VA medication good news, a foregone conclusion

Discussion in 'General Benefits' started by wheino sr., Jul 25, 2007.

  1. wheino sr.

    wheino sr. New Member

    Likes Received:
    0
    Trophy Points:
    0
    Regarding VA violation of 38 USC 1722a.

    The Board of Veterans' Appeals, denial, Conclusion of Law, states, "The appellant is obligated to pay VA copayment for each 30-day or less supply of medication provided by VA on an outpatient basis. 38 U.S.C.A. Sec. 1722a; 38 C.F.R. Sec. 17.110 (2006)."

    Finally, after the Criteria and Analysis, and references to other law statutes, the Board, in concluding states, “38 USCA 1722a clearly pertains to VA’s cost in dispensing the medication, not the cost to the appellant... The Federal register of July 16th, 2001; Also under U.S.C. 1722A, VA may not require a veteran to pay an amount in excess of the actual cost of medication and pharmacy administrative costs related to the dispensing of the medication. VHA conducted a study...and found that the VA incurred a cost of $7.28 to dispense an outpatient medication....under these circumstances, we believe that a $7 copayment would not exceed VA’s cost.”

    Clearly, dispensing of medication is the key to the Board’s argument, as well as mine.

    The VA pharmacy dispenses a supply of 30 pills, the copay cost, whether the amount is 15, 30, 60, or 90 pills the copay is $8. A 30 pill prescription may require that the supply be split. Now becoming a 2 month supply. VA’s copayment charge is $16.

    A supply of 30 pills carries the maximum copayment charge of $8, for a 30-day supply, and a veteran is not required to pay an amount in excess of the cost to the Secretary, as described in 38 USC 1722a paragraph 2, and noted in the Decision of the Board of Veterans Appeals reference. The Board citing the Federal register, 12/6/2001. “The VA incurred a cost of $7.28 to dispense an outpatient medication..” (rounded out to $8). Why is it, that a veteran is charged $16 for the exact same $8 prescription, 30 pill supply?

    The BVA in denying the appeal, they cite, “.. 1722a clearly pertains to VA‘s cost in dispensing the medication...,The VA incurred a cost...to dispense medication..”, providing the answer to their apperception. Dispensing! The VA charges the veteran twice, or double, as claimed, for the same dispensing cost required to dispense the exact same, one(1) 30-day, $8 supply. Exceeding the cost a veteran is not required to pay. I, like the Board, I am, “..unable to find any authority allowing for a deviation from the standard copayment.” As well, “The Board has no authority to act outside the constraints of the statutory and regulatory criteria.”
  2. wheino sr.

    wheino sr. New Member

    Likes Received:
    0
    Trophy Points:
    0
    Now the no-so-good news..
    =
    DALLAS, Jan. 13, 2009 — Fewer veterans filled their prescriptions for cholesterol-lowering drugs after an increase in co-payment costs for prescription drugs, researchers report in Circulation: Journal of the American Heart Association.
    =
    The question of excessive copay for VA split pill prescriptions has been settled. Even though the VA mentions their concern for “reasonable charges.., billings practices closer to industry standard charge structures and billing practices”, and the question of “actual cost of dispensing” , veterans will continue to be overcharged for spilt pill prescriptions. The United States Court of Appeals for Veterans’ Claims has made their ruling. A two (2) to one (1) decision. Judge Hagel, dissented, and accordingly, found the ruling, “..arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law.” and filed a separate opinion. University of Washington School of Law professor Thomas Andrews agrees, “Overall, I am sympathetic to the Court and the VA’s desire to avoid doing a cost analysis on every single drug but find Judge Hagel to be legally more persuasive.” Judge Hagels comments follow.
    =
    UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS.
    NO. 09-112 (Decided April 11, 2011)
    =
    “HAGEL, Judge, joins, concurring in part and dissenting in part: I concur with the majority's conclusion that the plain and unambiguous language of 38 U.S.C. § 1722A(a)(1) requires a veteran to pay a full copayment for a 30-day supply of medication, without regard to the dosage or number of pills prescribed to the veteran. I write separately, however, to express my disagreement with the majority's conclusion that the phrase "cost to the Secretary for medication," as used in section 1722A(a)(2), is susceptible to more than one interpretation.”
    =
    “When a pure question of law, such as the interpretation of a statute, is at issue, the Court
    reviews the conclusions of the Board de novo, without deference. Smith v. Gober, 14 Vet.App. 227, 230 (2000). As explained above, after reviewing the language of section 1722A, I would conclude that the plain and unambiguous language of subsection (a)(2) prohibits the Secretary from requiring a veteran to pay an amount in excess of the cost to the Secretary for each 30-day supply of medication furnished to him or her, without regard to the administrative costs incurred by the Secretary in actually dispensing such medication. I would therefore conclude that the Board's interpretation of that provision was arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law. See Kent v. Principi, 389 F.3d 1380, 1384 (2004) (holding that the "arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law" standard of review "contemplates de novo review of questions of law"). Accordingly, I would set aside the Board's December 2008 decision to the extent that it concluded that the appellant's copayment was not excessive under section 1722A(a)(2) and would remand the matter for further development and readjudication consistent with a proper interpretation of section 1722A(a)(2).
    =
    Lastly, I understand that some might say that the interpretation that I express would place
    an unnecessary accounting burden on VA. The calculation that I believe the statute requires VA to make in these instances is, however, routinely made up front by private pharmacies when determining the profit margin sought on each drug dispensed to their customers. Thus, I do not believe that such a calculation places an unreasonable burden on VA. As a result, I do not believe that my interpretation of section 1722A produces an absurd result”.
  3. abc160561b1

    abc160561b1 Member

    Likes Received:
    0
    Trophy Points:
    16
  4. abc160561b1

    abc160561b1 Member

    Likes Received:
    0
    Trophy Points:
    16
  5. abc160561b1

    abc160561b1 Member

    Likes Received:
    0
    Trophy Points:
    16
    Thị trường hàng xách tay nhập khẩu rất sôi động, đặc biệt là vào cuối năm.
    Không còn len lỏi trong những ngõ nhỏ để bán vài món mỹ phẩm, quần áo…, cửa hàng bán hàng xách tay những năm gần đây mọc lên như nấm ở những phố trung tâm Hà Nội. Nhiều cửa hàng dù chỉ có vài chục mét vuông cũng trương biển "Siêu thị hàng xách tay" để thu hút người tiêu dùng, với sản phẩm từ cuộn giấy vệ sinh đến những lọ nước hoa, thuốc đông y... Chuộng nhất vẫn là hàng xuất xứ từ các nước châu Âu (Pháp, Đức), Nhật, Hàn Quốc...

    Thị trường cũng rất nhiều loại, nếu bạn muốn hàng Đức chuẩn tốt nhất là vào website http://hangxachtayduc365.com/

Share This Page