By Annette M. Boyle
SUPERIOR, WI — Late last month, the VA introduced a tiered pharmacy benefit designed to decrease the cost of outpatient medications for most veterans.
The new structure establishes set copayment amounts for different classes of drugs and replaces a previous regulation that would have caused pharmacy prices to rise three times in the next six years, according to the VA.
“The new tiered copayment structure will decrease the costs of outpatient medications for most veterans, aligning with VA’s goals to reduce out-of-pocket costs, encourage greater adherence to prescribed outpatient medications and reduce the risk of fragmented care that results when multiple pharmacies are used to fill veteran prescriptions,” according to the description.
Previously, a calculation based on the prescription drug component of the Medical Consumer Price Index was used to set the copayment amounts for veterans. As those costs rose in the future, so would prescription copayments for veterans, explained Susan A. Reed, VHA’s executive director for revenue operations.
The change eliminated the formula and created three medication tiers for treatment of non-service-connected conditions. Tier 1 includes preferred generics; Tier 2 covers nonpreferred generics and over-the-counter drugs; Tier 3 includes brand-name medications. Medications in Tier 1 have a $5 copay for a 1-30-day supply. Tier 2 and Tier 3 have $8 and $11 copays, respectively.
Under the previous system, nonexempt veterans in Priority Groups (PG) 2-6 paid $8 for all outpatient medications and those in PG 7-8 paid $9 for a month’s supply. Veterans previously exempt from having to make copays will remain exempt.
“Most veterans will receive a savings of $1 to $4 per fill or experience no cost increase under the new policy. Some veterans will have a small $2 to $3 increase for Tier 3 brand-name outpatient medications,” Reed said. The copayment amounts may be reviewed on an annual basis.