VA medication copayments frozen through 2016

VA medication copayments frozen through 2016

With a final rule effective September 15, 2015, VA medication copayments will be frozen through 2016.

VA medication copaymentsThe freeze on pharmacy copayments will be in effect all of calendar year 2016. Meanwhile, proposed and final rules will be developed and published in the Federal Register for the implementation of a tiered copayment structure for medication copayments. The VA believes a tiered structure will “further align VA’s medication copayment structure with other Federal agencies and the commercial sector.”

It is common knowledge with veterans and civilians alike that increased medication copayments decrease the use of a pharmacy benefit. Prices go up, fewer prescriptions filled. The unintended consequences can be very serious:

  • Significant financial hardship
  • Medical treatment plans not followed (provider wrote prescription(s) as part of a treatment plan, but it goes unfilled)
  • Medications not taken as prescribed (“getting by” on a half dose of medication, or filling only the less expensive medication)
  • Negative health effects (treatment or condition worsens or there is a cascade effect of other health conditions)

For the remainder of 2015 and for all of calendar year 2016, the copayment amounts will remain:

  • $8 for veterans in priority categories 2 through 6 of VA’s health care system
  • $9 for veterans in priority categories 7 and 8 of VA’s health care system

The calendar year medication copayment cap of $960 will remain in effect through December 31, 2016 for Veterans enrolled in the VA health system priority category 2 through 6.

Definitions of the VA health care system priority categories can be found here. VA medication copayments are in the Code of Federal Regulations at 38 CFR 17.110.