Frequently Asked Questions (FAQ)
- How do I get my prescriptions filled at the Veterans Affairs Pharmacy?
- How do I get enrolled into the VA Medical Center?
- How do I get my prescription refilled?
- Will my prescription cost me any money?
- Why does VA require a medication co-payment?
- Who decides if a medication is for treatment of a non service connected condition?
- Will the amount of the co-payment and the annual cap ever change?
- Can I get prescriptions obtained from my private health care provider filled at the VA pharmacy?
- What is covered by the medication co-payment?
- Are there any exemptions from the medication co-payment?
- What is the outpatient co-payment?
- What is the three-tiered outpatient co-payment?
- Are all veterans charged an outpatient co-payment?
- You must enroll or be enrolled at a VA Medical Center.
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You must have a VA Doctor write you the prescription.
- You need a copy of your DD 214.
- Will need your last year household income.
- Will need your spouse and dependent's Social Security numbers, birth dates and date of marriage.
- Will need last year non-reimbursed medical expenses for the whole family.
- What you had to pay for a funeral of your spouse or dependent child.
- If you the veteran went to school last year, need the amount you paid out of pocket that was not reimbursed to you.
- Will need to know how much money you have in checking and savings accounts, C.D.'s, I.R.A.'s, etc.
- Market value of land and buildings minus mortgages and liens. Do not count your primary home. Include value of farm, ranch or business assets.
- Value of stocks and bonds and value of other property or assets.
- Bring all the above information to this office so we can help get you enrolled. Veterans Assistance Commission, 201 West Pearl St., Jerseyville, IL 62052. The office telephone is 618-498-1810.
- You sign the slip that is included with your bottle and mail it back to VA.
- Or you can call 1-800-228-5459, and follow the instructions.
- The Department of Veterans Affairs (VA) charges a co-payment for each 30-day or less supply of
medication provided on an outpatient basis for the treatment of a non service-connected condition.
The co-payment as of now is set at $8.00.
- At times the VA issues a 90 day supply of medications and this will cost you $24.00 if you have to
pay a co-payment.
- By law (PL 101-508 and PL 106-117), VA must charge veterans a co-payment for their outpatient
medications. The Veterans Millennium Health Care and Benefits Act (PL 106-117) authorized VA to increase the
co-payment amount and to establish an annual cap on the amount of medication co-payments charged.
- The VA doctor makes this determination.
- If the medication prescribed is for treatment of a service connected condition, no co-payment is required.
- The amount of the medication co-payment and the annual cap may change on an annual basis.
- For the specific current annual amounts, contact the VA Revenue Coordinator at the St Louis VA health
care facility at 1-800-228-5459 then dial "0" and ask for the revenue coordinator's office.
- To qualify for pharmacy benefits, you must be enrolled in and receiving health care from the VA
health care system. A VA health care provider will review any prescriptions from a private health care provider
to determine if they can be rewritten by a VA health care provider and dispensed from a VA pharmacy.
- The medication co-payment applies to medications and over the counter medications
(aspirin, cough syrup, vitamins, etc.) that are dispensed from a VA pharmacy.
You are not charged a co-payment for medical supplies (syringes, alcohol wipes, etc.).
- The following are exempted from the medication co-payment.
- Service connected veterans rated greater than 50 percent;
- Medications dispensed for service connected conditions; and
- Veterans with a low income (by law, a veteran whose annual income is determined to be lower than the VA
pension level).
- The Department of Veterans Affairs (VA) is required by law (PL 99-272) to charge veterans,
in certain income categories, a co-payment for their outpatient visits. The Veterans Millennium Health
Care and Benefits Act (PL 106-117) authorized VA to decrease the outpatient co-payment amount provided
for some services. As a result,
VA has made changes and has implemented a three-tiered outpatient co-payment structure.
- The co-payment will be based on primary care visits ($15), specialty care visits ($50), and no
co-payment designations.
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Primary Care ($15), A primary care outpatient visit is an episode of care furnished in a primary
care clinic that provides health care services. Veterans do not need a referral to access the
primary care clinician.
- Specialty Care ($50) A specialty care outpatient visit is an episode of care furnished in a
clinic that does not provide primary care, and is only provided though a referral. Some examples
of specialty care clinic are surgical consultative services, audiology, optometry, cardiology,
MRI, CAT scan, Nuclear medicine studies and ambulatory surgery.
- Service for which there will be no co- payments; Publicly announced VA public health
initiatives (for example: a health fair, etc). An outpatient visit solely consisting of
preventive screening and immunizations, (for example: influenza immunization, pneumonococcal
immunization, hypertension screening, hepatitis C screening, tobacco screening, alcohol screening,
hyperlipidemia screening, breast cancer screening, cervical cancer screening, education about the
risks and benefits of prostate cancer screening and others.
- Service connected veterans are exempt from outpatient co-payment charges. Most nonservice connected
veterans and noncompensable 0 percent service connected veterans are required to complete an annual means test.
The means test is a measure of your family's income and assets. Means test threshold levels change on an annual
basis. If your income & assets fall below the threshold, you will not be charged co-payments for outpatient
care.