For Vets Using VA Medical Care – Something to Consider

This article is directed at any veterans out there who (1) are using the VA for medical care, (2) are rated at <50% disability, and (3) have a reasonable level of income.  It’s particularly applicable for those who also have Tricare eligibility.

Be careful concerning prescriptions from the VA and where you opt to get them filled.  Letting the VA fill all your prescriptions may not be in your best economic interests.

The VA divides individuals entitled to VA medical care into several priority groups.  These priority groups are, roughly, determined by the individual’s VA disability rating.  Copayment requirements vary with the priority group for which the veteran qualifies.

For many priority groups, a prescription copayment of $8.00 month for each prescription filled by the VA is required.  This co-payment is waived for (1) prescriptions related to the treatment of service connected conditions, and (2) for those with a VA disability rating of >50% or who are determined by the VA to be “catastrophically disabled” or in receipt for payment from the VA due to a demonstrated need for of continual aid and attendance.

However, for veterans with VA disability ratings of <50% the VA prescription copayment is in general NOT waived for treatment of non-service-connected conditions. The copayment is, however, dramatically reduced for veterans with household incomes below VA-determined income thresholds.  (That’s why the VA now asks for a sh!tload of financial info when you apply for eligibility for VA medical care.)

Bottom line:  for individuals with a disability rating of 40% or less, a copayment is often required for prescriptions filled by the VA relating to treatment of non-service-connected conditions.  If you have a reasonable income, those co-payments can add up.

I recently learned of a case where a service-connected veteran with a disability of less than 50% ended up paying much more in copayments for prescriptions filled by the VA than they would have elsewhere.  The specific situation occurred when the individual was treated by the VA for two different non-service-connected conditions.  That individual was given three prescriptions – one for a generic drug for the treatment of gastric reflux, and two for over-the-counter medications.  All of these prescriptions were filled at the VA pharmacy at the VAMC where treatment was provided.

The individual is also entitled to Tricare coverage, and thus is also entitled to Tricare pharmacy services.  The VA co-payment for the generic drug prescription was considerably higher (literally almost 2 1/2 times higher) than the individual would have paid at Wal-Mart to have the same prescription filled.  The individual could also have obtained the same generic drug free by having the prescription filled at a military pharmacy and picking them up in-person.

This same individual was also assessed copayments for the two over-the-counter items provided by the VA pharmacy.  The VA copayment for at least one of these items was literally higher than the commercial cost of purchase for the same or equivalent over-the-counter item.  (I haven’t yet determined if the copayment for the second was above or below the cost of the same/equivalent item purchased commercially.)

When the veteran attempted to have the prescription for the generic gastric reflux drug transferred to another pharmacy, they were told by the VA:  “We don’t do that.”  The individual was required to contact their primary VA care facility and request a new hardcopy of the prescription be mailed to them.  They’re still waiting for the hardcopy.  Luckily, they have a considerable supply of the medication on-hand.

I have personal knowledge of the above situation, and no – there’s no mistake above.  Exactly what I describe above happened.

Moral of the story:  if you’re getting your medical from the VA but have a lower disability rating (e.g., <50%) and have a reasonable level of income, you might want to ask around at a couple of local pharmacies before you opt to have the VA fill prescriptions relating to care for any non-service-connected conditions.  Getting a hardcopy prescription for any generic drug prescribed and having it filled elsewhere might end up being considerably cheaper than getting the same items through the VA’s pharmacy.  That’s particularly true if you’re entitled to coverage under Tricare and live close enough to a military base to make having prescriptions filled there feasible, or if the item prescribed is an over-the-counter item.

Yes, it’s convenient to just let the VA pharmacy fill prescriptions if you use the VA as your primary health care provider.  But if you’re also entitled to Tricare or have prescriptions for several common generic drugs and aren’t rated at 50% or higher, that decision could end up costing you literally $100s per year.

Category: Veteran Health Care