Documenting the Prescription Drug Use of Medicare Advantage Members Who Use the VA

As you may know, 22% of all Medicare Advantage members are veterans. 5% of all Medicare Advantage members receive care through the VA. Medicare Advantage plans have, historically, had a limited understanding of who the veterans are within their populations.  At BeneLynk, we think of a member’s service in the military as an important Social Determinant of Health.  It is a core part of many members’ stories, and one which they often want to share. 

Because the VA is prohibited from coordinating benefits with Medicare or Medicare Advantage plans, the care those MA members receive through the VA is generally invisible.  This is the first challenge we set out to solve when we founded BeneLynk in 2016.  While we were able to document inpatient and outpatient care that these members received at the VA, prescription drugs remained a challenge.  Many MA members who are also eligible for VA care choose to get prescriptions through the VA.  The co-pays for these drugs are very low and sometimes free altogether. Generally a veteran will pay $5/$8/$11 for a 30 supply of drugs from tiers 1,2, and 3.

BeneLynk’s government relations team has engaged VA facilities throughout the country about the challenge of obtaining documentation of prescription drug fill information. These discussions have proven fruitful and, so far in 2020, almost 50% of all member charts retrieved by BeneLynk have contained prescription drug fill information

This prescription drug information is invaluable to Medicare Advantage plans, giving a more complete picture of the care that members receive.  Without this information, Medicare Advantage plans do not know what prescriptions members might have been given by a VA provider, or if the member is remaining compliant in filling and taking those prescriptions. We’re happy to be able to close yet another divide between Medicare and the VA. 

At BeneLynk, we are helping Medicare Advantage plans with more than 10 million members better understand who the veterans are in their populations, and to document the care that they receive. As always, we are excited to talk about our Veteran Lynk program or Social Determinants of Health in general.  If you want to chat, please drop us a note today at Sales@BeneLynk.com

About the Author

Sean Libby has been an advocate for seniors, people with disabilities, veterans, and individuals with low income for over 17 years.  At BeneLynk, we are committed to helping managed care plans to deliver superior Social Determinant of Health solutions to their members.  Drop us a note at Sales@BeneLynk.com