{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:15:06Z","timestamp":1777932906122,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["IIR 16-261-2"],"award-info":[{"award-number":["IIR 16-261-2"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["RCS 20-192"],"award-info":[{"award-number":["RCS 20-192"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Care Res Rev"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>In February 2017, the Department of Veterans Affairs (VA) restructured outpatient medication copayments, creating three medication tiers comparable with private-sector value-based insurance designs (with copayments: US$5, US$8, US$11 per 30-day supply for Tiers 1\u20133, respectively); however, Veteran medication management experiences have not been assessed following this change. We invited a random sample of Veterans with chronic conditions (e.g., diabetes, hypertension) who utilized VA services to complete a mailed survey about VA and non-VA pharmacy use and medication management experiences following this restructuring. There were 2,884 respondents (29% response rate). Veterans with the lowest proportion of medications from Tier 1 after the restructuring had the highest predicted probability of non-VA pharmacy use from regression analyses. Among respondents subject to VA copayments, 27% reported being better able to afford medications after the restructuring. However, 29% reported worrying about paying for medications, and 18% reported making tradeoffs (e.g., spending less on utilities, food) to pay for prescriptions.<\/jats:p>","DOI":"10.1177\/10775587251356369","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T11:23:01Z","timestamp":1754306581000},"page":"55-66","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of VA Medication Copayment Restructuring With Pharmacy Use, Medication Costs, and Financial Burden of Medications"],"prefix":"10.1177","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9735-4929","authenticated-orcid":false,"given":"Kevin T.","family":"Stroupe","sequence":"first","affiliation":[{"name":"Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA"},{"name":"Parkinson School of Health Sciences and Public Health, 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P.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Department of Health Economics, Systems, and Policy, Peter O\u2019Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, USA"},{"name":"Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beverly","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Geriatrics and Extended Care Data Analysis Center, Canandaigua VA Medical Center, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlesnika T.","family":"Evans","sequence":"additional","affiliation":[{"name":"Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA"},{"name":"Department of Preventive Medicine, Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie J.","family":"Suda","sequence":"additional","affiliation":[{"name":"Center for Healthcare Evaluation, Research, and Promotion, VA Pittsburgh Healthcare System, PA, USA"},{"name":"Division of General Internal Medicine, University of Pittsburgh School of Medicine, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chad","family":"Osteen","sequence":"additional","affiliation":[{"name":"Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibuola","family":"Kale","sequence":"additional","affiliation":[{"name":"Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Administration Hospital, Hines, IL, 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(2016 August 10). Medicare advantage value-based insurance design model. https:\/\/www.cms.gov\/newsroom\/fact-sheets\/medicare-advantage-value-based-insurance-design-model"},{"key":"e_1_3_3_5_1","unstructured":"Centers for Medicare & Medicaid Services. (2025). Chronic condition warehouse. https:\/\/www2.ccwdata.org\/web\/guest\/condition-categories"},{"issue":"2","key":"e_1_3_3_6_1","article-title":"Value-based insurance design","volume":"26","author":"Chernew M. E.","year":"2007","unstructured":"Chernew M. E., Rosen A. B., Fendrick A. M. (2007). Value-based insurance design. Health Affairs (Project Hope), 26(2), w195\u2013w203.","journal-title":"Health Affairs (Project Hope)"},{"key":"e_1_3_3_7_1","volume-title":"Designing and conducting mixed methods research","author":"Creswell J. W.","year":"2011","unstructured":"Creswell J. W., Plano Clark V. L. (2011). Designing and conducting mixed methods research (2nd ed.). 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