VA Central Iowa Health Care System
Pharmacy Copay changes Reducing Out-of-Pocket Cost
Effective February 27, 2017, the Department of Veterans Affairs will amend its regulations concerning copayments for outpatient medications used to treat non-service connected conditions. This change aligns with VA’s goals to reduce out-of-pocket costs, encourage greater adherence to prescribed outpatient medications and reduce the risk of fragmented care that results when Veterans use multiple pharmacies fill prescription.
Under the current regulations, medication copay amounts are based on priority groups and established using a formula based on the medication components of the Medical Consumer Price Index formula. VA estimates that copayment amounts would increase three times over the next six years if the current regulations are left unchanged. The revised rulemaking will eliminate future rate increases and the current formula used to calculate medication copays. In addition, Veterans will see a decrease in the current copayment cap of $960 to $700 per year.
Effective February 27th, 2017 the copayment regulations and associated cost for Veterans filling outpatient medications prescribed to treat non-service connected conditions will change, establishing three classes of outpatient medications tiers. Each tier will have a fixed copayment amounts and will only vary depending upon the class of outpatient medication in the tier.
Tier 1- Preferred Generics will cost $5 for a 30-day or less supply.
Tier 2 Non-Preferred Generics will cost $8 for a 30-day or less supply.
Tier 3- Brand Name -$11 for a 30-day or less supply.