Improving medication adherence for individuals with diabetes or hypertension has been challenging as health plans and employers increase medication copayments, 9-16 lower limits on the number or total reimbursement of covered medications,1 7,18 and introduce tiered benefits. 3-6 Pharmacologic therapy is a mainstay in the management of both conditions, but only 50% to 70% of patients receiving medication management are adherent to medications. 1,2 Between 20% and 40% of patients with these conditions receive no medication management. Copayment increases need to be considered carefully by the Department of Veterans Affairs to ensure that veterans who have greater comorbidity and lower incomes than the general US population do not forgo needed medications.ĭiabetes and hypertension are among the most common chronic conditions in the United States, with prevalence rates of 9.6% and 29.7% for individuals age 20 years and over in 1999-2001.

A $5 copayment increase (from $2 to $7) adversely impacted medication adherence for veterans subject to copayments.The impact of the copayment increase was particularly adverse for veterans with diabetes who were required to pay copayments.Ĭonclusion: A $5 copayment increase (from $2 to $7) adversely impacted medication adherence for veterans subject to copayments taking oral hypoglycemic agents, antihypertensive medications, or statins.Īdherence to diabetes, hypertension, and hyperlipidemic medications among veterans exempt from copayments and propensity-matched nonexempt veterans was examined at 4 Veterans Affairs medical centers. The change in adherence between the preperiod and the postperiod was significantly different for exempt and nonexempt veterans in all 3 cohorts, and nonadherence increased over time for veterans required to pay copayments. Results: Adherence to all medications increased in the short term for all veterans, but then declined in the longer term (February-December 2003). Adherence differences were assessed in a difference-in-difference approach by using generalized estimating equations that controlled for time, copayment exemption, an interaction between time and copayment exemption, and patient demographics, site, and other factors. The main outcome measure was medication adherence 12 months before and 23 months after the copayment increase. The diabetes sample included 1069 exempt veterans and 1069 nonexempt veterans, the hypertension sample included 3545 exempt veterans and 3545 nonexempt veterans, and the sample of veterans taking statins included 2029 exempt veterans and 2029 nonexempt veterans. Methods: This study compared medication adherence at 4 Veterans Affairs medical centers between veterans who were exempt from copayments and propensity-matched veterans who were not exempt. Study Design: Retrospective pre-post observational study. Objective: To examine the impact of a medication copayment increase on adherence to diabetes, hypertension, and hyperlipidemic medications.

Va copay rates 2012