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VA RIN: 2900-AP35 Publication ID: Spring 2017 
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. Prior to this final rule, VA charged non-exempt veterans either $8 or $9 for each 30-day or less supply of medication, and that amount may have changed in future years. This rulemaking replaces those rates and establishes three classes of medications for copayment purposes, identified as Tier 1, Tier 2, and Tier 3. These tiers are defined further in the rulemaking and 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. For non-exempt veterans these copayment amounts will result in lower out-of-pocket costs, thereby encouraging greater adherence to taking prescribed medications and reducing the risk of fragmented care that results when veterans use non-VA pharmacies to fill their prescriptions.

 
Agency: Department of Veterans Affairs(VA)  Priority: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Completed Actions 
Major: Yes  Unfunded Mandates: No 
CFR Citation: 38 CFR 17.110   
Legal Authority: 38 U.S.C. 501   
Legal Deadline:  None
Timetable:
Action Date FR Cite
NPRM  01/05/2016  81 FR 196   
NPRM Comment Period End  03/07/2016 
Final Rule  12/12/2016  81 FR 89383   
Final Rule Effective  02/27/2017 
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

Bridget Souza
Deputy Director, Business Policy CBO
Department of Veterans Affairs
90 K Street NE.,
Washington, DC 20002
Phone:202 382-2537
Email: bridget.souza@va.gov