Function 700 - Veterans' Benefits and Services
Increase Prescription Drug Copayments for All Veterans
CBO periodically issues a compendium of policy options (called Options for Reducing the Deficit) covering a broad range of issues, as well as separate reports that include options for changing federal tax and spending policies in particular areas. This option appears in one of those publications. The options are derived from many sources and reflect a range of possibilities. For each option, CBO presents an estimate of its effects on the budget but makes no recommendations. Inclusion or exclusion of any particular option does not imply an endorsement or rejection by CBO.
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Veterans who enroll in the health care system of the Department of Veterans Affairs (VA) have little or no out-of-pocket costs for medications that treat health conditions not connected to the veteran's military service. Veterans who have a service-connected disability rating of at least 50 percent, who have a disability that makes them unemployable, or who have received the Medal of Honor do not have to pay for prescriptions. Most other veterans have small copayments, which are tiered by type of drug: preferred generic, nonpreferred generic and some over-the-counter, and brand name.
In 2021, copayments ranged from $5 to $11 for a 30-day prescription, with an annual limit of $700. Those rates and the annual limit have not changed since 2017.
This option would remove the annual $700 cap and increase copayments for all enrolled veterans to rates similar to those paid by TRICARE beneficiaries at retail pharmacies. Under this option, copayments would range from $14 to $68 for a 30-day prescription, depending on the type of drug. Rates would be adjusted for inflation, similar to how retail prescription copayments are calculated under the TRICARE program.