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2.4 Million Veterans Will Pay New Fee
February 26, 2005

Republican majorities on the House and Senate veterans' affairs committees have voted to impose an enrollment fee of at least $230 a year on 2.4 million veterans - one of every three now eligible for Veterans Affairs Administration health care.

Those targeted are in priority categories 7 and 8, meaning they are neither poor nor suffering from service-connected disabilities. Half of the 2.4 million used the VA health system last year.

The Bush administration proposed the enrollment fee to hold down costs. The VA committees rejected another Bush proposal to raise co-payments on VA-filled prescriptions for these same priority 7 and 8 veterans.

While both committees endorsed enrollment fees, differences emerged. The Senate panel, chaired by Sen. Larry Craig, R-Idaho, embraced the Bush plan for a straight $250 annual fee.

The House committee, chaired by Rep. Steve Buyer, R-Ind., voted to set the fee for priority 7 enrollees at $230, matching the enrollment fee of under-65 military retirees using Tricare Prime, the military managed care program. For priority 8 veterans, Buyer proposes a sliding scale fee of $230 to $500, depending upon veteran income.

Both Craig and Buyer, in separate letters to their budget committees, said difficult choices have to be made this year, given a tight VA budget and the number of new veterans returning from war with severe injuries. Against that backdrop, they defended enrollment fees against the stiff criticism expected from veterans' service organizations.

Pharmacists needed

The Air Force and Navy likely will have to hire a few hundred more pharmacists over the next 18 months to meet tougher standards being imposed on use of pharmacy technicians.

Even the Army, which for years has kept a higher ratio of pharmacists to pharmacy technicians than the other medical services, could be required to boost its number of pharmacists by an August 2006 deadline.

The Joint Commission on Accreditation of Healthcare Organizations formally notified the military surgeons general this month of a change in standards for accredited military hospital and clinics to meet regarding handling and dispensing of medications.

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The association no longer will exempt the military from a requirement that a pharmacist review all prescriptions and hospital medication orders before drugs are dispensed.

The exemption recognized that military pharmacy techs receive more comprehensive training than private sector counterparts, said Joseph Cappiello, the commission's vice president for field operations. But standards on patient safety have evolved to where allowing technicians alone to fill prescriptions by having military techs check other techs no longer will be acceptable if hospitals and clinics are to stay accredited.

The change takes effect March 1, but the services have 18 months to hire the extra pharmacists they need or, in some cases, to buy technology for pharmacists to supervise dispensing of drugs at remote sites.

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