MEDICATION COPAYMENT CHANGES IN 2017

David W. Riley, DAV National Commander and Frances J. Costa, DAVA National Commander

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DAV is pleased that there will be a reduction in copayments for many service-connected veterans in accordance with DAV Resolution No. 135.
VA issued final regulations set to take effect February 27, 2017, changing VA's current copayments structure for each 30-day or less supply of medication and how future year copayment amounts and annual caps are calculated.
Veterans who are currently exempt from medication copayments remain exempt, including but not limited to, a veteran with a service-connected disability rated 50 percent or more, medication for a service-connected disability, and a former prisoner of war.
Currently, Priority Group (PG) 2-6 veterans must pay $8 for each 30-day or less supply of medication and PG 7-8 veterans must pay $9.  Under the new rule, VA will essentially assign three categories for medication and associated copayments:

• Tier 1 - preferred generics - $5 copayment for 30-day supply;
• Tier 2 - non-preferred generics - $8 copayment for 30-day supply; and
• Tier 3 - brand name drugs - $11 for 30-day supply.

In addition, current copayment costs for veterans in PG 2-6 is limited to a $960 annual copayment cap and PG 7-8 veterans have no protections afforded by a cap.  Under the new rule, VA will reduce the annual copayment cap to $700 for all veterans, including PG 7-8 veterans, who are required to pay medication copayments.
It is estimated that a large majority of veterans will encounter no cost increase, or will realize savings, while a small percentage of veterans-veterans who only fill Tier 3 medications-may experience a small increase in medication copayments.  Based on a comparison of the current and proposed copayment amounts, VA anticipates that most veterans would realize between a 10 and 50 percent reduction in their annual pharmacy copayment costs. VA also estimates, 94 percent of copayment eligible veterans will experience no cost increase, and 80 percent will realize a savings of between $1 and $4 per 30-day supply of medications.
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