VA Health Care: Opportunities to Significantly Reduce Outpatient Pharmacy Costs
HEHS-97-15
Published: Oct 11, 1996. Publicly Released: Oct 11, 1996.
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Highlights
GAO reviewed the Department of Veterans Affairs' (VA) provision of over-the-counter (OTC) medications, medical supplies, and dietary supplements to veterans, focusing on: (1) what OTC products VA pharmacies dispense; (2) how VA provision of OTC products compares with that of non-VA health care providers; (3) how much VA spends on OTC products and how much VA recovers through veterans' copayments; and (4) opportunities to reduce federal expenditures for OTC products.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| Congress could reduce federal expenditures for OTC products provided to veterans by amending 38 U.S.C. 1722A to increase the medication copayment amount. | The Veterans Millennium Health Care and Benefits Act (P.L.106-117) gave the Secretary, Department of Veterans Affairs, authority to increase the amount of the medication copayment. | |
| Congress could reduce federal expenditures for OTC products provided to veterans by amending 38 U.S.C. 1722A to expand the coverage of the medication copayment to include medical supplies. | The Congress has not addressed this issue. | |
| Congress could reduce federal expenditures for OTC products provided to veterans by amending 38 U.S.C. 1722A to lower the income threshold VA uses to determine which veterans owe medication copayments. | The Congress has not addressed this issue. |
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should require the Under Secretary of Health to limit OTC products for nonservice-connected conditions to those most directly related to VA hospitalizations or those considered most essential to prevent hospitalization. |
VA intends to take no further action. This is because VA does not believe that it can implement the recommendation uniformly among its 172 facilities.
|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should require the Under Secretary of Health to standardize the availability of OTC products to give veterans more consistent levels of access to them systemwide. |
VA directed the establishment of a national drug formulary (VHA Directive 96-063) that will standardize the availability of OTC products for veterans nationwide.
|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should require the Under Secretary of Health to reduce VA dispensing costs for OTC products by: (1) providing, when appropriate, more economical quantities (more than a 90-day supply) of medications and supplies; and (2) limiting mail service to certain situations. |
VA has taken steps to reduce dispensing costs by encouraging multi-month dispensing nationwide when appropriate. However, VA does not intend to limit mail service because it considers this to be a reasonable service that obviates the need for veterans to make time-consuming trips to the facility for the sole purpose of picking up OTC products.
|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should require the Under Secretary of Health to require veterans to make copayments at the time OTC products are dispensed. |
VA does not intend to require veterans to make copayments at the time OTC products are dispensed. However, VA has encouraged veterans to make copayments when OTC products are dispensed. VA will not deny a medically necessary product if, for some reason, a veteran can not make a copayment at the time the products are dispensed.
|
| Department of Veterans Affairs | The Secretary of Veterans Affairs should require the Under Secretary of Health to direct facilities to apply the statutory income threshold to determine which veterans owe medication copayments. |
In March 1997, VA issued a directive (VHA Directive 97-011) which required facilities to apply it to determine which veterans owe medication copayments.
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Budget receiptsCommercial productsDrugsHealth care cost controlHealth care programsHealth insuranceMedicaidMedical suppliesMedicarePatient care servicesVeterans benefitsDeductibles and CoinsuranceMedical copayments