Filling Diabetes Medications Through VA or Medicare, or Both: Factors in Decision Making, Challenges, and Informational Needs.

BACKGROUND: Veterans' dual use of VA and Medicare Part D to fill diabetes medications is common and has advantages as well as disadvantages. OBJECTIVE: To understand the factors Veterans and their care partners consider when choosing whether to fill their diabetes medications through VA only, Part D only, or both, as well as their medication acquisition challenges and informational needs. APPROACH: Semi-structured interviews between April and September 2023. Transcripts were analyzed via descriptive content analysis with deductive and inductive approaches. PARTICIPANTS: In total, 24 Veterans and 12 care partners. MAIN MEASURES: Drivers of choice, medication acquisition challenges, and informational needs that Veterans and care partners report when choosing where to fill their diabetes medications. KEY RESULTS: Cost, followed by formulary access, were main drivers of where Veterans and their care partners chose to fill their diabetes medications. Drive time, convenience, and preference for a particular provider were also considered, and care partners expressed a desire to streamline all of a Veteran's care to VA or Medicare for convenience and time savings. Veterans and care partners had mixed experiences with dual use, with some expressing frustration related to communication challenges between providers and incompatibilities between different health systems. Health-related risks associated with dual use were rarely mentioned. Veteran and care partner informational needs included relative costs and availability of medications on the formularies, and there was a preference to have direct access to information alongside telephone-based pharmacy support. CONCLUSIONS: Cost and then medication access as well as drive time, convenience, and preference for a particular provider influenced Veteran and care partner choices on where to fill medications. Care partners often preferred one system. Differences and incompatibilities between VA and Medicare at times led to frustration and challenges filling medications. Information and support are needed to help Veterans and their care partners.

Duke Scholars

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