The VA says that pharmacy co-pays will remain at the current levels until at least 2017.
In a rule recently published in the Federal Register, VA has said it will hold the co-pays at their current level until at least December 2016. The current co-pay rates have been in effect since 2014.
The co-pay rates for a 30 day supply of prescription medications will remain at $8 for veterans in priority groups 2-6 and $9 for veterans in priority groups 7-8. Veterans in priority group 1, which includes those who have 50% or greater disability are not required to pay a co-pay.
Medications for service-connected conditions remain free of charge. Veterans receiving prescriptions for conditions that are not service-connected have to pay a co-pay to the VA based on their priority group, which is determined by several factors including income and service combat status. They can choose to pay the co-pay themselves or submit the claim to a private insurer.
Some Veterans qualify for free healthcare and/or prescriptions based on special eligibility factors including but not limited to:
- Former Prisoner of War status
- 50% or more compensable VA service-connected disabilities (0-40% compensable service- connected may take copay test to determine prescription copay status)
- Veterans deemed catastrophically disabled by a VA provider
Many Veterans qualify for free healthcare services based on a VA compensable service-connected condition or other special eligibilities, however some veterans are required to complete a financial assessment or means test at the time of enrollment to determine if they qualify for free health care services. Veterans whose income exceeds VA income limits as well as those who choose not to complete the financial assessment at the time of enrollment, must agree to pay required co-pays for health care services to become eligible for VA healthcare services.