VA prescription co-pay?

rufrdr

rufrdr

Well-Known Member
Supporting Member
Joined
Jun 22, 2018
Messages
4,306
Location
Willow Spring
Rating - 100%
81   0   0
My non VA doc just put me on Humira which has a 2k a month co-pay through my medicare advantage program. The pharmacy is applying on my behalf to the maker for co-pay relief but no idea if or how much it will be. I can't afford 2k a month for a prescription.

I have free VA medical care that I have only used for glasses and hearing aids. Do prescriptions from the VA have a co-pay? I am told this drug is a tier 5.
 
I pay a copay for some of my prescriptions but they are prescribed through the VA.
 
DRFury said:
I pay a copay for some of my prescriptions but they are prescribed through the VA.
Click to expand...
Turns out the pharmacy hasn't applied for anything on my behalf so I have to start calling for co pay assistance on my own. I may see if I can get an appointment with a VA specialist.
 
It really depends on what your disability rating is. If you’re getting glasses and hearing aids, you’re probably service connected enough for prescriptions…maybe.
 
I think there’s some sort of federal program that takes a good chunk of the humira cost. The wife had it, I’ll ask her the details.
 
rufrdr said:
10% and 0% service related.
Click to expand...
Yeah, best thing you can do is talk to the VA. I’m sure there’s going to be a co pay.
 
Last edited:
It’s called the patient assistance program.

Here

Give them a call. I do remember the wife having to stay on top of the payouts from the program, but it really helped with the cost of humira.
 
Last edited:
Only problem with VA and specialty medicines is they have to be prescribed by their specialists. At least in my case, until I go to a VA endocrinologist the regular doctor can't write the prescription.
 
At 10% disability rating, a copay test determines if you'll pay for meds. You need to be below the VA pension threshold (approx $16k annual income for a single veteran), otherwise meds are $5, 8, or 11 for 30day supplies depending on if generic or name brand.

You can only request a waiver through the billing office after you've incurred the bills, they're going to do a deeper financial assessment to determine if you qualify.
 
rufrdr said:
Turns out the pharmacy hasn't applied for anything on my behalf so I have to start calling for co pay assistance on my own. I may see if I can get an appointment with a VA specialist.
Click to expand...

Its a pretty painless process, go to your va hospital and fill out a release of information form so va can get your current docs records. VA should fill those scrips no problem
 
If it a Medication that the VA will cover I have one that neither the VA or Tricare will cover
 
DonRavioli said:
It’s called the patient assistance program.

Here

Give them a call. I do remember the wife having to stay on top of the payouts from the program, but it really helped with the cost of humira.
Click to expand...
Thanks, talked to them today and started the process. I think I'll see about setting up an appointment with the primary at VA to get a referral too.
 
I talked with my Medicare HMO today about the prescription cost. I was told that the actual cost of a monthly prescription is $8,000 and that total cost of which I pay 2k puts me in the catastrophic coverage range at which point I pay $450 a month. Still haven't heard back from the co-pay assistance people but I am moving ahead on this.
I will also approach the V.A. to see what they say on the prescription cost.
 
Talked to the VA today: if I get a VA doc to prescribe the Humira it has a co-pay of $11 per month! I've made an appointment with the Clayton VA facility for Monday with a primary care doctor to get a referral to a rheumatology doc to see about the VA doing the prescription. Even if it takes months to get an appointment with the specialist it will be worth it! I stopped the prescription fill with Acreedo.
 
Last edited:
Visited the VA today in the process to get Humira. I was there from 10 to 2:30, they were incredibly thorough. I was seen by two docs together who easily spent over 30 minutes reviewing my medical situation. I had 7 vials of blood drawn, multiple x rays done and ultrasounds also done. They sent me on my way with 4 prescriptions to hold me until the Humira is worked out.

I've said it before but it is worth repeating: the staff at the Durham VA are the nicest, kindest, most helpful group of people under one roof I have ever encountered.

I got home to find a letter from Duke medical telling me that the RA doc that I waited months to get an initial appointment with, and saw only once, is gone and they are shutting that unit down. The letter essentially wished me luck. The doc had gone radio silence about a month ago. I had a follow up appointment scheduled next week that I was going to cancel anyway.

Thank God for the VA.
 
Last edited:
You must log in or register to reply here.
Back
Top Bottom