§17.110 Co-payments for medication.

(a) General. This section sets forth requirements regarding Co-payments for medications provided to veterans by VA.

(b) Co-payments .

(1) Unless exempted under paragraph (c) of this section, a veteran is obligated to pay VA a co-payment for each 30-day or less supply of medication provided by VA on an outpatient basis (other than medication administered during treatment). For the period from February 4, 2002 through December 31, 2002, the co-payment amount is $7. The co-payment amount for each calendar year thereafter will be established by using the Prescription Drug component of the Medical Consumer Price Index as follows: For each calendar year beginning after December 31, 2002, the Index as of the previous September 30 will be divided by the Index as of September 30, 2001. The ratio so obtained will be multiplied by the original co-payment amount of $7. The co-payment amount for the new calendar year will be this result, rounded down to the whole dollar amount.

Note to Paragraph (b) (1): Example for determining co-payment amount. If the ratio of the Prescription Drug component of the Medical Consumer Price Index for September 30, 2003, to the corresponding Index for September 30, 2001, is 1.2242, then this ratio multiplied by the original co-payment amount of $7 would equal $8.57, and the co-payment amount for calendar year 2004, rounded down to the whole dollar amount, would be $8.

(2) The total amount of Co-payments in a calendar year for a veteran enrolled in one of the priority categories 2 through 6 of VA’s health care system (see §17.36) shall not exceed the cap established for the calendar year. The cap for calendar year 2002 is $840. If the co-payment amount increases after calendar year 2002, the cap of $840 shall be increased by $120 for each $1 increase in the co-payment amount.

(c) Medication not subject to the co-payment requirements. The following are exempt from the co-payment requirements of this section:

(1) Medication for a veteran who has a service-connected disability rated 50% or more based on a service-connected disability or unemployability;

(2) Medication for a veteran’s service-connected disability;

(3) Medication for a veteran whose annual income (as determined under 38 U.S.C. 1503) does not exceed the maximum annual rate of VA pension which would be payable to such veteran if such veteran were eligible for pension under 38 U.S.C. 1521;

(4) Medication authorized under 38 U.S.C. 1710(e) for Vietnam-era herbicide-exposed veterans, radiation-exposed veterans, Persian Gulf War veterans, or post-Persian Gulf War combat-exposed veterans;

(5) Medication for treatment of sexual trauma as authorized under 38 U.S.C. 1720D;

(6) Medication for treatment of cancer of the head or neck authorized under 38 U.S.C. 1720E; and

(7) Medications provided as part of a VA approved research project authorized by 38 U.S.C. 7303. (Authority: 38 U.S.C. 501, 1710, 1720D, 1722A)

[66 FR 63451, Dec. 6, 2001]