enrollment status. We also compared receipt of HRMs from VA and Part D–reimbursed pharmacies by plan type (FFS vs MA) and pharmacy use groups (VA only, Part D–reimbursed only, or dual). Logistic regression analyses were conducted to assess factors associated with MA versus FFS enrollment in 2008-2009, which included veterans’ demographic characteristics, health status, and zip code–level factors. All analyses were conducted using Stata version 14.2 (Stata Corp; College Station, Texas). Human subject approval for this research was obtained from the Edward Hines, Jr. VA Hospital Institutional Review Board.

RESULTS

Veterans’ Characteristics by Medicare Type

There were 262,371 veterans who met the study inclusion criteria, of whom 203,723 (77.6%) were enrolled in Medicare FFS and 58,648 (22.4%) in MA. A majority (81.3%) of MA-enrolled veterans were enrolled for 12 months in MA plans during the year. The majority of veterans were non-Hispanic white, aged between 76 and 85 years, and residing in an urban location. Descriptive characteristics of veterans by MA enrollment status are presented in Table 1 [part A and part B]. Compared with those in the FFS sector, MA enrollees were more likely to receive medications for the treatment of pain, which had the largest difference between the 2 groups (29.4% vs 23.9%), followed by medications for congestive heart failure/hypertension (59.0% vs 56.7%), diabetes (24.8% vs 22.5%), hyperlipidemia (66.4% vs 63.1%), and benign prostatic hypertrophy (29.4% vs 27.0%).

In the adjusted analyses, compared with those in the FFS sector, MA enrollees had a 2-fold increase in the odds of having VA co-payments for some (odds ratio [OR], 2.25; 95% CI, 2.15-2.35) or all (OR, 2.41; 95% CI, 2.30-2.52) drugs. They also had greater odds of residing in urban settings (OR, 2.01; 95% CI, 1.96-2.06) and in the West (OR, 1.13; 95% CI, 1.10-1.16) compared with all other regions. MA and FFS enrollees differed significantly regarding 9 of the 10 most common clinical conditions in this population (listed in Table 1), excluding hypertension. Pain was the condition most associated with MA enrollment; MA enrollees had 33% (OR, 1.33; CI, 1.30-1.37) greater odds of having pain medication prescribed compared with FFS sector enrollees.

Medication Use by Medicare Type

A higher percentage of MA enrollees were enrolled in Medicare Part D compared with FFS sector enrollees (73.7% vs 24.3%). In Figure 1, we present unadjusted analyses comparing medication use by MA enrollment status. MA enrollees were more likely to use any VA or Medicare-reimbursed medication (92.8% vs 70.2%) and to be dual (32.3% vs 7.0%) or Medicare-only (31.1% vs 14.5%) pharmacy users. For VA or Medicare-reimbursed medication users, Medicare FFS enrollees and MA enrollees received a similar number of 30-day medication supplies in 2009 (mean [SD], 62.6 [43.9] vs 62.9 [40.9], respectively; P = .3482) from VA or Part D–reimbursed pharmacies (data not shown). Medicare FFS enrollees obtained medications from fewer drug classes (mean [SD] = 8.3 [5.2]) compared with MA enrollees (mean [SD] = 8.8 [5.1]; P <.001) from VA or Part D–reimbursed pharmacies. A comparison of the prevalence for all the RxRisk-V classes and a detailed comparison of medication use from VA or Part D–reimbursed pharmacies by Medicare plan enrollment status are presented in eAppendix Tables 1 and 2.

The 10 most frequently prescribed drug classes by Medicare enrollment status are presented in Table 2 [part A and part B]. In both groups, the most frequently obtained drug class from VA and Part D–reimbursed pharmacies were antilipemic agents, followed by β-blockers. For example, 38.5% of Medicare FFS enrollees obtained antilipemic agents from VA pharmacies and 12.1% obtained them from Part D–reimbursed pharmacies. Opioid analgesics, quinolones, and antidepressants were drug classes dispensed from Part D–reimbursed pharmacies that were not included in the list of 10 most frequently obtained drug classes from VA pharmacies. The most frequent drug classes that dual pharmacy users obtained with an overlapping days’ supply from both VA and Part D–reimbursed pharmacies for more than 7 days are also presented; the list included antilipemic agents, β-blockers, antidepressants, and opioid analgesics, among others (Table 2).

In total, 15.1% of the veterans received HRMs; of these, 6.7% received the medication from VA pharmacies and 7.9% from Part D–reimbursed pharmacies (Figure 2A). A higher proportion of MA enrollees received HRMs compared with the FFS sector enrollees (17.0% vs 14.3%; P <.001) (Figure 2B). A higher proportion of dual users (24.4%) received HRMs compared with users of Part D–reimbursed (20.7%) or VA-only (10.1%) pharmacies (P <.001) (Figure 2C). The 10 most frequent HRMs that veterans obtained from VA and Part D–reimbursed pharmacies are presented in Table 3.


 
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