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Outpatient Medication Copay Decreases for Most Veterans Thanks to New Regulation

Posted on December 19, 2016 by Disability Help Group

The Department of Veterans Affairs (VA) offers several types of health care services to veterans, even if their military service did not cause their ailments. Currently, if a veteran is seeking medication for a non-service connected condition, the VA expects to receive an outpatient medication copay.

However, the VA is modifying the regulation that sets the costs of this copay to reduce the monthly costs of these necessary medications. Currently, under VA healthcare, outpatient medications cost between $8 and $9 for a 30-day medication supply. The VA bases this calculation on the Medication Consumer Price Index, which means that the cost to veterans could increase if that index rises in the future.

The new amendment switches the pricing system to a set value, rather than relying on a formula to calculate prices. The new system classifies medications under a tiered system:

  • Tier 1 (preferred generics): $5 for a 30-day or less supply.
  • Tier 2 (non-preferred generics): $8 for a 30-day or less supply.
  • Tier 3 (brand name medications: $11 for a 30-day or less supply.

The new system classifies over-the-counter medications as Tier 2.

The medication copay changes will affect veterans seeking care for conditions that do not relate to their military service, veterans with disability ratings under 50 percent who are seeking care for non-service-connected conditions, and veterans whose yearly income is higher than the set limit. These copay changes will not affect former Prisoners of War, veterans deemed catastrophically disabled, or veterans covered by other exceptions.

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