Copay Amount For VA Prescriptions Changing

Holding a medicine bottle.

The VA is changing and simplifying the drug copay process effective February 27, 2016.

The only time a veteran is required to make a copay for medications prescribed by the VA is if the medicine is for a non-service connected issue. For example, if you have a service connected disability for a back injury but go the VA and are prescribed cholesterol medication, you will probably have to pay the VA a small payment called a "copay" when you get your medicine.

Veterans receiving medications for service-connected conditions will see no changes, they still will have no charge for their medications. Low-income veterans who are receiving medications for non-service connected conditions will also see no changes, based on their income a medication copay will probably not be charged.

Currently veterans receiving medications for non-service connected conditions must pay a monthly copay of either $8 or $9 for prescriptions, depending on which priority group they are in. There is currently an annual copay limit of $960 for medications. See our VA Health Care Eligibility page for an explanation of VA Priority Groups.

The new regulation simplifies the copay program, bringing it more in line with civilian insurance and TRICARE. The new copays are as follows:

Medication Tier Copay Amount
  1 - 30 day supply 31 - 60 day supply 61 - 90 day supply
Tier 1 (Preferred Generic) $5 $10 $15
Tier 2 (Non-Preferred Generic & Some Over-the-Counter Drugs) $8 $16 $24
Tier 3 (Brand Name) $11 $22 $33

Generic drugs, which are the most commonly prescribed, will have the lowest copay amount. The annual copay limit a veteran must pay will decrease to $700 from the current $960. Veterans who pay more than the annual copay limit will continue to receive their medications but will not have to pay anything for them.

With this adjustment of copay amounts, the VA is removing the Priority Group difference that existed in the past. However, veterans in Priority Group 1 will still have no copay for any VA dispensed medications. Priority Group 1 includes veterans with a disability rating of 50% or more, or who are considered unemployable due to service-connected disability.

If your income is below certain limits the VA will not charge you any copay for your medications. The income limits are very complicated, they differ by location and by the size of your household. See the VA's website for more information. If you have private insurance, the VA will bill your insurance company for the cost of drugs prescribed to treat non-service connected conditions. If you cannot pay, the VA will not withhold your medications, you can work out a payment plan or apply for a waiver.

 

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