Copay Freeze for Veterans Extended Through 2016

Veterans who obtain their prescriptions at a VA pharmacy will see their copays remain steady through 2016.

Under a new rule published in the Federal Register on September 16, 2015, the Department of Veterans Affairs (VA) will extend its freeze on co-payment increases until at least December 31, 2016.

This federal rule comes as a relief for VA officials who expressed concerns that veterans would reduce their use of pharmacy benefits if their co-pays increased, thus affecting their adherence to prescribed medication regimens.

Currently, veterans must pay a portion of their prescription drug costs for non-service-related conditions if their income exceeds established thresholds. Depending on their eligibility status in the VA system, this can translate to $8 or $9 per 30-day prescription.

While the co-pay freeze is a victory for veterans’ health, some other recent policy changes may negatively affect veterans and their families.

Beginning next month, for instance, Tricare-covered military families and veterans who choose to fill their prescriptions at retail pharmacies will have to pay out-of-pocket for certain brand-name drugs.

This new rule only applies to brand-name “maintenance medications” regularly taken to treat chronic health conditions. Tricare will still cover drugs such as antibiotics that are intended to treat acute conditions under the current rate.

All generic medications filled at retail pharmacies will continue to cost $8 for a 30-day supply.

Members of the Tricare for Life military health care program for retired veterans have already experienced this change during a 2014 pilot program. However, those participants were permitted to opt out after a year—an option that will not be available after the new rule is fully implemented.

Another recent change to the Tricare health program has reduced coverage for compounded prescription medications.

Thirty-one US Representatives formally opposed this policy change in a letter to Department of Defense (DOD) leadership.

"We understand these recent changes are in response to deceptive marketing practices conducted by a select few compounders,” they wrote. “While we believe deceptive entities should be pursued and dealt with accordingly, Tricare beneficiaries should not be denied access to compounded medications due to a few bad actors.”