Factors Influencing Choice of Pharmacy Settings Among Age 65+ Department of Defense Health Care BeneficiariesObjective: Department of Defense (DoD) healthcare planners want to motivate a voluntary migration of pharmacy workload from military and retail pharmacies into their mail order program. We examined the pharmacy utilization patterns among the 65+ beneficiary population, traditionally the heaviest users of the TRICARE prescription drug benefit, to identify factors that influence their choice of pharmacy setting(s). Outpatient prescription fill records for 65+ beneficiaries (N = 300,084) residing in North Carolina, Texas, and California from December 1, 2004 through February 28, 2005 were examined. Binary logistic regression models were run for each type (military, retail, and mail order) and number of pharmacy settings used by beneficiary gender, age group, catchment area status (40-mile radius around military pharmacies), state, and number of medications obtained. The mean number of medications per beneficiary and mean cost per medication were tabulated for each type and number of settings used.
Results: Overall, military, retail, and the mail order pharmacies were used by 45.4%, 67.6%, and 22.1% of beneficiaries, respectively, during the study period. Two thirds of the study population used one setting exclusively and 2.4% used all three settings. Noncatchment residents were 10 times less likely (AOR = 0.108, 95% CI 0.106, 0.110) to use a military pharmacy, and 3 times more likely to use a retail pharmacy (AOR = 3.319, 95% CI 3.261, 3.377) or mail order pharmacy (AOR = 3.248, 95% CI 3.189, 3.308) relative to catchment residents. Beneficiaries taking 10 or more medications were 40 times more likely (AOR = 43.644, 95% CI 43.644, 39.760) to use all settings relative to those who obtained 3 or fewer medications. Retail pharmacy and single setting use was more common among women and generally increased with patient age. Men were more likely users of the military and mail order pharmacies, and multiple settings. Single setting users obtained a mean of 5.3 medications and paid a mean $7.85 per medication. Those who used all three settings obtained a mean of 10.0 medications and paid mean of $4.77 per medication. Beneficiary choice of pharmacy setting(s) appears to be primarily driven by the number of medications needed, and secondarily, by their proximity to a military pharmacy, where drugs may be obtained at no cost. These findings highlight the challenge of voluntarily migrating workload into the mail order pharmacy. The heavy use of retail pharmacies, despite being the most expensive option, and the availability of free medications at military pharmacies suggests that financial incentives alone may be inadequate for promoting a switch to the mail order option among those not already using it. The Department should consider targeting specific maintenance medications to focus their migration effort while understanding that one-time prescription fills, the need for non-prescription medications, and other factors will continue to motivate the use of both military and retail pharmacy settings.