The Effect Of Veterans Health Administration Coverage On Cost-Related Medication Nonadherence

Health Aff (Millwood). 2020 Jan;39(1):33-40. doi: 10.1377/hlthaff.2019.00481.


High out-of-pocket drug spending worsens adherence and outcomes, especially for patients who are poor, chronically ill, or members of minority groups. The Veterans Health Administration (VHA) system provides drugs at minimal cost, which could reduce cost-related medication nonadherence. Using data for 2013-17 from the National Health Interview Survey, we evaluated the association of VHA coverage with such nonadherence. Although people with VHA coverage were older and in worse health and had lower incomes than those with other coverage, VHA patients had lower rates of cost-related medication nonadherence: 6.1 percent versus 10.9 percent for non-VHA patients, an adjusted 5.9-percentage-point difference. VHA coverage was associated with especially large reductions in nonadherence among people with chronic illnesses and with reduced racial/ethnic and socioeconomic disparities in nonadherence. The VHA pharmacy benefit is a model for reform to address the crisis in prescription drug affordability.

Keywords: Chronic disease; Co-payments; Cost-related medication nonadherence; Health disparities; Health policy; Pharmaceuticals; Prescription drug costs; Prescription drugs; Veterans Health Administration; Veterans health; cancer.

MeSH terms

  • Chronic Disease / drug therapy
  • Female
  • Health Care Surveys
  • Health Expenditures / statistics & numerical data*
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Poverty
  • Prescription Drugs / economics*
  • Prescription Drugs / supply & distribution
  • United States
  • United States Department of Veterans Affairs
  • Veterans / statistics & numerical data*


  • Prescription Drugs