VA Wants to Waive Some Copays for Vets at High Risk for Suicide

Steps & Strides Against Veteran Suicide fall festival and walk South Carolina
The South Carolina National Guard supports the South Carolina Department of Veteran Affairs in their third annual Steps & Strides Against Veteran Suicide fall festival and walk, Sept. 25, 2021, in Columbia, South Carolina. (U.S. Army National Guard photo by Sgt. Tim Andrews)

The Department of Veterans Affairs is planning to drop copayments for outpatient appointments and decrease medication copays for veterans considered at high risk for suicide.

In a notice published in the Federal Register on Wednesday, the VA announced a proposal to modify copayments for medical appointments and medications to encourage veterans to seek medical care and mental health treatment.

According to VA Secretary Denis McDonough, research has shown that frequent medical visits can decrease the risk of suicide. Eliminating copayments for any visit -- not just those for behavioral health -- may encourage vets to seek care, he said in a statement.

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"Through these efforts, VA will continue to address this national public health crisis by further eliminating financial burdens on veterans which may negatively influence their engagement in mental health treatment and their critical medication availability," McDonough said.

Many veterans who receive medical care outside a VA hospital -- at an outpatient clinic or community health provider -- pay a $15 or $50 copayment per medical appointment, depending on whether the visit is considered primary care or specialty care.

The proposal would eliminate the expense for all medical appointments for veterans who have been flagged in the VA's system as being at high risk for suicide.

A physician may determine that a veteran is at high risk if they have an acute mental health issue; are experiencing a number of life events that are associated with increased risk, such as losing a job, housing, a relationship or money; or if they express thoughts of suicide or talk or write about death, dying or suicide.

The VA also is proposing to change the drug copayment structure for high-risk veterans as it considers reducing the number of pills high-risk veterans can receive at one time.

Currently, veterans may pay between $5 and $11, depending on the drug, for prescriptions covering up to 30 days. Under the proposal released Wednesday, however, the VA would allow physicians to restrict the number of pills prescribed to high-risk veterans at any one time -- a seven-day prescription, for example, instead of a 30-day script. To reduce the financial burden of these increased prescriptions on high-risk veterans, the VA plans to change the copayment to $2 per prescription, regardless of medication type.

"The [VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide] includes a strong recommendation to prescribe medication in less than 30-day supplies for veterans at high risk of suicide in order to prevent fatal or medically serious overdoses," the notice states.

VA officials believe that reducing the copayment amount would help patients stick to treatment and remove any "deterrents and barriers" to a veteran accepting the increased number of prescriptions resulting from shorter prescription supply, according to the notice.

The number of veterans who died by suicide declined by 7.2% in 2019 from the previous year, a rate of roughly 17 per day, down from an estimated 22 per day in 2012, according to a report released in September 2020.

Public comment on the notice can be made at the Federal Register. The comment period ends March 7.

The Veterans Crisis Line can be reached 24 hours a day, 7 days a week by calling 1-800-273-8255 and pressing 1, or by texting 838-255 or engaging via the Crisis Line's website.

-- Patricia Kime can be reached at Follow her on Twitter @patriciakime.

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