Decrease in Medication Copay begins February 27 - Coatesville Veterans Affairs Medical Center
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Coatesville Veterans Affairs Medical Center

 

Decrease in Medication Copay begins February 27

Effective February 27, the Department of Veterans Affairs (VA) will change the federal regulations concerning copayments charged to Veterans for medications required on an outpatient basis to treat non-service connected conditions.

Effective February 27, the Department of Veterans Affairs (VA) will change the federal regulations concerning copayments charged to Veterans for medications required on an outpatient basis to treat non-service connected conditions.

Monday, January 23, 2017

Effective February 27, the Department of Veterans Affairs (VA) will change the federal regulations concerning copayments charged to Veterans for medications required on an outpatient basis to treat non-service connected conditions.

Estimates show that copayment amounts would increase three times over six years if the current regulations are left unchanged, but switching to a tiered system and freezing associated copayments will continue to keep costs low for Veterans.

The new tiered copayment structure will decrease the costs of outpatient medications for most Veterans, aligning with VA’s goals to reduce out-of-pocket costs, encourage greater adherence to prescribed outpatient medications and reduce the risk of fragmented care that results when multiple pharmacies are used to fill Veteran prescriptions.

Under the new regulation, copayment amounts would be fixed and would only vary depending upon the class of outpatient medication in the tier. The rulemaking will establish three classes of outpatient medications tiers identified as: Tier 1, Preferred Generics; Tier 2, Non-Preferred Generics including over-the-counter medications; and Tier 3, Brand Name. Copayment amounts for each tier would be fixed and vary depending upon the class of outpatient medication in the tier.

These copayment amounts will be effective February 27, 2017:

  • $5 for a 30-day or less supply - Tier 1 outpatient medication
  • $8 for a 30-day or less supply - Tier 2 outpatient medication
  • $11 for a 30-day or less supply - Tier 3 outpatient medication

These changes apply to Veterans without a service-connected condition, or Veterans with a disability rated less than 50 percent who are receiving outpatient treatment for a non-service connected condition, and whose annual income exceeds the limit set by law. Medication copayments do not apply to former Prisoners of War, catastrophically disabled Veterans, or those covered by other exceptions as set by law.

Copayments stop each calendar year for Veterans in Priority Groups 2-8 once a $700 cap is reached.

More information on the new tiered medication copayment can be found at: https://www.gpo.gov/fdsys/pkg/FR-2016-12-12/pdf/2016-29515.pdf.


Frequently Asked Questions

If I am required to make a copayment and can’t, will VA withhold my treatment or medications?

No. VA will not withhold treatment or medication. An account is automatically established when you are required to make a copayment. However, if you are having financial difficulties and are unable to pay assessed copayment charges, you may apply for a waiver, compromise or repayment plan.

Will the amount of the medication copayment and the annual cap ever change?

The amount of the medication copayment and the cap may be changed on an annual basis. The VA health care facility will inform the Veteran of any medication copayment and/or annual cap change.

Will my insurance company be charged for medication for my service-connected condition?

No, VA is not authorized to bill your insurance company for medication related to treatment of your service-connected conditions.

Who decides if a medication is for treatment of a non-service connected condition?

A VA health care provider makes this determination. If the medication prescribed is for treatment of a service-connected condition or special authority, no copayment is required.

Can I get prescriptions from my private health care provider filled at the VA pharmacy?

No, VA will only provide medications that are prescribed by authorized providers in conjunction with VA medical care. VA health care providers are under no obligation to prescribe a medication recommended by a non-VA provider.

How can I transfer my prescriptions prescribed in the community to the VA System?

VA will fill prescriptions prescribed by a non-VA provider only if all the following criteria are met:

  • You are enrolled in VA health benefits
  • You have an assigned Primary Care Provider
  • You have provided your VA health care provider with your medical records from your non-VA provider
  • Your VA health care provider agrees with the medication prescribed by your non-VA provider. VA health care providers are under no obligation to prescribe a medication recommended by a non-VA provider. Patients are encouraged to bring a current list of medications, dose, and frequency for every visit.

Will the changes affect medications prescribed prior to February 27?

The copay will include refilled prescriptions as well as new prescriptions. Refills after the implementation date should be billed appropriately and seamlessly for patients and providers.

How do I pay for my prescriptions?

You may provide payment via the following methods:

  • Online: https://pay.gov
  • By mail: PO Box 530269, Atlanta, GA 30353-0263
  • In person: A VA Medical Center
  • By Phone: 1-888-827-4817

Pay by check, money order, or credit card payable to “VA.” and include your Account Number. Do not send in requests for prescription refills with your payment. If you do, your prescription refill will be delayed.

Will I be charged for over-the-counter medications?

Medication copayments are charged for all over-the-counter medications, such as aspirin, cough syrup, and vitamins that are i dispensed from a VA pharmacy. You are not charged a medication copayment for medical supplies (syringes, alcohol wipes, etc.) or for medications administered during treatment.

How do I know if my medication is on the VA Formulary?

Please visit the Pharmacy Internet Formulary at http://www.pbm.va.gov/apps/VANationalFormulary/ to learn more.

How do I know what tier my medication is in?

Please visit the Health Benefits site at http://www.va.gov/healthbenefits/ to learn more.

How do I change my medication(s) to a lower tier?

A VA health care provider must make this determination. They will review any prescriptions and determine if the type of medication being taken can change to a lower tiered medication.

How do I refill my prescription?

Prescriptions can be refilled online, by mail, or by phone. Visit http://www.va.gov/HEALTHBENEFITS/access/prescriptions.asp for more information.

Where does the money go?

Funds collected from medication copayments, other VA copayments, and health insurance reimbursements are used to provide additional health care services to Veterans.

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