VA drug copay

Newly proposed guidelines created by the Department of Veterans Affairs may result in lower drug copay for veterans purchasing prescription drugs.

If approved, the changes would begin January 1, 2017. The changes to a tiered system may result in many veterans seeing a significant reduction in how much they pay annually for their respective drug copay and avoid annual increases in payment amounts.

SEE IT: Proposed Drug Copayment Changes Document

NEW VA DRUG COPAY TIER SYSTEM

The current VA drug copay for non-exempt veterans is $8-$9 for each 30-day or less medication prescription. The new rulemaking would limit future rate increases and instead, create a three-tiered system to classify the drugs and respective copay amounts. Tier 1 would cost $5. Tier 2 would cost $8. Tier 3 would cost $11. Veterans who are exempt will still receive their exempt status.

COST SAVINGS FOR VA DRUG COPAY CHANGE

VA predicts the tiered system will result in lower payments for most veterans:

Based on a comparison of the current and proposed copayment amounts, we anticipate that most veterans would realize between a 10 and 50 percent reduction in their overall pharmacy copayment liability each year based on historic utilization patterns. By our estimates, 94 percent of copayment eligible veterans would experience no cost increase, and 80 percent would realize a savings of between $1 and $5 per 30-day equivalent of medications. The proposed copayment amounts intends to support patient adherence, reduce instances of veterans not filling prescription medications and assisting veteran health improvements from chronic disease…. Annual savings would be even greater for veterans with a large number of medication copayments. VA estimates that at least 50 percent of all billable prescriptions would be in Tier 1, with no more than 35 percent in Tier 2, and approximately 15 percent in Tier 3. Exact estimates for Tier 1 and Tier 2 are not possible at this time and would depend on the final list of medications selected for Tier 1.

RESEARCH SUPPORTING VA DRUG COPAY CHANGE

VA proposed the changes based on research showing certain pricing strategies were putting veterans at risk from failures to seek medications due to cost pressures:

In addition to higher copayments increasing the risk that veterans will not fill their prescriptions, VA’s lack of competitive copayment pricing increases the likelihood that veterans will obtain their prescribed medications from other sources. Fragmentation of prescription records to more than one pharmacy increases the risk of an incomplete medication record, which can lead to unintended adverse reactions. Different clinicians caring for the patient may not be aware of all the medications that the patient is taking VA medical providers need to be aware of all of the medications a veteran is taking to avoid unintended prescribing of contraindicated medications. Through this rulemaking, we believe that we can prevent or minimize these unintended or adverse effects of patients choosing multiple pharmacies to fill their prescriptions.

According to VA, a large body of research shows that higher copayment amounts negatively affect a patient’s adherence to a certain treatment plans. So the apparent argument in support of the change is that veterans will have greater access to pharmaceutical medications.

On the surface, this plan seems like a win for veterans in the long term. Be sure to take a look at the proposed rule change to see what you think. Will it truly help veterans or is there an ulterior motive?

Source: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-33052.pdf

namnibor
When you read that entire publication, they seem to simply repeat the same crap about the “Three Tiers” and “Tier Pricing”…I am failing to see absolutely anything new here. You want to know what would be *better* regarding VA and Prescriptions? If the VA were to seriously update their damn “Pharmacy Formulary” to reflect medical advances in difficult to treat long-term health conditions then and only then would I even ponder the possibility of utilizing the VA Deathcare. What that… Read more »
Patricia Carter
I agree 100% with what nanibor has stated. VA was treating me for over 20 years for PTSD. I kept telling them that nothing prescribed was working but they kept adjusting and changing meds. The real culprit was catching Hep C from what I believe was from the vaccination air guns used by the military back in the 70’s (And NO I’m not a intravenous drug user or ever have been.) Countless veterans are living with this disease (diagnosed and… Read more »
Lynn Seiser PhD MFT

Gotta second Pat’s position – as a veteran with service-connected hepatitis C (from mass jet gun inoculations) now “undetected” thanks to VA, any assistance to get the right medication to veterans will be appreciated …

CorpsmanuP! (@Tang1967)
This is just a scheme to keep veterans at the VA and kill them. If you have comorbid chronic health problems, especially liver disease, you should not be taking 30 + days of meds that drag on for years without ang improvement to your health. The meds alone will damage your kidneys and liver over a period of time if not properly monitored. Don’t get drawn in by saving $$$$!!!! Money kills and that is their weapon of choice. The… Read more »
namnibor
Some chronic conditions require one to take those very meds the rest of one’s life and that can include as an example; being co-infected with Hep B and HIV…the rest of one’s life, even when undetectable because “medication vacations” are and have been a thing of the past for almost 10 years now, (the VA is at least 12 years behind research), Infectious Disease Specialists in civilian medical field found that once a person ceased taking regularly the meds or… Read more »
namnibor
This is related to healthcare. Obama’s proposal plan on gun control could easily make any person that is deemed by ANY health professional or Mental Health Dr., to report and place them on banned from buying AND owning ANY guns. I read a lot about this last night and this morning and nowhere in proposal does it state where they draw the line with that. Is any Veteran with Anxiety, PTSD, Depression, and taking meds for same or other conditions… Read more »
johnny5

That’s 20 million and 60 million that the government has not been authorized to spend by congress, and….they really don’t have it…they are already over budget..

