VA prescription overcharges
While the media publish that the VA is warning veterans of telephone prescription scams, the VA continues it's own in house prescription scam on millions of veterans. I thought that I would provide some insight as to one aspect of the workings of VA affecting prescription co-payments over-charges. Something I am in the process of correcting.
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As you may know, veterans pay a co-pay of $8.00 for each 30-day prescription. However, there are well over 1.1 million VA prescriptions that veterans are being over-charged for, in violation of the law. In other words double the cost. Something I?ve been fighting for over 5 years. Veterans continue to be over-charged and they will never recover their loss.
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I began informing the Veterans Administration in March 2002, that the VA is in violation of 38 USC 1722a, regarding prescription co-payment over-charges. Where is this case at the moment? But first, being unfamiliar with my claim, briefly.. paragraph 1 states, that a veteran is required to pay $8 for a 30-day prescription. This 30-day supply can be 30, 60 or 90 pills, all for the $8 co-pay cost.
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Here?s the United States Code; 38 USC 1722a. ?Paragraph (a)(1) subject to paragraph (2), the Secretary shall require a veteran to pay the United States $8.00 for each 30 day supply of medicine?if the amount supplied is less than a 30 day supply the amount of the charge may not be reduced.?
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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.?
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I will explain the VA violation by illustrating in this example, a normal 30 day supply, using a 30 pill prescription, $8 veteran co-payment. The VA, using creative accounting, will use this same exact identical prescription and supply, and increase the cost from $8 to $16. Double the cost. Why? Because? the prescription requires splitting pills. This 30 pill, $8 supply is now a 2 month, split 15 pill, 30 day, $16 co-pay supply.
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While your taking in that $16 supply, keep in mind the 30,60,90 pill, 30-day supplies at $8 copay.
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Paragraph 2, states, ?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.? And what was the described co-pay cost? To the veteran who?s prescription for the exact identical 30-day, 30 pill supply, ?..as described in paragraph 1?, it was $8.
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There may be those who want to believe, these 15 split pill prescriptions, in reality, are $8 co-pay, 30-day supplies, as paragraph 1 suggests. I submit that, with no mention of quantity, but considering the abundant supplies shipped, the amount of the 30-day supplies involved, neither the Code of Federal regulations, or the United States Code itself, gives reference, to greater co-pay costs beyond what has been established for like 30-day, $8 co-pay supplies. This generous abundance.... of seemingly endless supply, and availability of medication of 30, 60, 90 or more, $8, 30-day supplies, stops at a prescription that calls for pill splitting. This $8, 30-day supply has been limited to only 15 pills, and has doubled in cost.
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To those of you, as well as those at the Veterans Administration, who may be confused, to the meaning of 30 day supplies, 38 USC 1722a paragraph 1 states, ?..the Secretary shall require a veteran to pay the United States $8.00 for each 30 day supply of medication.?
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The Veterans' Medical Care Appropriations and Funding Process, dated 9/30/2004. Congressional Research Service (CRS) report for Congress explains and supports further my BVA claim, and this 30-day or less cost. Stated in the ....
The Veterans Millennium Health Care and Benefits Act of 1999 (P. L. 106-117)
authorized VA to increase the medication co-payment amount and to establish annual
caps on the medication co-payment amount.26
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26 "This law allowed VA to increase the co-payment amount for each 30-day or less supply of medication provided on a outpatient basis (other than medication administered during treatment) for treatment of a non-service-connected condition."
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"Other than medication administered during treatment", CRS documentation describing the co-pay charge, and how it is to be applied. This is of further significance in understanding 38 USC 1722a. Meaning medication required in the treatment of more than one 30-day supply of 15 pills (split), this law does not allow an increase in the co-payment for, "..an amount in excess of the cost to the Secretary for medication as described in paragraph 1." If the cost to the Secretary for a 45 pill, or more, 30-day monthly supply is $8.00, as described in paragraph 1, why then are veterans' being charged $24.00 (split pill) for an $8.00 30-day supply?
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Imagine, 30, 60, 90, or more 30 day $8 supplies of medication so low in cost to the VA, and considered by the VA so insignificant it was not even considered as a factor in determining and setting the co-pay cost. 12/6/01,Federal Register: ?VHA conducted a study of the pharmacy administrative costs relating to the dispensing of medication on an out-patient medication... even without consideration of the actual cost of the medication.?
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Update to my Board of Veterans Appeals claim submitted Dec. 29, 2005.
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My claim effecting VA prescription over-charges for split pill supplies of well over 1.1 million veterans' remains on the docket as originally scheduled. Illinois Senator Richard Durbin made an appeal on my behalf to advance my case on the docket, because of the ?general application? nature of my claim, effecting millions of veterans?. However, the requirement to advance relies on the precise language, ?general application effecting other claims?. Because my claim may perhaps be the only claim, the BVA would not budge. Never mind the over-charges for those millions of veterans. For them, and me, these over-charges will continue. During my recent call to them (1/22/07), I was told the Board is presently working on claims submitted in March 2005.
