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Lower medication copays now in effect for Veterans


February 28, 2017

Pittsburgh , PA — Veterans using VA Pittsburgh Healthcare System’s outpatient pharmacy who have copays for their medication will most likely see a reduction in monthly and annual costs.

Under an amended federal regulation effective Feb. 27, VA prescription copays were restructured into three tiers ranging from $5 to $11 for a 30-day supply. Previously, Veterans with copays paid either $8 or $9 for a monthly supply of medication. The regulation also caps Veterans’ annual medication copays at $700.

"The new copays help decrease 'price-shopping' by making VA medicine costs more in line with our private sector counterparts," said Lucy Speerhas, VA Pittsburgh's pharmacy chief. "We would rather Veterans get all of their medications from us, as a matter of both medication safety and as a convenience for them."

The new rates are:

Tier 1 - Preferred Generics: $5 for a 30-day or less supply 

Tier 2 - Non-Preferred Generics including over-the-counter medications: $8 for a 30-day or less supply

Tier 3 - Brand Name: $11 for a 30-day or less supply

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.

"Switching to a tiered system continues to keep outpatient medication costs low for Veterans," said VA Secretary 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."

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Sheila Tunney, Public Affairs Specialist


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