Co-pay guideline change proposed for 2017

First Posted: 2:48 pm - February 15th, 2016

Thomas Crisp - Contributing Columnist

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The U.S. Veterans Affairs Department announced new proposed guidelines meant to lower the copay for veterans buying prescription drugs.

The VA estimates about 80 percent of eligible veterans would save between $1 and $5 per month’s supply of a prescription under the new guidelines and 6 percent would see an increase.

The proposed rule comes at a time of intense discussion concerning prescription drug prices. Polls have shown rising costs as a chief concern for Americans and 2016 presidential candidates have stumped on the issue. The proposed guidelines would eliminate the current procedure, which charges $8 or $9 for a 30-day supply of a drug.

That price increases based on the Medical Consumer Price Index, although the VA has frozen co-pays every year since 2009. It would be replaced with a system involving three tiers. Generic medications would fall under tier one, with a co-pay of $5, and tier two, with a co-pay of $8.

Third tier medications would include brand name drugs still under patent protection and would have a co-pay of $11.

The VA predicts that at least half of all medications requiring a copay would fall in the first tier. The prices would not increase automatically and could be changed only by further rulemaking. The new guidelines, which would go into effect in January 2017, would also create an annual co-payment cap of $700.

The current cap is $960 and increases along with the co-payments. The VA estimates the new limit will increase the number of veterans saving money with the cap from less than 3 percent to about 9 percent. It says the co-payment amounts would increase three times over six years if the current regulations are left unchanged.

Roscoe Butler, deputy director for veterans’ affairs at the American Legion, said he hadn’t seen enough data yet to judge how the change might affect veterans. He said he didn’t know of any outreach to advocacy groups on how to change the guidelines.

“It doesn’t give us enough information to say whether this will help or not,” he said.

The issue should be discussed at the next meeting with veteran service organizations, he said. The proposed copay rule has been declared economically significant and therefore will be reviewed by the Office of Management and Budget to determine cost savings or increase for the VA. (Source: Modern Healthcare | Shannon Muchmore | January 4, 2016)

Thomas Crisp

Contributing Columnist

Thomas Crisp is a retired military officer from Whitmire.


Thomas Crisp is a retired military officer from Whitmire.


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