Someone needs to stand up and stop the idiots in charge from making these fiscally irresponsible actions.

91Veteran
This entire proposal is bullshit because either the problem does not exist (gun show loopholes) or the DOJ does such a pathetic job of prosecuting existing laws such as straw purchasers. All of the other crap is nothing more than schemes for federal tax dollars to flow to the right people expected to support this nonsense, and will do little to curb the problem. What part of this will fix the problem in Chicago? Baltimore? How many crimes involving illegal… Read more »
crazy elf
Does anyone see what’s happening? He’s slowly stripping legitimate American gun owners of their rights under the 1st, 2nd, 5th & 8th Amendments of our Constitution & Bill of Rights. I watched a video on Utube yesterday with Ted Nugent. He stated something interesting. He said, “Let’s forget we have a document!” (Refering to the Constitution.) “Forget it exsists!” He then continued, “Who has the right, while I’m on or inside my property, to tell me HOW I’m supposed to… Read more »
namnibor
Yep. Overreach is an understatement in what Obama is proposing. Speaker Ryan is vehemently against this as well as many other politicians and Americans alike. Trump said he will shred any Executive Order as soon as he got in…I am thinking that this needs prevented way before that. Let’s just say I agree fully with Ted. Nugent as well. What Obama is proposing will only vilify anyone that receives any type of mental health care because this highly encourages them… Read more »
Cantigny
that’s right, that’s exactly what is going to happen. disarm as many veterans as possible. many of us have seen the tactics the va docs use to get one to divulge they own a weapon. used to flat out ask, but they do it now round-robin type wording in what you think is just a conversation and veteran innocently says something, that in any other place would be ignored, but va doc will use it, you can bet your arse.… Read more »
Walt

Crazy elf, what exactly is “illegal” about Obama’s executive order?

91Veteran

Well, his removal of due process for one. His removal or restriction of Constitutional rights without that due process. His unilaterally changing HIPAA law by fiat.

crazy elf
@Walt He is cicumventing Congress by spending taxpayer’s monies to implement this. He cannot ever use “executive powers” when spending taxpayer’s monies without it first going before Congress. Therefore he is illegally NOT abiding by his NONauthority of NOT having Congress pass a spending bill on this issue, period. According to many “Constitutional Authorities”, what he’s been doing, especially with this issue, IS an impeachable offense. Lastly, he’s been threatening to do this for months. It’s only been more apparent… Read more »
namnibor
@crazyelf- THAT may just be what pushes Obama to literally go ape$hit…the monetary approvals needed for half a Billion for mental health and all the new hires, et al….meanwhile, the Feds. cannot keep a Veteran Suicide Program viable…what’s terribly wrong with this picture? Obama going ape$hit would be Kenyan Full Dictator Mode (KFDM, and not to be confused with the great music group), and declaring Martial Law. I hope to God I am wrong but I saw this shit coming… Read more »
crazy elf
@namnibor and others Do y’all remember me and others telling about that vet up in Idaho, this past early summer, who had his weapons taken away because VA said he was incompetent? Then all of a sudden a couple of representatives (one from Washington State), the Chief of Police and LOTS of others decended and defended him? There was a big uproar over it! Well, in the end, the VA capitulated. Gave him his rights and money back. And have… Read more »
91Veteran
I recall that, and recall a few members of Congress speaking out about his gun grabbing then. That happened after another vet in California had his taken away. Which brings the question, why is he only doing this with social security recipients now? Why did he single out veterans back then? I believe he fully intended to roll this out piecemeal covering all federal agencies hoping nobody would notice, or that another mass shooting would give him the excuse he… Read more »
namnibor
@crazyelf and all- THAT is what is called “A Momentary Lapse of Reason”…when Politicians do the right thing. They do occasionally are very helpful but this is not to be expected. I often wonder of my Senator would have been so helpful had he not known I was one of the Team Leader Field Managers that worked on his re-election campaign. However, as hot as an issue as Gun Ownership and guarantee to arm oneself is, I think Obama may… Read more »
figure8fan
Something I have been thinking about is the huge push to take away the narcotic pain medication and replace it with the anti depressants. This is happening across this nation and if they can use the fact that you are taking depression medication, even though it is for pain, could this be enough to deny you the ability to get a gun? Could it be used to take away the guns you already have? Could this have been the big… Read more »
namnibor
@f8f You and I and others on here and reading are on the exact same wavelength. Yes, the push is on in the civilian mental health field as well, trying to get patients that have been ‘stabilized’ from Anxieties/PTSD with Benzo’s are now finding the Dr.’s trying to get you to get off the meds that work, even if one has already gone through years of playing darts with your brain with meds until one feels just right…and I refuse… Read more »
figure8fan
nam, I agree on watch what you say. I now have a suicide risk assessment in my permanent medical records because my psychologist and I were talking and I brought up a different view on the question that is asked, and displayed everywhere within and around the VAMC’s. That is the “do you feel as if you are a harm to yourself or others?” question that is asked at least once during a visit, phone call, meeting, ETC… and I… Read more »
Walt
Crazy elf, I am no Obama supporter and have had my share of problems with the VA, nevertheless let me set the record straight on the US Constitution and Executive powers (orders). The president does in fact have the authority to spend tax payer dollars through executive orders, a power granted to him (her) by the US Constitution and tightening of gun control does not violate any of our so called 2nd Amendment rights. The constitution is vague on most… Read more »
91Veteran
Having a Constitutional Law degree no longer impresses me given the number of times Obama’s actions have been ruled unconstitutional in the courts. Since you believe tightening of gun controls does not violate any 2A rights, please apply that to any other rights and see how you feel about things. Tightening control of the drivel I see daily in the media doesn’t affect anyone’s so called 1A rights. Tightening control of crooks demanding warrants doesn’t affect your so called 4A… Read more »
crazy elf
1.) it’s been reported Obama voluntarily turned in his “law degree” a few years ago. As did his wife in 2009! Let’s just say it was due to “dubious college disagreements over whether or not he attended said university!” 2.) He cannot spend money until it goes through Congress. That is NOT stated anywhere in the Constitution. Where you got that info is also dubious. 3.) the first AND second Amendments ARE straight forward in their wording. As is all… Read more »
CorpsmanuP! (@Tang1967)

