Patients with diabetes who are covered by the US healthcare insurance Medicare are two to three times more likely to use expensive brand-name drugs compared to patients treated within the Veterans Affairs Healthcare System.
The study, which is published in the Annals of Internal Medicine, is the first large-scale comparison of prescription drug use between Medicare Part D and the Veterans Affairs Healthcare System. It was carried out by researchers from the University of Pittsburgh, VA Pittsburgh Healthcare System and Dartmouth College and investigated use of oral hypoglycaemics, statins, angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and insulin analogues in 1,061,095 Medicare Part D beneficiaries and 510,485 veterans aged 65 years or older with diabetes.
Brand-name drug use for patients using Medicare compared to patients covered by the Veterans Affairs Healthcare System was 35.3% versus 12.7% for oral hypoglycemics, 50.7% versus 18.2% for statins, 42.5% versus 20.8% for ACE inhibitors or ARBs and 75.1% versus 27.0% for insulin analogues.
The results showed that diabetic patients covered by Medicare were two to three times more likely to use brand-name drugs compared to similar patients covered by the Veterans Affairs Healthcare System. As a result, Medicare Part D spent an estimated US$1.4 billion more in 2008 than the Veterans Affairs Healthcare System for the medications studied.
The way the two systems approach drug prescribing may be the reason for such differences. Medicare contracts with more than 1,000 private insurance companies, each using a distinct formulary and cost-sharing arrangement for prescribing drugs, whereas the Veterans Affairs Healthcare System uses a single formulary and all veterans have the same cost-sharing arrangement.
Conflict of interest
The study was jointly funded by the Veterans Affairs, National Institutes of Health (NIH) and Robert Wood Johnson Foundation.
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