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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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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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Objee

The V A Drug Formulary

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This from National Review Online:

"The V.A. buys drugs from pharmaceutical companies at the Federal Ceiling Price — a minimum 24 percent discount below the Average Manufacturer’s Price, or the “best price” offered to private-sector purchasers, whichever is lower. Not surprisingly, paying drug suppliers nearly one-quarter below wholesale (or less) generates myriad economic distortions for which patients pay the price.

The vaunted VANF covers some 1,300 drugs, just 30 percent of the 4,300 drugs available on Medicare’s market-priced formulary.

“The V.A. system does not provide a formulary that is comparable in scope to those currently provided by Medicare Part D plans,” Kathleen Hughes, Wendy Watson, and Thomas Goss concluded in their December study for Covance Market Access Services. “The V.A. formulary is more limited both with respect to more popular drugs in general, and with respect to the drugs currently used to treat conditions that are common in the Medicare population such as hypertension, depression, diabetes, and high cholesterol.”

Covance’s paper, prepared for the Pharmaceutical Research and Manufacturers of America, analyzed the 226 drugs most commonly prescribed for Americans over age 65. Of these, Medicare covers 213. VANF includes 165, or just 73 percent, of these agents.

Among 83 high-blood-pressure drugs Covance studied, Medicare covers 81 (98 percent) while VANF includes 66 (80 percent). Medicare covers all 26 anti-depression compounds Covance examined; VANF includes 17 (65 percent).

Medicare also pays for all 13 anti-cholesterol drugs Covance explored; VANF covers just 7 (54 percent). Crestor and Lipitor are among the popular drugs unavailable through the V.A.

Of the 34 anti-diabetic treatments Covance considered, Medicare covers 30, while VANF includes just 15 (44 percent).

Covance found 26 drugs Medicare covers that VANF excludes. These drugs accounted for 264 million prescriptions in 2004. Beyond the reach of V.A. patients, these drugs include Nexium for acid reflux and Alimta, Avastin, and Herceptin for cancer.

It is vital that patients have access to as diverse a pharmacopoeia as possible since, for instance, anti-depressant A might produce frightful hallucinations while anti-depressant B yields sheer bliss. The price-fixed VANF restricts rather than expands patient choice.

VANF also resembles the medicine chest in a long-abandoned house. Its contents may be cheap, but they’re hardly modern. Columbia University’s Frank Lichtenberg discovered in 2005 that V.A.’s formulary includes only 38 percent of the drugs the FDA approved in the 1990s and just 19 percent of those it authorized since 2000.

“New drugs as a matter of V.A. policy are not considered for the V.A. formulary for three years, regardless of improved effectiveness or reduced side effects,” Manhattan Institute senior fellow Benjamin Zycher wrote in the November 29 RealClearPolitics.com. Three years awaiting a new drug may be merely excruciating for Americans with arthritic knees. But for those fighting, say, pancreatic cancer or other aggressive, life-threatening diseases, such foot dragging could prove fatal."

The finest medical care available???????

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I guess what is really starting to bug me is pill splitting and also changing what you are taking in mid stream. Last year I had three prescriptions changed with no notice and not much for me to say.

You can get the VA to issue off formulary meds but it practically takes an Act of Congress. We should have access to the same things that everyone on Medicare Part D has.

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Pete53... If you think you are upset because of having to split your VA prescribed pills, you are going to be doubly upset when I tell you are being overcharged as well. There are well over 1.1 million VA split pill prescriptions, meaning overcharges to these many veterans that can least afford it. A scam that has been going on since March of 2002, when I first notified the VA and Mr.Principi.

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Let me explain. Let's assume you are at the VA picking up your prescription. You and another veteran in line in front of you are prescribed the exact same identical prescription of 30 pills. Both supplies carry a copay of $8. Right? But, your prescription requires that you split your supply. You now have a two month supply (15 pills 1/2 pill per day). This $8 supply now increases in copay cost to $16, for the exact pill medication and supply that costs $8. But let's kick it up a notch, assume that veteran in front of you, having still the same prescription, his supply for a 30-day supply is instead 90 pills. Copay remains at $8 for this 30-day 90 pill supply.

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Hope this explains, how the veteran is overcharged by the VA, and just got shafted again (3/13/07) by the Board of Veterans Appeals (BVA).What veterans have known as fact, is that veterans continue to lose benefits. This is just another example.

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Criteria & Analysis by the Board of Veterans Appeals.

“. ...The appellant contends that the standard copayment is excessive in light of the pill splitting.” No where in my claim did I mention the word ‘standard.’ To determine what then is the standard $8, 30 day supply, one must compare 2 supplies. The VA apparently has two(2) standard supplies. A 30 day supply of 30-60-90 pills. Copayment cost $8. Then a second standard 30 day supply of 15 pills, $8 copay. Two distinct and different standards. A standard in cost, but no standard in supply. One does not have to read any further to see the unfairness of the BVA decision.

