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VA RIN: 2900-AP35 Publication ID: Fall 2016 
Title: Tiered Pharmacy Copayments for Medications 
Abstract:

The Department of Veterans Affairs (VA) adopts as a final rule, with changes, a proposal to amend its regulations concerning copayments charged to certain veterans for medication required on an outpatient basis to treat nonservice-connected conditions. This rulemaking establishes three classes of medications for copayment purposes, identified as Tier 1, Tier 2, and Tier 3. These tiers are distinguished in part based on whether the medications are available from multiple sources or a single source, with some exceptions. Copayment amounts are fixed and would vary depending upon the class of medication. The following medication copayment amounts are applicable on the effective date of this final rule: $5 for a 30-day or less supply of a Tier 1 medication, $8 for a 30-day or less supply of a Tier 2 medication, and $11 for a 30-day or less supply of a Tier 3 medication.

 
Agency: Department of Veterans Affairs(VA)  Priority: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Final Rule Stage 
Major: Yes  Unfunded Mandates: No 
EO 13771 Designation: uncollected 
CFR Citation: 38 CFR 17.110   
Legal Authority: 38 U.S.C. 501   
Legal Deadline:  None

Statement of Need:

This rulemaking will result in lower out-of-pocket costs for most veterans, thereby encouraging greater adherence to prescribed medications and reducing the risk of fragmented care that results when veterans use multiple pharmacies to fill their prescriptions.

Summary of the Legal Basis:

38 U.S.C. 501

Alternatives:

Anticipated Costs and Benefits:

Risks:

Timetable:
Action Date FR Cite
NPRM  01/05/2016  81 FR 196   
NPRM Comment Period End  03/07/2016 
Final Rule  12/00/2016 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Small Entities Affected: No  Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
Kristin Cunningham
Chief, Business Office (16)
Department of Veterans Affairs
Veterans Health Administration, 810 Vermont Avenue NW.,
Washington, DC 20420
Phone:202 461-1599
Email: kristin.cunningham@va.gov