VA Proposes New Guidelines To Lower Rx Copays for Veterans

On Monday, the Department of Veterans Affairs unveiled proposed guidelines to lower copayments for veterans purchasing prescription drugs, Modern Healthcare reports.

VA currently charges veterans an $8 or $9 copay for a 30-day supply of a drug. The copay can increase based on the Consumer Price Index. However, VA has frozen copays annually since 2009.

Proposed Guideline Details

Under its proposal, VA would replace its existing copay procedure with a three-tier system that requires varying copays based on the type of drug. According to the proposal:

• Tier one would include generic prescription drugs, with a $5 copay;
• Tier two would include other generic medications, with a copay of $8; and
• Tier three would include brand-name drugs, with a copay of $11.

Copays would not increase annually and could only be changed if additional rules are implemented.

In addition, the proposed guidelines would lower VA's annual copay cap from $960 to $700. The current cap increases with copays.

The proposed changes, if finalized, would take effect in January 2017.

VA: Changes Would Reduce Costs for Most Veterans

VA projects that about half of all prescription drugs that currently require a copay would fall under tier one of the proposed system. Further, VA estimates that about 80% of eligible veterans would save between $1 and $5 per monthly supply of a drug under the proposed system, while 6% would see cost increases.

In addition, VA said its proposed changes to its annual copay limit could increase the percentage of veterans who save money under the cap from less than 3% to about 9%.

According to Modern Healthcare, the proposal has been deemed economically significant and therefore will be reviewed by the Office of Management and Budget to determine its potential cost effects (Muchmore, Modern Healthcare, 1/4).