facts you should know: medication copay you should know. medication copay. ... cial hardship for...
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Medication CoPay Brochure_FINAL3.indd 1 5/13/2010 2:05:19 PM
Facts You Should Know
Medication Copay
For more information about medication copays, call 1-877-222-VETS (8387) or visit our website: www.va.gov/healtheligibility.
IB 10-336, P96391 05/2010
Revision for Web made on 07/2010
Pleasedonotsendinrequestsforprescriptionrefillswithyourpayment.Ifyoudo,yourpre-scriptionrefillwillbedelayed.
Where the Money GoesFundscollectedfrommedicationcopays,otherVAcopaysandhealthinsurancereimbursementsarereturnedtothelocalVAhealthcarefacilityandusedtoprovideadditionalhealthcareservicestoVeteransatthatfacility.
Commonly Asked QuestionsQ. If I am required to make a copay and can’t,
will VA withhold my treatment or medications?A. No.VAwillnotwithholdtreatmentormedi-
cation.Anaccountisautomaticallyestablishedwhenyouarerequiredtomakeacopay.However,ifyouarehavingfinancialdiffi-cultiesandareunabletopayassessedcopaycharges,youmayapplyforahardship,waiver,compromiseorrepaymentplan.
Q. Will the amount of the medication copay and the annual cap ever change?
A. Theamountofthemedicationcopayandthecapmaybechangedonanannualbasis.YourVAmedicalhealthcarefacilitywillinformtheVeteranofanymedicationcopayand/orannualcapchange.
Q. Will my insurance company be charged for medication for my service-connected condition?
A. No,VAisnotauthorizedtobillyourinsur-ancecompanyformedicationrelatedtotreat-mentofyourservice-connectedconditions.
Q. Who decides if a medication is for treatment of a non-service-connected condition?
A. AVAhealthcareprovidermakesthisdetermi-nation.Ifthemedicationprescribedisfortreat-mentofaservice-connectedcondition,nocopayisrequired.
Q. Can I get prescriptions from my private health care provider filled at the VA pharmacy?
A. Toqualifyforpharmacybenefits,youmustbeenrolledinandreceivinghealthcarefromtheVAhealthcaresystem.AVAhealthcareproviderwillreviewanyprescriptionsfromaprivatehealthcareprovidertodetermineiftheycanberewrittenbyaVAhealthcareprovideranddispensedfromaVApharmacy.
Q. Will I be charged for over-the-counter medications?
A. Medicationcopaysarechargedforallover-the-countermedications,suchasaspirin,coughsyrup,andvitaminsthataredispensedfromaVApharmacy.Youmightwanttoconsiderpurchas-ingover-the-countermedicationsonyourown.Youarenotchargedamedicationcopayformed-icalsupplies(syringes,alcoholwipes,etc.)orformedicationsadministeredduringtreatment.
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Fac ts You Should Know About Medica t ion CopayMedication CopaysTheDepartmentofVeteransAffairs(VA)chargesacopayforeach30-dayorlesssupplyofmedicationprovidedonanoutpatientbasisforthetreatmentofanon-service-connectedcondition.Forthecurrentcalendaryear,thecopayamountsare:
Priority Groups
Copay Amount
1–30 day supply
31–60-day supply
61–90-day supply
2 through 6 $8 $16 $24
7 and 8 $9 $18 $27
Why VA Requires a Medication CopayBylaw(PL101-508andPL106-117),VAmustchargeVeteransacopayfortheiroutpatientmedications.TheVeteransMillenniumHealthCareandBenefitsAct(PL106-117)authorizedVAtoincreasethecopayamountandtoestablishanannualcap(maximumyearlyamount)ontheamountofcopayschargedformedication.
Annual Cap on Medication CopaysAnannualcapwasestablishedtoeliminatefinan-cialhardshipforVeteransenrolledinPriorityGroups2through6,whomightrequireanunusu-allylargeamountofmedications.Thecurrentannualcapthatcanbechargedis$960.Veteranswhoexceedtheannualcapwillcontinuetoreceivemedicationswithouthavingtomakefurthercopays.AnannualcapwasnotestablishedforVeteransenrolledinPriorityGroups7or8.
The medication copay applies to you if:1.YouareaVeteranreceivingoutpatienttreat-mentforanon-service-connectedcondition,andyourannualincomeexceedsacertainthreshold.Thisthresholdchangesonanannualbasis.Forthecurrentamount,contacttheEnrollmentCoordinatoratyournearestVAhealthcarefacility.
2.YouareaVeteranwithaservice-connectedcondi-tionratedlessthan50percentdisabled,butarereceivingoutpatienttreatmentforanon-service-connectedcondition,andyourannualincomeexceedsthespecifiedthreshold.
Exemptions From Medication Copay1.Veteransrated50percentormoredisabledwithaservice-connectedcondition.
2.Medicationsdispensedforservice-connectedconditions.
3.VeteranswhoareformerPOWs.
4.Medicationforradiation-exposedandcombatVeterans,asauthorizedunder38U.S.C.1710(e).
5.Medicationfortreatmentofmilitarysexualtrauma,asauthorizedunder38U.S.C.1720D.
6.Medicationfortreatmentofcanceroftheheadorneck,asauthorizedunder38U.S.C.1720E.
7.MedicationsprovidedaspartofaVA-approvedresearchproject,asauthorizedby38U.S.C.7303.
8.Veteranswithalowincome(annualincomelowerthantheapplicableVApension).
Applying for Low Income ExemptionVeteranswhohaveaservice-connectionratingof40%orlessandwhoseincomeisatorbelowthe
applicableNationalIncomeThreshold(whichcanbefoundat www.va.gov/healtheligibility)mightwishtocompleteamedicationcopayexemptiontest.
Payment OptionsPaymentisencouraged,butnotrequired,whenyoupickupyourmedicationsatyourVAhealthcarefacility.Ifyouareunabletopayatthattime,anaccountwillbeestablishedforyou,andyouwillbebilledmonthly.Prescriptionsdispensedafterhours,onweekendsandholidays,inemergencysituationsandthroughtheConsolidatedMailOutPharmacy,willbebilledtoyouraccount.
Toavoidinterestandadministrativecharges,makepaymentsbeforeyournextmonthlybillingstate-ment.Weencourageyoutopaybycheck,moneyorderorcreditcard.Youshouldnotsendcashthroughthemail.Thenationalpaymentaddressisprintedonthemonthlybillingstatement.IfyouwouldliketopayyourVApatientcopaybalanceelectronically,youmaylogintowww.pay.gov andfind“DepartmentofVeteransAffairs”ontheagencylist.Thisserviceisavailabletoyouatnocost.
Billing Questions:Ifyoureceiveabillthatyoubelievetobeinerror,pleasecontactthetoll-freenumberlistedonyourbillingstatement.
Reimbursementsreceivedfrominsurancecarrierswillbeusedtooffsetoreliminateyourcopayonadollar-for-dollarbasis.TheunpaidVAcopayremainsyourresponsibility.VAdoesnotbillHighDeductibleHealthPlans(whichareusuallylinkedtoaHealthSavingsAccount).HealthSavingsAccountscannotbeutilizedtomakeVAcopays.