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The VA is set to lower copays for prescriptions


Col. Teresa Bisnett, Department of Defense - Veterans Affairs Joint Venture Hospital and 673rd Medical Group commander, and Maj. Suzanne Green, 673rd Medical Group Emergency Department Flight commander on Joint Base Elmendorf-Richardson, Alaska, speak with Robert McDonald, secretary of Veterans Affairs, as part of a tour around DoD/VA Joint Venture Hospital

The Department of Veterans Affairs says that it is "amending its regulation" on the copays that veterans pay for medications they receive that are not for service related conditions.

Currently, veterans pay $8 and $9 for a 30-day (or less) supply of prescriptions.

The VA says that the new system will "keep outpatient medication costs low for Veterans."

Dr. David J. Shulkin, the VA Undersecretary for Health, said "Reducing their out-of-pocket costs encourages greater adherence to priscribed outpatient medications and reduces the risk of fragmented care that results when multiple pharmacies are used."

The new system tossed out the old way of determining costs, which was based on the Medical Consumer Price Index.

Three classes of outpatient medications have been designed to help curb the costs.

  • Tier 1 is for preferred generics, and will cost veterans $5 for a 30-day or less supply.
  • Tier 2 is for non-preferred generics, which includes over the counter medications, and will cost veterans $8 for a 30-day or less supply.
  • Tier 3 is for brand name medications, and will cost veterans $11 for a 30-day or less supply.

The new system will go into effect February 27th, 2017, and only apply to medications that are not for service connected issues.

Veterans who are former Prisoners of War, catastrophically disabled, or are covered by other exceptions will not have to pay copays.

Veterans who fall into Priority Groups 2-8 will have a $700 cap on copays, at which point the copays do not apply. To find out which Priority Group you fall into, check out the VA's list of Priority Groups in their Health Benefits tab (here).

According to 38 U.S.C. 1722A(a), the VA is compelled to require veterans to pay a minimum copay of $2 for every 30-day (or less) supply of medications which are prescribed for non-service related disabilities or connections, unless there is an exemption for the veteran. 38 U.S.C. 1722A(b) gives the VA the authority to set the copay amount higher and to put caps on the amount veterans pay.