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2018 Constituent Service Democracy Award Finalist

Congressman Hank Johnson

Representing the 4th District of Georgia

Veterans

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 here.

 

To everyone reading this page, please know that it is an honor to serve you – you have served us so well – and now it’s our time to serve you. There’s not much in Congress we do that’s more important than serving our veterans.

As a member of the House Armed Services Committee since 2007, every day I’m inspired to work on behalf of all our military personnel and veterans.
 
Ensuring that quality services are being delivered to each of you is one of my greatest missions as a public servant. I am happy to assist veterans with obtaining their military records and medals, with questions they have concerning eligibility for benefits provided by the U.S. Department of Veterans Affairs (VA), or who may be experiencing difficulties with the VA Health Care System or the VA claims and appeals process.

I thank each of you for your service and can assure you that as long as I am in The Congress, your needs will remain a priority for me and my staff.

A Privacy Act Release form will need to be completed and sent with a detailed explanation of your request for assistance to one of my district offices.

Thank you, Rep. Hank Johnson.

Claims & Appeals

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What are Compensation anbenefits.va.gov/benefits/d Pension Benefits?

How do I file a claim for VA disability compensation?

How long will it take to receive a decision on my compensation claim?

How does A Beneficiary File A Death Claim?

Can I have my claim reconsidered even though denied in the past?

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Can VA provide Small Business Loans?

How can I apply for a medal, award, or decoration that I earned while in the service?

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What is the period of eligibility for the Post-9/11 GI Bill?

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VetJobs: America's Premier Job Board for Veterans

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What is a VA Guaranteed Home Loan?

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