VA Changes Billing Process for Third Party Pharmacy Prescriptions.
April 7, 2011

Change Will Not Affect Co-pay Status of Veterans

WASHINGTON – The Department of Veterans Affairs (VA) is implementing a new billing process for charging third party insurers for outpatient prescription medications provided to Veterans for conditions unrelated to their military service. This change will not affect Veterans’ co-payments for prescriptions.

“This is a simple change that makes sense for delivering Veterans’ health care,” said Gary Baker, chief business officer of VA’s Veterans Health Administration. “VA should recoup from insurers the actual costs for prescriptions provided to Veterans rather than a flat fee that is the average of all medication costs.”

Starting March 18, VA began charging third party insurers of Veterans for the full costs of prescription medications plus an administrative fee of $11.40, rather than the flat fee of $51 that is currently billed.

The rule change, published in the Federal Register on Oct. 6, 2010, will contribute to VA’s mission of providing exceptional health care that improves health and well-being. The new billing process will be similar to how the private sector bills for prescription medications.

Veterans who receive prescriptions through VA for illnesses that are not related to their disabilities resulting from military service, currently pay a maximum of $9 in co-pay per 30-day prescription, with many Veterans paying no co-pay at all.

Veterans with questions about their health care benefits can call the VHA Health Resource Center at1-877-222-VETS (8387) or visit http://www.va.gov/healtheligibility/.