Va Copays For Medications

Posted : admin On 1/2/2022
VA » Health Care » Wilmington VA Medical Center » Features » Medication Copays Changing

Medication – Prescription copayment charges were established by Congress. The charge ranges from $5 to $11 for each 30 day or less supply of medications provided on an outpatient basis for. Medication copayments are charged for all over-the-counter medications, such as aspirin, cough syrup, and vitamins that are dispensed from a VA pharmacy.

  • VA Medications List. Print - Click this link to display a Printer Friendly page. Refill a Prescription - Click this link to display the My HealtheVet Rx Refill page titled: Refill Prescriptions. NOTE - The columns for Medication, Category, Status, Start Date, Stop Date, and Pharmacy, can be sorted in ascending or descending order. To sort a column, click on a triangle (or ).
  • Medication copayments are also charged for all over-the-counter (OTC) medications (like aspirin, cough syrup, and vitamins) that are dispensed from a VA pharmacy. You may want to consider purchasing over-the-counter medications on your own. NOTE: There is an annual medication copayment cap of $700 for Veterans in Priority Groups 2 through 8.
  • Over-the-counter medications (like aspirin, cough syrup, or vitamins) that you get from a VA pharmacy. You may want to consider buying your over-the-counter medications on your own. Note: The cost for any medications you receive while staying in a VA or other approved hospital or health facility are covered by your inpatient care copay.
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Medication Copays Changing

Prescription copays have been restructured and will lower the costs of outpatient medications for most Veterans.

The Department of Veterans Affairs (VA) is amending its regulation on copayments for Veterans' outpatient medications for non-service connected conditions. VA currently charges non-exempt Veterans either $8 or $9 for each 30-day or less supply of outpatient medication, and under current regulations, a calculation based on the medication of the Medical Consumer Price Index (CPI-P) would be used to determine the copayment amount in future years.

Pay my va prescription bill
'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.'

This new regulation eliminates the formula used to calculate future rate increases and establishes three classes of outpatient medications identified as Tier 1, Preferred Generics; Tier 2, Non-Preferred Generics including over-the-counter medications; and Tier 3, Brand Name. Copayment amounts for each tier would be fixed and vary depending upon the class of outpatient medication in the tier.

Copays

These copayment amounts will be effective February 27, 2017:

  • $5 for a 30-day or less supply - Tier 1 outpatient medication
  • $8 for a 30-day or less supply - Tier 2 outpatient medication
  • $11 for a 30-day or less supply - Tier 3 outpatient medication

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.
Frequently Asked Questions

How can I transfer my prescriptions prescribed in the community to the VA System?

VA will fill prescriptions prescribed by a non-VA provider only if all the following criteria are met:
  • You are enrolled in VA health benefits
  • You have an assigned Primary Care Provider
  • You have provided your VA health care provider with your medical records from your non-VA provider
  • Your VA health care provider agrees with the medication prescribed by your non-VA provider. VA health care providers are under no obligation to prescribe a medication recommended by a non-VA provider.
Patients are encouraged to bring a current list of medications, dose, and frequency for every visit.

Va Copays For Medications

How do I pay for my prescriptions?

You may provide payment via the following methods:
  • Online: https://pay.gov
  • By mail: P.O. Box 530269 Atlanta, GA 30353-0263
  • In person: A VA Medical Center
  • Pay by check, money order, or credit card payable to 'VA.' Include Account Number. Please do not send in requests for prescription refills with your payment. If you do, your prescription refill will be delayed.
Will I be charged for over-the-counter medications?
Medication copayments are charged for all over-the-counter medications, such as aspirin, cough syrup, and vitamins that are dispensed from a VA pharmacy. You are not charged a medication copayment for medical supplies (syringes, alcohol wipes, etc.) or for medications administered during treatment.
How do I know if my medication is on the VA Formulary?

What Is The Copay For Va Prescriptions

Please visit the Pharmacy Internet Formulary at http://www.pbm.va.gov/apps/VANationalFormulary/ to learn more.
How do I change my medication(s) to a lower tier?

A VA health care provider must make this determination. They will review any prescriptions and determine if the type of medication being taken can change to a lower tiered medication.
How do I refill my prescription?
Prescriptions can be refilled online, by mail, or by phone. Please visit http://www.va.gov/healthbenefits/access/prescriptions.asp for more information.
Note: Please do not send in requests for prescription refills with your payment. If you do, your prescription refill will be delayed.
Where does the money go?
Funds collected from medication copayments, other VA copayments, and health insurance reimbursements are used to provide additional health care services to Veterans.


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