=
As you may know, veterans pay a co-pay of $8.00 for each 30-day prescription. However, there are well over 1.1 million VA prescriptions that veterans are being over-charged for, in violation of the law. In other words double the cost. Something I?ve been fighting for over 5 years. Veterans continue to be over-charged and they will never recover their loss.
=
I began informing the Veterans Administration in March 2002, that the VA is in violation of 38 USC 1722a, regarding prescription co-payment over-charges. Where is this case at the moment? But first, being unfamiliar with my claim, briefly.. paragraph 1 states, that a veteran is required to pay $8 for a 30-day prescription. This 30-day supply can be 30, 60 or 90 pills, all for the $8 co-pay cost.
=
Here?s the United States Code; 38 USC 1722a. ?Paragraph (a)(1) subject to paragraph (2), the Secretary shall require a veteran to pay the United States $8.00 for each 30 day supply of medicine?if the amount supplied is less than a 30 day supply the amount of the charge may not be reduced.?
=
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.?
=
I will explain the VA violation by illustrating in this example, a normal 30 day supply, using a 30 pill prescription, $8 veteran co-payment. The VA, using creative accounting, will use this same exact identical prescription and supply, and increase the cost from $8 to $16. Double the cost. Why? Because? the prescription requires splitting pills. This 30 pill, $8 supply is now a 2 month, split 15 pill, 30 day, $16 co-pay supply.
=
While your taking in that $16 supply, keep in mind the 30,60,90 pill, 30-day supplies at $8 copay.
=
Paragraph 2, states, ?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.? And what was the described co-pay cost? To the veteran who?s prescription for the exact identical 30-day, 30 pill supply, ?..as described in paragraph 1?, it was $8.
=
There may be those who want to believe, these 15 split pill prescriptions, in reality, are $8 co-pay, 30-day supplies, as paragraph 1 suggests. I submit that, with no mention of quantity, but considering the abundant supplies shipped, the amount of the 30-day supplies involved, neither the Code of Federal regulations, or the United States Code itself, gives reference, to greater co-pay costs beyond what has been established for like 30-day, $8 co-pay supplies. This generous abundance.... of seemingly endless supply, and availability of medication of 30, 60, 90 or more, $8, 30-day supplies, stops at a prescription that calls for pill splitting. This $8, 30-day supply has been limited to only 15 pills, and has doubled in cost.
=
To those of you, as well as those at the Veterans Administration, who may be confused, to the meaning of 30 day supplies, 38 USC 1722a paragraph 1 states, ?..the Secretary shall require a veteran to pay the United States $8.00 for each 30 day supply of medication.?
=
The Veterans' Medical Care Appropriations and Funding Process, dated 9/30/2004. Congressional Research Service (CRS) report for Congress explains and supports further my BVA claim, and this 30-day or less cost. Stated in the ....
The Veterans Millennium Health Care and Benefits Act of 1999 (P. L. 106-117)
authorized VA to increase the medication co-payment amount and to establish annual
caps on the medication co-payment amount.26
=
26 "This law allowed VA to increase the co-payment amount for each 30-day or less supply of medication provided on a outpatient basis (other than medication administered during treatment) for treatment of a non-service-connected condition."
=
"Other than medication administered during treatment", CRS documentation describing the co-pay charge, and how it is to be applied. This is of further significance in understanding 38 USC 1722a. Meaning medication required in the treatment of more than one 30-day supply of 15 pills (split), this law does not allow an increase in the co-payment for, "..an amount in excess of the cost to the Secretary for medication as described in paragraph 1." If the cost to the Secretary for a 45 pill, or more, 30-day monthly supply is $8.00, as described in paragraph 1, why then are veterans' being charged $24.00 (split pill) for an $8.00 30-day supply?
=
Imagine, 30, 60, 90, or more 30 day $8 supplies of medication so low in cost to the VA, and considered by the VA so insignificant it was not even considered as a factor in determining and setting the co-pay cost. 12/6/01,Federal Register: ?VHA conducted a study of the pharmacy administrative costs relating to the dispensing of medication on an out-patient medication... even without consideration of the actual cost of the medication.?
=
Update to my Board of Veterans Appeals claim submitted Dec. 29, 2005.
=
My claim effecting VA prescription over-charges for split pill supplies of well over 1.1 million veterans' remains on the docket as originally scheduled. Illinois Senator Richard Durbin made an appeal on my behalf to advance my case on the docket, because of the ?general application? nature of my claim, effecting millions of veterans?. However, the requirement to advance relies on the precise language, ?general application effecting other claims?. Because my claim may perhaps be the only claim, the BVA would not budge. Never mind the over-charges for those millions of veterans. For them, and me, these over-charges will continue. During my recent call to them (1/22/07), I was told the Board is presently working on claims submitted in March 2005.
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