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Research Letter
Health Care Policy and Law
July 22, 2019

Association Between Dual Use of Department of Veterans Affairs and Medicare Part D Drug Benefits and Potentially Unsafe Prescribing

Author Affiliations
  • 1Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 2Division of Pharmaceutical Outcomes and Policy, UNC-Chapel Hill Eshelman School of Pharmacy, Chapel Hill, North Carolina
  • 3Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4Corporal Michael J. Crescenz Veterans Affairs Medical Center and the Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
  • 5Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 6Center Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System Durham, North Carolina
  • 7Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
JAMA Intern Med. Published online July 22, 2019. doi:10.1001/jamainternmed.2019.2788

Veterans 65 years and older with prescription drug benefits from the Department of Veterans Affairs (VA) are almost universally eligible for Medicare Part D (hereinafter referred to as Part D). Although dual eligibility may increase access to necessary medications, receiving prescriptions from 2 systems (dual use) may also fragment care and undermine prescribing safety. Previous work showed that dual VA–Part D prescription drug use is a risk factor for potentially unsafe medication (PUM) exposure in veterans with dementia1 and opioid users.1,2 However, whether these risks generalize to the entire Medicare-covered population of older VA users remains unknown. We evaluated the association of dual prescription use through the VA and Part D (vs VA-only use) with the prevalence of PUM exposure in a national cohort of dually eligible older veterans.

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