The Department of Veterans Affairs (VA) is amending its regulation on co-payments for Veterans’ outpatient medications for non-service connected conditions.
The VA currently charges veterans who do not qualify for free health care either $8 or $9 for a 30-day or less drug supply.
But under a new plan set to kick in February 27th, the VA will categorize drugs into tiers, with tier 1 medications (preferred generics) costing $5, and tier 2 (non-preferred generics) costing $8 for a 30-day or less supply. Tier 3 (brand name) will cost $11 for a 30-day or less supply.
Most veterans will see a 10 to 50 percent reduction in the cost of the drugs they receive from the VA.
“Switching to a tiered system continues to keep outpatient medication costs low for Veterans,” said VA Under Secretary for Health Dr. David J. Shulkin. “Reducing their out-of-pocket costs encourages greater adherence to prescribed outpatient medications and reduces the risk of fragmented care that results when multiple pharmacies are used; another way that VA is providing better service to Veterans.”
A series of seven criteria is used by the VA to determine which generic drugs are on the lower-cost “preferred generics” list, and which drugs are “non-preferred generics” and cost $3 more per 30-day or less supply, according to the rule proposal.
For example, generic drugs typically used to treat a common “chronic condition,” such as hypertension, will be on the list, while topical creams, products used to treat musculo-skeletal conditions, antihistamines and steroid-containing generics would not because they are typically used on an “as-needed basis,” the document says.
Co-payments stop each calendar year for Veterans in Priority Groups 2-8 once a $700 cap is reached.
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 co-payments do not apply to former Prisoners of War, catastrophically disabled Veterans, or those covered by other exceptions as set by law.