September 30, 2015
What Veterans Choice Means for Community Pharmacists
Washington, D.C.—The Veterans Choice Program, which allows patients treated by the Veterans Health Administration to get outside care if they live more than 40 miles from a VA hospital or have an excessively long wait time for an appointment, has been widely publicized. Yet, not much information has been disseminated on how it affects community pharmacists asked to fill prescriptions for program participants.
The program, passed by Congress last year, established a 3-year pilot program that pays for non-VA care for enrolled veterans. Recently, the program has been amended to apply to veterans “based on geographic challenges, environmental factors, or a medical condition.”
Usually, veterans under VA care are required to visit an in-house provider to get a prescription that can be deemed medically necessary and appropriate, and then filled at a VA pharmacy.
In its Interim Final Rule, however, the VA provided veterans eligible for the Choice program a special exemption from this validation requirement. The department said it recognized that “imposing such a requirement on veterans eligible under the program would not make sense because their eligibility is predicated on either being unable to be seen within a timely manner or because of difficulties they face in traveling to a VA medical facility.”
As a result, the VA will fill and pay for most prescriptions written by Choice providers, including prescriptions for drugs, over-the-counter medications and medical and surgical supplies.
So where do community pharmacies fit in?
If there is an urgent need, VA patients can fill a prescription at any local, non-VA pharmacy. Those prescriptions are limited to a 14-day supply with no refills, however, and veterans are required to pay upfront for them. The patient then can submit a request for reimbursement to the VA.
Adding to the confusion is that the Veterans Choice Program is being administered by more than one contractor in three regions. So, for veterans and providers who fall in the region where Health Net serves as the third-party administrator, urgent prescriptions filled at an outside pharmacy must conform to the National Formulary.
In Truest regions, on the other hand, providers are allowed to write prescriptions for 14 days of an urgently or emergently needed medication to be filled at an outside pharmacy but must complete the Formulary Request Review Form to the VA for consideration for any additional days of the medication.
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