Prescription Copays with A VA Disability Rating

Prescription Copays with A VA Disability Rating

VA disability ratings provide more value than compensation. It opens doors that few veterans know about, like prescription medications and co-payments. While the information on this is available, it can be challenging to find. No worries though, we intend to break it down for you here. 

VA Exemption Requirements 

There is no surprise the VA has requirements for veterans to meet for eligibility on all the medical and disability benefits available. However, if a veteran meets some of the requirements already, it provides more benefits. Take prescription medication copay exemption. 

As stated on the VA’s website, “Exemptions… are provided for veterans service-connected 50% or more, former POWs, and for veterans whose income is less than the established dollar threshold.” Additionally, veterans are also exempt if they are receiving treatment for any of the following: 

  • Ionizing Radiation 
  • Agent Orange
  • Persian Gulf 
  • Military Sexual Trauma 
  • Certain Cancers of The Head And Neck  
  • Recent Combat Veterans 

If you are service connected with a 40% VA disability or lower and based on your income, you could qualify for free medications as well. It is important to note that your financial income is a vital factor in qualifying, and it can vary by state. According to the VA, they may ask a veteran to “provide their gross household income (which includes spouse/partner and dependent children, if applicable) for the previous year when applying for enrollment for VA health care.”  

Medication Copays Through The VA 

Back on February 27th, 2016, the VA changed the drug copay process, which reduced the annual copay cap of $960 to $700. What this means is that veterans are only required to make a copay for medications that are for non-service connected disabilities. For example, if you are rated for tinnitus and receive a prescription for triglycerides, more than likely, you’ll pay the VA’s copay. 

Here are the VA’s 2019 outpatient medication copay amounts. 

Outpatient medication tier 1-30 day supply 31-60 day supply 61-90 day supply 
Tier 1 
(preferred generic prescription medicines) 
$5 $10 $15 
Tier 2 
(non-preferred generic prescription medicines and some over-the-counter medicines) 
$8 $16 $24 
Tier 3 
(brand-name prescription medicines) 
$11 $22 $33 

VA Resources to Get Started With 

While the amount of information can get overwhelming, we suggest starting here with the VA. Once you are on the VA’s website, click on “Determine the income limit for your residential area, based on your number of dependents”. This opens a pop-up. In the pop-up, input your residential zip code and number of dependents. You’ll then see specific thresholds in your area. 

We know that not everything is black and white. If you have questions about receiving VA compensation, and you want real answers from real Veterans who have been through the same, please give us a call today at 800-761-9004 or get started with our medical self-assessment. Strategic Veteran is a free resource for all Veterans.