2 December 2015 Legislative News Update
weekly electronic newsletter, and is published
every Thursday when Congress is in session.
NEW RULES ANNOUNCED FOR THE VETERANS’ CHOICE PROGRAM
The Surface Transportation and Veterans’ Health Care Choice Improvement Act of 2015, signed into law July 31, included provisions designed to make participation in the Veterans’ Choice Program easier and more convenient. The Department of Veterans’ Affairs (VA) announced that the changes will be effective immediately.
Under the old policy, a veteran was eligible if he/she had enrolled in the VA healthcare system by August 2014; had experienced an unusual or excessive burden because of geographical challenges, environmental factors or a medical condition impacting the ability to travel; and lived more than 40 miles driving distance from the closest VA medical facility.
Now under the updated eligibility requirements, a veteran is eligible for the program if he/she is enrolled in the VA health care system and meets at least one of the following criteria:
- Cannot get an appointment at a VA facility within 30 days;
- Lives more than 40 miles driving distance from the closest VA medical facility with a full-time primary care physician;
- Needs to travel by air, boat or ferry to reach the VA medical facility closest to his/her home;
- Faces an unusual or excessive burden in traveling to the closest VA medical facility based on geographic challenges, environmental factors, a medical condition, the nature or frequency of the care needed and whether an attendant is needed; or,
- Lives in a State or Territory without a full-service VA medical facility which includes: Alaska, Hawaii, New Hampshire (Note: Veterans in New Hampshire who live within 20 miles of the White River Junction VAMC are excluded) and the United States Territories (excluding Puerto Rico, which has a full service VA medical facility).
“As we implement the Veterans Choice Program, we are learning from our stakeholders what works and what needs to be refined,” said VA Secretary Robert A. McDonald. “It is our goal to do all that we can to remove barriers that separate Veterans from the care they deserve.” To date, more than 400,000 medical appointments have been scheduled since the Veterans’ Choice Program went into effect on November 5, 2014.
To confirm Veterans who wish to eking to use the Veterans’ Choice Program or wanting to know more about it, can call1-866-606-8198 to confirm their eligibility and to schedule an appointment.
TRICARE BENEFICIARIES MUST MOVE MAINTENANCE DRUGS OUT OF RETAIL
A new law, mandated by the fiscal 2015 National Defense Authorization Act, requires TRICARE beneficiaries to refill prescriptions for select maintenance drugs through TRICARE Pharmacy Home Delivery or at a military pharmacy. Maintenance drugs are those you take on a regular, ongoing basis for chronic, long-term conditions such as those used to control blood pressure. This does not include drugs your doctor prescribes for a short-term condition, such as antibiotics.
The Defense Health Agency and Express Scripts, the TRICARE pharmacy contactor, advises that if TRICARE beneficiaries continue to fill the prescription at a retail pharmacy, they will pay 100% of the costs.
The law was effective on October 1, 2015, but allowed two 30-day refills of an affected drug from a retail pharmacy. For many, those two refills will run out in December.
The change does not apply to:
- active duty military members,
- short-term medications, such as antibiotics,
- generic medications,
- beneficiaries living overseas,
- beneficiaries who have other prescription drug coverage,
- beneficiaries who apply for and receive a waiver to continue having their prescriptions filled at a retail pharmacy. Waivers can be obtained by calling Express Scripts at 1-877-363-1303.
For more information call Express Scripts at 1-877-882-3335 or visit http://www.tricare.mil/RxNewRules.