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
One thing to also consider is this: there are 4 pharmacies within 8 miles of my house. 2 of them, CVS & Walgreens, refuse to accept VA prescriptions. The reasons why were not forthcoming, but basically a “because, shut up. That’s why!” sort of response. WalMart and a local private pharmacy are both willing to fill them provided that the hard copy of the prescription has the Doctor’s entire info on it.
Anyway, there’s also this to consider: Filling those prescriptions you listed might still be as expensive as using the VA if you factor in the cost of gas, any tolls, etc for you to travel to get them. It’s worth considering those ancillary expenses, as well as the expense of your time traveling elsewhere to save a couple bucks when you could get ALL your prescriptions filled at one location, or mailed to you at your home (that’s what I do).
I don’t think that there is any one right solution. Each veteran using the system needs to take a long look at everything and decide for themselves which method would work the best for them.
Thanks for posting this, Hondo. Good advice to consider.
When I had my service-related bum knee replaced at VA they charged me for all the meds at first; took almost two months to get them appealed and repaid.
AW1 Tim: certainly, each individual’s situation is different. Intent was just to point out the possible pitfall. The VA certainly doesn’t emphasize this when someone goes to them for care.
For most generics, Wal-Mart is a much better option financially. WalMart copayments for 30 and 90 day prescriptions for many generics are $4 and $10. The VA copayments for the same are $8 and $24, respectively. And if you live near a DoD installation, you can get many if not most prescriptions for generic drugs filled at no cost if you pick them up vice having them mailed to you.
In short: YMMV. But you should check it to see what you’re getting.
I’m 40%. I receieved a script for those 8mg asprins, that I didn’t want or need, from my provider. A three month supply just showed up one day, with a $24 dollar bill. I could have got a thousand at Costco for less than that. However, (so far) I have had no issues with getting a hard script for other non-service connected pills, from the provider and getting them filled at Safeway, Riteaid or the military pharmacy. With Tri-Care I think Safeway and Riteaid was $5 co-pay, military free (but usually a hell of a wait for military pharmacy so paying $5 is kinda worth it for me).
I am 90 percent SC and the pharmacy at VAMC Richmond has refused to fill Scripts written by outside docs….
While I was at the VA last week the Dr advised me that they would charge me $8 a piece for Sudafed and Benadryl and I was better off to get it myself in the grocery store. But still asked if I wanted it filled at the VA.
bigjohn: best solution would be to take a copy of the outside prescription to the VA and have one of their docs write you a prescription for same (or a generic equivalent if one exists). IMO that’s the least-hassle option for your case.
As you noted, the VA won’t accept just any prescription that someone hands them. However, the VA indicates that there is a procedure by which they will accept some (but not all) outside prescriptions. Suggest you take a look at this and see if you’ve done what they require:
http://www.va.gov/healthbenefits/access/prescriptions.asp
If you’ve already done what’s listed as required for the VA to fill an outside prescription, I’d suggest you find the Patient Advocate at the Richmond VAMC, take them the info showing what you’ve done, and ask them to assist. If not, I’d suggest you get and take the required items to your primary care provider pronto in order to get that prescription into the VA’s system.
Be advised that if the VA disagrees with your other doctor on what medication is required, they won’t accept the prescription. Might be a good idea to have the other doctor give you a written, signed list of alternate meds that he/she considers acceptable just in case (if there are any).
No surprise here.
And my favorite is when the VA, Tricare and other insurance companies all point to one another claiming they are the primary carrier and we are the secondary.
While the patient gets behind on bills.
What a fucking mess.
Could someone answer a question? How does a 60% disabled vet NOT know that he could be insured by Tricare? Friend of mine, an E-9 retired said he paid out the nose for insurance in a new job and then saved money with Tricare that he knew nothing about? How.does.that.happen.?
Green Thumb: unless the commercial policy is a Tricare or CHAMPVA supplement (if those even exist) – the commercial company is primary.
http://www.humana-military.com/library/pdf/coordinating-with-medicare-ohi.pdf
http://www.mytricare.com/internet/tric/tri/tricare.nsf/PGS/SystmPgs_OthrHlthInsrncFQs_2
I think this is per Federal law, but I’m not positive and haven’t been able to run that one to ground (e.g., find the specific citation for that in the US Code) yet.
However, I haven’t ever been able to get a straight answer regarding how the VA and Tricare coordinate payments.
I don’t think they do; I think the VA leaves it to the the patient to file with Tricare for reimbursement (if any is due) after they pay the outstanding amount. But I haven’t been able to find out for certain what the law or Federal regulations say on the matter.
DefendUSA: Tricare coverage is completely unrelated to VA disability and/or VA medical entitlement. A person can be rated as 60% disabled by the VA (and thus entitled to medical care from the VA), but may or may not be entited to squat from Tricare.
In the example you give, the individual is a military retiree. Military retirees are entitled to Tricare coverage – period. I simply cannot believe the individual didn’t realize they had Tricare entitlement. It’s far more likely that they elected to get civilian insurance also, and over-insured themselves bigtime.
Having other insurance isn’t necessarily a bad thing. Tricare’s not bad, but it doesn’t cover 100% of everything. The problem is when you overinsure grossly – you end up paying way too much.
Someone who’s discharged from the military without being medically retired but has a VA disability rating is entitled to VA medical care, but has no Tricare entitlement. A person can end up discharged from the military, then be rated as 60% disabled by the VA substantially post-discharge. (VA disability ratings are sometimes boosted many years after discharge if a service-connected condition continues to deteriorate.) That individual would be 60% disabled per the VA, be eligible for VA medical care, but would not be eligible for Tricare.
I’ve had civilian prescriptions filled by the VA several times. I either talk to my nurse or doc, then hand them the script, and they convert it into a VA prescription.
Hondo ………. great info!
I’ll have to remember that when I finish school and get a job. Right now my income is extremely low and I don’t pay for meds. When I first started using the VA for all my medical needs I was told I could not get a prescription to take to another pharmacy. My meds cost me over $800 a year. Good information to remember.
DefendUSA; I am assuming that as he is an e-9 he must be retired. If he did not know about TRICARE at the time of his retirement the command has a piss-poor out-process system. The other reason is the the retiree is asleep at the switch. Ether way I hope all is well now. If he is using TRICARE, regardless of his VA ratings, stay away from VA care. I am retired (27 years)and do not use the VA for anything but hearing aids. I am totally satisfied with TRICARE.
This is why I won’t use the VA… I don’t have any service connected disability, so why burden the system with my needs? Sure, I’m diabetic and have high blood pressure, but I get my maintenance drugs (all generic…) at Bi Mart. I only pay $3.95 for each of my prescriptions (3…), and I get my insulin at Wal Mart for $24.95 a vial. I’m healthy enough not to need the VA, and financially well enough off, so for those of you out there that need the system, you’re welcome to use my share!
Lewis Moore: even if the guy’s outprocessing was p!ss-poor or he slept through it, I still have a hard time believing the “I didn’t know” claim. I simply cannot fathom how it would be possible for someone to retire from the military after 20+ years of service and not know they had Tricare eligibility. After retired pay, it’s the most important bennie a military retiree has.
Hondo, I completely agree w/you. Sometimes people need to take responsibility for their own well-being.