04 Jul Medication and Co-Pays
Getting Medications from VA Pharmacies and Your Co-Pay
Filling Your Prescription
The VA medical care staff and VA providers work together to provide you with your medications. Your VA physician prescribes your medications from an approved list called a formulary. Once your VA physician writes a prescription, you can get it filled at the pharmacy located within the VA medical facility.
Your Routine Refills
In most cases the VA doesn’t provide routine refills at its pharmacy windows. Instead, VA-prescribed medications can be refilled in several ways.
By mail: you can use the refill notice you got when your original prescription was filled. Once the refill notice is received, the VA pharmacy processes and mails out your medication. Note – you should order refills at least 20 days before you run out of medication in order to get your refill on time.
By phone: Some VA pharmacies have toll-free automated telephone refill systems which you can call when it’s time for a routine prescription refill.
Online: the quickest and easiest way to manage VA prescription refills is through the VA’s “MyHealtheVet” Web site. MyHealtheVet’s Prescription Refill service makes it easy for VA patients to manage their VA-prescribed medications – but you must be a registered user of MyHealtheVet. You can sign up and access this service at www.myhealth.va.gov
What About My Non-VA Prescriptions?
The VA will not fill or rewrite prescriptions prescribed by your private physician. If you see a non-VA provider and want to have prescriptions filled by the VA, you must meet all the following conditions:
- You must be enrolled in VA healthcare. See the “Making your case for VA medical care” section.
- You need to have a primary-care provider assigned by the VA.
- You must provide your VA healthcare provider with your medical records from your non-VA provider.
- Your VA healthcare provider has to agree with the medication prescribed by your non-VA provider.
- Your VA healthcare provider is under no obligation to prescribe a medication recommended by a non-VA provider.
Co-Pays for Medical Care
If you’re in priority Groups 1 through 5 you do not have to share costs for medical care. If you are in Group 6 you have do not have to pay for anything that is connected to a service-related disability but co-pays must be paid in full for any medical care you receive which is not related to your military service.
If you are in Group 7 you have to pay 80%$ of co-pays and if you are in Group 8 you have to pay full co-pays.
The VA makes this determination based on financial information you provide on VA Form 10-10EC, Application for Extended Care Services. This form is available at any VA medical facility (see Appendix C) or online at www.va.gov/vaforms/medical/pdf/vha-10-10EC-fill.pdf.
The maximum co-pay for inpatient extended care facilities is $97/day, which includes:
- nursing homes,
- respite centers,
- geriatric evaluation centers,
- community residential care,
- home healthcare,
- homemaker/home health aide services
Outpatient extended care maximum is $15/day and can include:
- geriatric evaluation,
- adult day care,
- hospice/palliative services
The maximum co-pay for these services is $15 per day. The maximum amount you can be required to pay for domiciliary care is $5 per day.
Co-pays for extended care services start on the 22nd day of care. The first 21 days are free.
Co-Pay for VA Medications
You may also be required to pay co-pay for prescription medications and refills you receive from the VA.
There is a medication co-pay cap of $960 per calendar year for all enrolled veterans except those in Group 7 or 8.
All co-pays are subject to change at the whims of Congress. For current co-pay amounts, visit the VA’s Web site at:
Addressing Your Finances: Travel reimbursement
In certain instances the VA will pay for you to travel to another VA medical facility if you need medical care. You will be given 28.5 cents per mile if you meet one of the following conditions:
- You have a service-connected disability rating of 30 percent or more
- You’re traveling for treatment of a service-related condition.
- You receive a VA pension
- Your income doesn’t exceed the maximum annual VA pension rate
- You’re traveling for a scheduled examination to determine your eligibility for VA disability compensation or pension
- You are eligible to receive reimbursement for special transportation (ambulance, wheelchair van, and so on) if you meet one of the first four criteria listed here and the travel is preauthorized by the VA (preauthorization isn’t necessary for emergencies if a delay would be hazardous to your life or health).
- If you are traveling for medical care under one of the first two conditions, your travel is subject to a deductible of $7.77 per one-way trip ($15.54 for a round trip). However, the maximum deductible you’d have to pay in one month is $46.62. After that amount is reached, the rest of your trips during that month aren’t subject to the deductible.
- If, through no fault of your own, you must return to the VA medical facility, to repeat a lab test, X-ray, or other exam to obtain VA disability compensation or VA pension the VA will pay you 17 cents per mile in travel reimbursement. This payment isn’t subject to the travel deductible.