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Infographic-Accessing Community Care for Veterans Enrolled in VA Health Care on For Veterans > Overview

Accessing Community Care for Veterans Enrolled in VA Health Care

Step 1: Go to VA. Schedule an appointment with a VA provider (doctor). Your VA care team will work with you to see if you are eligible for community care. Eligibility is based on your medical needs, care that is available at VA, and other requirements. Important: Make sure VA confirms you are eligible and authorized before going to the next step.

Step 2: Make an Appointment. VA will work with you to find a community provider and make an appointment. You can select a community provider or VA can select one for you. Important: The community provider selected must be in VA's network and be willing to accept payment from VA.

Step 3: Receive Care. Arrive promptly for your appointment. Important: If you need to schedule a follow-up appointment, check with your community provider to make sure VA authorized the care. If VA did not authorize the care, your community provider should contact VA to arrange the care you need. If you have a question about your specific care needs, contact your VA medical facility.

Image includes VA seal.

You can also visit the Community Care Veterans Overview for more information.


Press Release PDF on VHA OCC News—January 2017

New Regulation Decreases Cost of Outpatient Medication Copay for Most Veterans

Washington – 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.

“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.

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.

More information on the new tiered medication copayment can be found at Federal Register/Vol. 81, No. 238.