Medicare Coverage of Erectile Dysfunction Drugs Caused a Drop in VA Claims

During a 2-year period when erectile dysfunction drugs were included on both the Medicare Part D formulary and the Veterans Affairs (VA) formulary, veterans’ prescriptions for phosphodiesterase-5 (PDE-5) inhibitor medications filled at VA pharmacies decreased, according to a study in the July Journal of Managed Care & Specialty Pharmacy.

Meanwhile, veterans’ prescriptions for PDE-5 inhibitors filled at Medicare-reimbursed pharmacies increased.

“While the descriptive nature of the study precludes an exact determination of the reasoning for veterans changing how they accessed medications during this time period, this study highlights that veterans may access medications outside of the VA health care system, particularly for lifestyle medications and those with formulary restrictions,” researchers wrote. “This action can complicate medication management if veterans do not report use of these medications to VA providers.”

The study focused on PDE-5 inhibitor use among veterans older than age 66 between 2005 and 2009. The drugs were originally covered under Medicare Part D when the program was launched in 2006. In 2007, erectile dysfunction drugs were dropped from the Part D benefit, although more than $3 million in such drugs were mistakenly covered during 2007 and 2008 due to an incomplete list of excluded medications in the Medicare Drug Data Processing System, researchers explained.

With the inception of Medicare Part D in 2006, the number of veterans filling prescriptions for PDE-5 inhibitors at VA pharmacies dropped 68% and the number of PDE-5 inhibitor 30-day equivalents dispensed decreased nearly 87%, according to the study. During the full coverage period in 2006 and the accidental partial coverage period in 2007, Medicare Part D PDE-5 inhibitor prescriptions increased, followed by a decrease in 2008. In October 2007, VA prescriptions for PDE-5 inhibitors returned to 2005 levels.

The study did not investigate why veterans switched from VA to Medicare coverage. During the coverage period, however, Medicare deemed 1 tablet per day acceptable, researchers noted, compared with a 4-tablet-per-month quantity limit for VA coverage.

“Implementation of Medicare Part D reduced VA PDE-5 inhibitor acquisition. However, after removal of PDE-5 inhibitors from the Part D formulary, use of VA pharmacies for PDE-5 inhibitors resumed,” researchers wrote. “Medication policies outside the VA can affect medication use. Veterans with access to non-VA health care may obtain medications from the private sector because of VA restrictions.”—Jolynn Tumolo

Reference

Spencer SH, Suda KJ, Smith BM, Huo Z, Bailey L, Stroupe KT. Erectile dysfunction medication use in veterans eligible for Medicare Part D. Journal of Managed Care & Specialty Pharmacy. 2016;22:818-824.