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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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Tbird

Va Formulary

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http://www.pbm.va.gov/NationalFormulary.aspx

VA Prescription Benefits

Many veterans prefer to have their prescriptions filled at the St. Louis VA Medical Center to take advantage of the pharmacy benefit available to veterans.

The VA Medical Center Pharmacy cannot fill prescriptions written by non-VA physicians.

Patients are eligible for medications only for those conditions for which they are receiving active treatment at the VA Medical Center.

The VA Medical Center will not provide medications that are not listed on the VA Medication Formulary

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Bull - it depends on your PCP. Caveat: you would probably need to be at least 70% svc connected in order for this to work. All you need to do is go to your VA doc to see him/her about the same condition you were seen for out here in the real world. Then....produce the prescription that your civilian doc gave you at the END of the appointment - ask, "do you think that this would be a good med to treat [your condition]??". Secret here is to make sure you let your PCP know that you're double checking (getting a 2nd opinion). Make sure that they think you value their opinion. There are exceptions to the VA formulary - they CAN and do order non-formulary meds. Ya' can't get it immediately, but if u come up with a script that there's no suitable formulary substitute (and it's a safe med) you should be able to get somewhere with it in the VA system. Do your research before u go to the VA and print out the RX sheet from a site like medscape dot com. If u suck up and make it appear that your PCP came up with the idea, your chances of getting this accomplished are maximized. A couple of times, my PCP came up with even a better choice for a better drug than the civilian doc wrote for, not on the VA formulary.

Ya' gotta nurture your relationship with your VA PCP. If your PCP is not a good fit, ask for a transfer. As long as you have a good reason for wanting a transfer after the first one, you can get it no matter what the local VA policy is. Also, make it personal - make sure your VA PCP knows about you and your family - pull out pics of your kids, grandkids, etc. Talk about your hobbies, interests, and your life - they're human. I've been with mine for the past 4-years - she ain't perfect, but she'll read/listen to anything I bring in to her and she's made some huge mistakes (I either agree to disagree or let her think it was a good choice, but come up with something better a couple of days after your appointment). Don't complain and don't accuse - just do your homework and present things.

Get a fax machine and use it. They love faxes - write a note to your PCP accompanied with whatever you found on the Internet or a copy of a magazine article, etc. Faxes are read at the end of the day and they are more receptive to those than playing phone tag with you. A fax gives them a chance to deal with you and your problem when they have time to give you their attention - then, your PCP nurse will call you back. Get educated about whatever you're trying to discuss. They aren't able to fax you back, but believe me they prefer dealing with you via a fax rather than a phone call. Keep it short, to the point, and always mention thanks for taking their time to help you. My PCP's patient load has doubled in the past 2 years - but, I assure you they all can recognize me by first name.

AND....get to know your PCP nurse - they have increasingly more freedoms that you could ever imagine. Heck, I've even seen my PCP's receptionist put in blood work for me and she isn't even trained in any sort of medical specialty. Don't create an adversarial situation EVER & don't jump the chain of command - I even send Christmas cards and thank you notes. Make sure they can always put a name with a face.

Chicopee116

100% Svc Connected

Vietnam Era, SP5

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I completely agree. You must suck up to your doctor. I have alot of medical problems so I introduced all my local docs to the VA docs. Now that they are somewhat accquainted and comfortable with one another, my life is much easier. Since the VA is so busy and my comdtion takes so much time(100% S/C), I think the VA doc prefers that my private doc does most of the work then calls her with his recommedation for meds. Most of the time they just show up in the mail. This has taken a few years to cultivate. And yes I send Christmas cards and treats to all of them and remember to say thank you.

The best advise I received was from a social worker with NORD (National Organization for Rare Disordrers). That my disease was rare and there were going to be mistakes made since there is no clear treatment plan. Go to a large hospital with the resourses to run all the very expensive test and can't cancel my isurance. Then she said to make some friends there with the doctors and staff and loose the attitude about what I thought I was entitled too. Life isn't fair and that it has been proven that patients that are likable get better care and have better surivial rates!!!!

None of my 20 drugs are on the VA formulary

SE 100% S/C Non Langerhans Cell Histiocytosis :lol:

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I looked up my current and best tolerated pain killer.

They appear to be validating their own lack of desire to prescribe.

http://www.pbm.va.gov/Clinical%20Guidance/Criteria%20For%20Use/Oxycodone%20CR,%20Criteria%20for%20Use%20and%20Treatment%20Algorithm.pdf

I've been trying to use less costly pain killers for many years.

Because I pay the whole price outa my own pocket because the VA will not.

Nobody at the VA has the stones to prescribe anything for pain for more

than one month anyway.

When they do 'give' me a pain killer it's never been oxycodone, always

one of the cheaper ones that my system will not tolerate.

The main reason for not prescribing oxycodone is the cost to the VA.

Except for addicts, I don't know anybody who likes pain 'or the pills'

that give some relief.

Would I be buying most of my medications and all of the

over-the-counter stuff that is prescribed if I did not have to?

NO.

The VA has the best health care!

Compared to Ethiopia or Somalia.

The private sector is using the VA model of delivering health care to

model their own.

That's why private sector health care has gone down the tubes.

Copying something that the VA does to veterans is not something that

I would be proud of.

sledge

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Get a prescription for oxycontin, demerol or dilaudid from private doctor and see if your VA PCP will fill it. I bet you they will not fill it unless you are dying from cancer. I asked pain doctors at the VA for vicodin and they refused and gave me morphine. Morphine is cheaper than vicodin. They do prescribe generic vicodin. It is cheap and very habit forming as is oxycodone. The shorter acting the drug the more addictive it is.

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    • Precedent Setting CAVC cases cited in the M21-1
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