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The BVA cites my argument, 38 U.S.C.A. Sec. 1722a “Copayment for medications. Paragraph (2) The Secretary may not require a veteran to pay an amount in excess of the cost to the Secretary for medication as described in paragraph (1).” As just described above.

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Paragraph "(a)(1) Subject to paragraph (2), The Secretary shall require a veteran to pay the United States $8 for each 30-day supply of medication furnished such veteran under this chapter on an outpatient treatment of a non-service connected disability or condition. If the amount supplied is less than a 30-day supply, the amount of the charge may not be reduced." If the 'standard', mentioned first by the BVA describing, "The appellant contends that the standard copayment is excessive.." and according to paragraph 1, is $8 for 30-day supplies of 30,60, or 90 pills, why are veterans charged $16 for a 2 month supply of 30 pills?

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"In addition, the Board notes that the references to the cost of medication contained in 38 USC 1722a clearly pertains to VA's cost in dispensing the medication, not the cost to the appellant." That statement is incorrect. Copayment For Medication, 1722a, (listed above) clearly, makes no mention the VA's cost of dispensing medication. It mentions only the veterans' copayment obligation. A reference is made to the VA cost in the Federal Register, however, the "cost in dispensing the medication" is not the argument. It is the cost in overcharges to the veteran.

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To you, and me it is quite simple. “The Secretary may not require a veteran to pay amount in excess of the cost to the Secretary for medication as described in paragraph (1).” If one supply can be a standard 60, or 90 pill 30 day supply with a copay of $8, how then can a 30 day supply, limited to only 15 pills, for medication administered during treatment lasting several months, at a copay of $8, each 30 day period be standard supply? "...As described in paragraph (1)". Therefore, an "excess of the cost" does indeed exist.

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If given to an eight grade grammar school class this arithmetic problem of the two supplies to find the excess of the cost, what would be their answer? They too, would find that an excess of the cost does exist, “..for medication as described in paragraph (1)” This is a bad sign. Indicating exactly how veterans with disabilities claims, going before the BVA, and Veterans' Law Judge, John E. Ormand, Jr., are adjudicated.

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“(:lol: The Secretary, pursuant to regulations which the Secretary shall prescribe may-...(1) increase the copayment amount in effect under subsection (a);..” "Pursuant to regulations" means according to the law as written. The BVA , has decided the Secretary (VA) can make law to fit, rather than prescribe the law, or regulations as written.

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Citing..Under 38 C.F.R. Sec. 17.110 Copayments for medications.

"(B) Copayments. (1) Unless exempted under paragraph © of this section, a veteran is obligated to pay VA a copayment for each 30-day or less supply of medication provided by the VA on an outpatient basis (other than medication administered during treatment)." If ‘administered during treatment’ meant hospitalization, that’s not what it says, or should have been worded. But it did not. It is not ambiguous in the context in which it is presented. Citing, ‘on an outpatient basis, other than medication administered during treatment’ The meaning is quite clear. A patient receiving 60, or 90 day outpatient supply is clearly a treatment of a condition, such as a heart condition, diabetes, etc.

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BVA mentions, “Thus, it is clear that the VA’s cost of filling the appellant’s 30-day prescription exceeds the $8 copayment under 38 C.F.R. Sec. 17.110.” Again the argument clearly is not the VA cost as noted in the Federal Register 12/6/2001. When determining the medication copay cost, VA factored in everything, except the cost of the medication. The BVA’s inadequacy, and mindset shown here, is for all to see.

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BVA denial in part, "...adherence in the face of overwhelming evidence in support of the result in a particular case: such adherence would result in unnecessarily imposing additional burdens on the VA with no benefit flowing to the claimant." Never mind the burden of overcharges, or the benefit flowing to well over 1.1 million veterans whose prescriptions call for pill splitting.

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It is clear, the BVA came up with this denial of overcharges claim due to national budget concerns due to the involvement in Iraq, Afghanistan, and who knows were else. Veterans did not cause that. But men and women went to military service because of it. This is how they get rewarded by a grateful nation. There are many things in life we do not like, but ignoring a veterans' cause, or the law is not an option. Who lost? Having sat in the lobby of my VA hospital and observed those that passed by, it's not hard to see, there are many who could use any help they can get, as well those returning from Iraq, Afghanistan, and Walter Reed.

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A claim with the United States Court of Appeals for Veterans Claims has been filed. 4/9/07 CVA docket No. 07-0864

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I don't think any Veteran should have to make a copay no matter how you slice it.

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Lets not forget that Vets service connected 50 percent or higher or catastropically disabled pay no Medicine Copays. I would like to see that extended to all Service connected Vets.

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