Regarding Va Violation Of 38 Usc 1722a.

[Chuck75]

This one is of great interest to me, since I am one of the veterans that is "requied" to split multiple pills. In addition, many of my pills are supplied in various numbers, with a maximum of three months in one bottle, and a minimum of one month.

When I started getting meds from the VA the "co-pay" was $2.50, reasonable since our private insurance had a co-pay of $5.00. At the same time the VA went to $8.00 the private insurance went to $15.00

The Board of Veterans' Appeals, denial, Conclusion of Law, states, "The appellant is obligated to pay VA copayment for each 30-day or less supply of medication provided by VA on an outpatient basis. 38 U.S.C.A. Sec. 1722a; 38 C.F.R. Sec. 17.110 (2006)."

Finally, after the Criteria and Analysis, and references to other law statutes, the Board, in concluding states, “38 USCA 1722a clearly pertains to VA’s cost in dispensing the medication, not the cost to the appellant... The Federal register of July 16th, 2001; Also under U.S.C. 1722A, VA may not require a veteran to pay an amount in excess of the actual cost of medication and pharmacy administrative costs related to the dispensing of the medication. VHA conducted a study...and found that the VA incurred a cost of $7.28 to dispense an outpatient medication....under these circumstances, we believe that a $7 copayment would not exceed VA’s cost.”

Clearly, dispensing of medication is the key to the Board’s argument, as well as mine.

The VA pharmacy dispenses a supply of 30 pills, the copay cost, whether the amount is 15, 30, 60, or 90 pills the copay is $8. A 30 pill prescription may require that the supply be split. Now becoming a 2 month supply. VA’s copayment charge is $16.

A supply of 30 pills carries the maximum copayment charge of $8, for a 30-day supply, and a veteran is not required to pay an amount in excess of the cost to the Secretary, as described in 38 USC 1722a paragraph 2, and noted in the Decision of the Board of Veterans Appeals reference. The Board citing the Federal register, 12/6/2001. “The VA incurred a cost of $7.28 to dispense an outpatient medication..” (rounded out to $8). Why is it, that a veteran is charged $16 for the exact same $8 prescription, 30 pill supply?

The BVA in denying the appeal, they cite, “.. 1722a clearly pertains to VA‘s cost in dispensing the medication...,The VA incurred a cost...to dispense medication..”, providing the answer to their apperception. Dispensing! The VA charges the veteran twice, or double, as claimed, for the same dispensing cost required to dispense the exact same, one(1) 30-day, $8 supply. Exceeding the cost a veteran is not required to pay. I, like the Board, I am, “..unable to find any authority allowing for a deviation from the standard copayment.” As well, “The Board has no authority to act outside the constraints of the statutory and regulatory criteria.”

[SLEDGE]

I only receive one months worth of anything and I do not co-pay.

However, the VA does not allow my doctor to prescribe anything that equals or exceeds the co-pays dollar value.

I got 3 months worth of one medication one time and then they cut me off, again.

When you question the cost of the medication, on a per-month basis, you are upsetting their system with a logical, sensible inquiry.

The VA operates on confusion, budget constraints and, 'that's how we have always done it'.

Government agencies are geared for the 'herd', not the individual client.

If they claim that the cost is equitable when the strength of the medication required by one patient is half that required of another patient, they are simply following the regulations regarding allowable co-pays.

Regardless of the cost, one months worth of any strength of any medication is equal to one co-pay.

From what I have seen in this thread, they are confusing the issue with quotes from statutes that do not address the actual question.

The VA is not even addressing the actual question.

Why does the same amount of pills/medicine cost some veterans twice as much as charged to other veterans?

I have not seen any evidence that the question has been answered by the VA.

Am I missing something?

Anyway, all they have to do is inflate the cost of the medication in question to get out of a straight answer.

The co-pay is equitable because the VA says so, your input is not required.

sledge

[Chuck75]

I have been charged $24 for one bottle containing a prepackaged 90 day supply.

Even worse, this can exceed the retail cost of the drug. (Esp. at Wal-Mart pricing)

Since it is a three month supply, my insurance company does not pay the VA for several reasons.

1. More than 30 day supply. (Insurance company pays for only a 30 day supply)

2. Amount billed by the VA exceeds the retail cost of the drug after insurance copay is applied. (The insurance company has a cost table that it goes by.) The insurance company does not care about VA co pay paid by the patient, except to reduce the amount it might pay the VA. By the way the medical insurance is the same plan used by the state gov. and public school systems. I receive an itemized statement showing what was paid to drug stores etc. ,but not to the VA. Never could get the same answer twice in a row as to why this occurs.

I am confused by this.

I am charged my $8.00 for meds for each bottle in each seperate package....

So... are they saying that we should ask our docs to fill the prescriptions at 2 month intervals to save ourselves money since the VA is only supposed to be charging us the cost of shipping the meds?

Edited September 28, 2007 by Chuck75

[SLEDGE]

Nine years worth of my previous VA co-pays is equal to ten months co-pays on the outside for me, if the insurance company approves the medication.

Our vets get the best medical care as long as that care falls within the preset, current budget.

If you aren't on the spit list.

If you don't mind traveling all over the country.

If your doctor is really a doctor.

If you can get by on FORMULARY drugs.

One doctor sent me on a 2 hour drive for an MRI, then a 3 hour drive to get the MRI read, then an 8 hour drive for treatment, which was refused.

After telling me NOT TO DRIVE.

For the next medical condition I was sent on the 3 hour drive to see the specialist again, he recommended the 8 hour drive for treatment again and this time I laughed in his face.

They tell me that my knee should be replaced but they refuse to prescribe anything for the pain.

Call this a rant if you must but it's all true.

sledge

[john999]

If I am service connected for heart disease should I be charged for cholesterol pills? The VA charges me for all kinds of pills that are actually for service connected conditions. I get pills to reduce blood sugar and am SC for DMII. I get charged for laxatives when I get opiates for SC conditions. Actually, my insurance pays and I don't have a co-pay but I resent them hitting my insurance. I have fought with them about this before and I get fed up. All the pills I get except heart burn could be for SC conditions. Even the heart burn pills could be for the anti-inflamatory pills since they hurt the gut.

[Speaking Out]

I found out from my my local VA (Indy) that the VARO does not notify the hospital when you get an increase in your rating. If you were at a rating that you had a co-pay and then get a higher rating, the hospital billing department doesn't get that info to update so that you are not charged anymore. I was told that it eventually gets updated and then you can request your overpayment back. I was told that you can fax for mail in a copy of your award letter and the info will be updated. I thought this might be useful knowledge for people. I paid a co-pay from 1996-2007 and should not have.