VA Maryland Health Care System
Health Watch Spring 2017
New Regulation Decreases Cost of Outpatient Medication Copay for Most Veterans
VA has amended its regulation on copayments for outpatient medications for non-service connected conditions. VA previously charged non-exempt Veterans either $8 or $9 for each 30-day or less supply of outpatient medication that is prescribed for a non-service connected condition.
The new tiered system establishes three classes of outpatient medications identified as Tier 1 (Preferred Generics), Tier 2 (Non-Preferred Generics including some over-the-counter medications), and Tier 3 (Brand Name). The copayment amounts for each tier are fixed and vary depending upon the class of outpatient medication in the tier.
"The new regulation is more consistent with how commercial insurances determine copays-where it's advantageous to use generic brands when possible-and it's an appropriate shift that makes sense for our Veterans," says Dr. Adam M. Robinson, Jr., director of the VA Maryland Health Care System. "Offering low costs copays at VA pharmacies encourages and helps Veterans to stick with their medications, and it reduces the use of multiple pharmacies which can cause fragmented care. Overall the new system will lead to better service to Veterans."
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. Veterans who exceed the annual cap will continue to receive medications without having to make further copayments.
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