• Loren J Schleiden, Carolyn T Thorpe, John P Cashy, Walid F Gellad, Chester B Good, Joseph T Hanlon, Maria K Mor, Joshua D Niznik, John R Pleis, Courtney H Van Houtven, and Joshua M Thorpe.
• Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, United States; Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, 3501 Terrace St, Pittsburgh, PA, 15213, United States. Electronic address: Loren.schleiden@va.gov.
• Res Social Adm Pharm. 2019 Jun 1; 15 (6): 701-709.

BackgroundObtaining prescription medications from multiple health systems may complicate coordination of care. Older Veterans who obtain medications concurrently through Veterans Affairs (VA) benefits and Medicare Part D benefits (dual users) are at higher risk of unintended negative outcomes.ObjectiveTo explore characteristics predicting dual drug benefit use from both VA and Medicare Part D in a national sample of older Veterans with dementia.MethodsAdministrative data were obtained from the VA and Medicare for a national sample of 110,828 Veterans with dementia ages 68 and older in 2010. Veterans were classified into three drug benefit user groups based on the source of all prescription medications they obtained in 2010: VA-only, Part D-only, and Dual Use. Multinomial logistic regression was used to examine predictors of drug benefit user group. The source of prescriptions was described for each of the ten most frequently used drug classes and opioids.ResultsFifty-six percent of Veterans received all of their prescription medications from VA-only, 28% from Part D-only, and 16% from both VA and Part D. Veterans who were eligible for Medicaid or who had a priority group score conferring less generous drug benefits within the VA were more likely to be Part D-only or dual users. Nearly one fourth of Veterans taking opioids concurrently received opioid prescriptions from dual sources (24.7%).ConclusionsMedicaid eligibility and Veteran priority group status, which largely decrease copayments for drugs obtained outside versus within the VA, respectively, were the main factors predicting drug user benefit group. Policies to encourage single-system prescribing and enhance communication across health systems are crucial to preventing negative health outcomes related to care fragmentation.Copyright © 2018 Elsevier Inc. All rights reserved.

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