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.

Medication CoPay Brochure_FINAL3.indd 2 5/13/2010 2:05:19 PM

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.