General Questions About Your Medicines
A formulary is a list of medicines from which your VA provider can choose to treat your medical condition. This list of medicines has been looked at and approved by a group of highly trained VA physicians and clinical pharmacists. New medicines usually are added to the formulary based on a complete review of published medical studies as well as available patient safety data.
Medicines are grouped by the VA as Formulary, Formulary-Restricted, or Non-Formulary. Formulary-Restricted medicines usually can be used only by those providers with specific experience in how these medicines are prescribed and monitored. For example, oncologists usually are the only VA providers who can use medicines used to treat cancer. Non-Formulary medicines are prescribed for those patients who either have failed or could not tolerate any of the VA Formulary medicines.
Usually your medicines are continued when you are admitted to the VA hospital. However, depending on your medical needs and length of time you stay in the hospital, your medicines may be changed or stopped. When you are discharged from the hospital, your VA provider may need to renew medicines that you were taking before your hospital stay. When you leave the hospital, you will be given instructions about which medicines to take at home.
When you are admitted to the VA hospital: No, leave your medicines at home UNLESS your VA provider or pharmacist asked you to bring them with you. You should bring an up-to-date list of 1) ALL the medicines you currently are taking including any over-the-counter medicines, herbal or alternative medicines (like St. John's Wort), or dietary supplements (like Co-enzyme Q-10, Vitamin C) and 2) the prescriptions given to you by VA or non-VA providers.
When you go to a clinic appointment with your VA provider: Yes, bring all your medicines and prescriptions with you so you and your VA provider or pharmacist can talk about your treatment plan and make sure you are taking the correct medicines.
The VA Pharmacy will fill ONLY those prescriptions written by providers approved by your VA facility. Your VA provider will decide which medicines are needed to treat your medical condition. VA providers can prescribe medicines necessary for your treatment that are similar and equally effective to those medicines ordered by your non-VA providers. Prescriptions written by non-VA providers and filled under the temporary VA Transitional Benefits Program are not included.
Copay charges for a 30-day or less supply of medication provided on an outpatient basis for treatment of nonservice-connected Veterans in priority groups 2-6 are $8. Copays for medication are charged only for outpatient treatment. The prescription co-payments are as follows:
Veterans enrolled in priority groups 2-6 will continue to have a cap on the amount that they can be charged for medication copays each year. This cap is now $960 per year. This means that Veterans in Priority Groups 2-6 will not pay more than $960 annually for medicine they receive on an outpatient basis.
Copay charges for a 30-day or less supply of medication provided on an outpatient basis for treatment of nonservice-connected Veterans in priority groups 7 and 8 increased from $8 to $9 on July 1, 2010. As in the past, there is no cap on annual copay amounts for outpatient medications provided to Veterans in Priority Groups 7 and 8.
Medication copays do not apply to former Prisoners of War (POW) or those covered by other exceptions as set by law or VA policy.
You will be billed for the prescription co-payment and can pay by check or credit card. Each VA location has a cashier window where you can pay this fee. Check with your VA Pharmacy if you have questions about paying your prescription co-payment.
If the VA computer does not have your correct address and your medicine is not delivered to you, the medicine will be returned to the VA Pharmacy. Sometimes patients who were discharged from the VA hospital do not pick up the medicines that their VA providers prescribed for them when they were discharged. Your medicine will be returned to the medicine stock in the Pharmacy and the billing for the medicine will be canceled. Even if you have refills left on your prescription, if your medicine was returned to stock, you cannot request a refill through the automated touch-tone telephone refill system. If you need this medicine, you must contact your local VA Telephone Linked Care (TLC) service and ask that the medicine be refilled.
In VISN 18, the average waiting time at a VA Outpatient Pharmacy window is less than 30 minutes. Before filling your prescription, the Pharmacy checks that the medicine prescribed by your provider does not interact with your other medicines. The Pharmacy also must make sure that the medicine was prescribed according to VA clinical usage guidelines. If your new medicine interacts with medicines you already are taking, the Pharmacy will need to contact your provider so that changes can be made to your medicine. Other activities the Pharmacy must do include making sure that medicine doses are correct (especially if the patient has kidney or liver disease) and checking for allergies or past adverse reactions to medicines. All of these activities may add to the time it takes the Pharmacy to fill a prescription.
Patients who do not use MyHealtheVet or the touch-tone telephone refill system and ask for prescription refills at the Outpatient Pharmacy window also add to the time it takes for the Pharmacy to fill a prescription. When prescription refills are ordered through MyHealtheVet or the Dial-A Refill touch-tone telephone refill system, the Pharmacy can focus on those Veterans who are very ill and need urgent medical treatment.
Most entities that currently provide prescription drug coverage to Medicare beneficiaries, including VA, must disclose whether the entity’s coverage is “creditable prescription drug coverage.”
· Enrollment in the VA health care system is creditable coverage. This means that VA prescription drug coverage is at least as good as the Medicare Part D coverage.
· Because they have creditable coverage, veterans enrolled in the VA health care program who choose not to enroll in a Medicare Part D plan before May 15, 2006 will not have to pay a higher premium on a permanent basis (“late enrollment penalty”) if they enroll in a Medicare drug plan during a later enrollment period.
· However, if you disenroll in VA health care or if you lose your enrollment status through no fault of his/her own (such as an enrollment decision by VA that would further restrict access to certain Priority Groups), you may be subject to the late enrollment penalty unless you enroll in a Medicare Part D plan within 62 days of losing your VA coverage.
· If you are a veteran who is or who becomes a patient or inmate in an institution of another government agency (for example, a state veterans home, a state mental institution, a jail, or a corrections facility), you may not have creditable coverage from VA while in that institution. If you think this applies to you, please contact the institution where you reside, the VA Health Benefits Service Center at 1 877-222-VETS (8387), or your local VA medical facility.