You are right, you have to draw titers and identify the viral strains through which CMV ( cytomeglavirus nucleus cells) that are resistant. In which a DNA profile of the virus can be identified. Research is key through evidence based medicine and actually listening to the patient . Evidence based medicine is actually listening to the patient

Wilson beaulieu

Probably if the co-pay was removed for all service connected veterans the modifications in va by reducing all other costs involved would save va and vet money.

91Veteran
Clinicians need to be aware of all medications a veteran is on? Well, they have the vets records readily available which they should be reviewing, so claiming this rule will help that is bullshit. The key to this is their comment about competitive pricing. This means they are solely worried about veterans going elsewhere for better care to simply refill a prescription. Many vets in some areas are not service connected and go to the VA simply because prescriptions are… Read more »
Seymore Klearly
I see the President is now on speaking about gun violence in the US while there is breaking news in Afghanistan about deaths of special operation forces. Also one of medevac helicopter sent in to evac the wounded was damaged and still sitting on the ground. The Washington Post claiming that the helicopter hit a wall while landing and other sources are saying it was hit by a mortar after landing. More likely it was hit by one of the… Read more »
namnibor
Benjamin- In today’s “Bad VA Art” it looks much more like the perfume counter staff at Macy’s showing a new perfume or powder rather than any VA Pharmacy…plus, the pharmacist is looking to be out of her cage and even acting like she has the casual time to do so when ANYONE that has used the VA knows that a VA Pharmacy is always as busy if not more so busy than a fast food restaurant at lunch hour…it’s literally… Read more »
Bill

Something I went to the United States Court of Appeals for Veterans Claims for, thanks to a Washington D.C. Law firm, but lost in a 2 to 1 decision, is finally sinking in. My VA charges for a 3 prescription 90 day supply is $84, Taking my VA prescription to my local drug store the cost for my 3 prescription-90 day supplies is $30. All dependent upon the medication needed.

Someday they may get it just right.

hurdey
You don’t need no stinkin’ drugs! They just kill your liver and kidneys. Drugs make you do more drugs due to side effects in an over 5:1 ratio. At least 15% of the population is chemical sensitive, mostly due to Cherokee Indian blood in the SE USA esp. (and SW USA too.) Some may need them, but I say stuff those gd drugs where the Sun don’t shine. ymmv I was given flouxetine, and I had internal GI bleeding, I… Read more »
Diana Smith Hill
Veterans should not pay ANYTHING for care! Chances are they are sick because of their service! I think it’s an atrocity to charge a veteran who put their lives in harms way any price since they gave themselves for the price of freedom! Also it’s atrocious that burial’s are not fully funded in any plot anywhere! $200 Burial allowance. the lies people are fed about benefits! The price of freedom is high and we pay it, the government and the… Read more »
namnibor
@Diana Smith Hill- You are spot-on. I have taken care of one of two Veteran best friends’ funeral/remains in last 5 years and I also found them lifeless doing wellness check after not hearing from them and using my keen intuition, and was alarmed that the VA is pretty much like Social Security in that it’s a few hundred dollars and when the VA says they will provide a “marker”, make no mistake that should mean anything remotely resembling a… Read more »
Gerald Springer

I take three different meds for service related disability, I also take three different meds for non service medical problems. The non service related meds cost me $24.00 each for a 90 day supply. I can get all three of those meds 90 day supply from local drugstores like Walmart or Fred Meyer etc for a little over $27.00 for all three of them instead of $24.00 each. Does that sound like the VA is ripping us off?

Gerald Springer

I should have added I know that is not very much money but when you live on social security and a 20% service related disability that extra $50-60 saved a month is a lot.

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