Eligibility of medicare-eligible veterans for out-patient medication benefit

(a)

Restatement of current law on drugs and medications and provision of Out-Patient medication benefit

Chapter 17 of title 38, United States Code, is amended by inserting after section 1710B the following new section:

1710C.

Drugs and medications; vaccines

(a)(1)The Secretary shall furnish to each veteran who is receiving additional compensation or allowance under chapter 11 of this title, or increased pension as a veteran of a period of war, by reason of being permanently housebound or in need of regular aid and attendance, such drugs and medicines (subject to subsection (d)) as may be ordered on prescription of a duly licensed physician as specific therapy in the treatment of any illness or injury suffered by such veteran. (2)The Secretary shall continue to furnish such drugs and medicines ordered under paragraph (1) to any such veteran in need of regular aid and attendance whose pension payments have been discontinued solely because such veteran’s annual income is greater than the applicable maximum annual income limitation, but only so long as such veteran’s annual income does not exceed such maximum annual income limitation by more than $1,000. (b)(1)Any medicare-eligible veteran may elect to be furnished by the Secretary, on an out-patient basis, such drugs and medicines (subject to subsection (d)) as may be ordered on prescription of a duly licensed physician as specific therapy in the treatment of any illness or injury suffered by such veteran. (2)In this subsection, the term medicare-eligible veteran means any veteran who— (A)is entitled to or enrolled in hospital insurance benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); or (B)is enrolled in the supplementary medical insurance program under part B of such title (42 U.S.C. 1395j et seq.). (3)The Secretary shall furnish to any veteran who makes an election under paragraph (1), on an out-patient basis, such drugs and medicines as may be ordered on prescription of a duly licensed physician as specific therapy in the treatment of any illness or injury suffered by such veteran. (4)(A)Notwithstanding any other provision of law and except as provided in subparagraph (B), a veteran who makes an election under paragraph (1) shall not be eligible for care and services under this chapter during the year covered by the election. (B)Subparagraph (A) shall not apply with respect to any veteran who has a compensable service-connected disability. (5)The furnishing of drugs and medicines under this subsection shall be subject to the provisions of section 1722A(b) of this title. (6)(A)An election under paragraph (1) shall be for a calendar year, and shall be irrevocable for the year covered by such election. An election may be renewed. (B)The Secretary shall prescribe the form, manner, and timing of an election. (7)Before permitting a veteran to make an election under paragraph (1), the Secretary shall provide the veteran such educational materials and other information on the furnishing and receipt of drugs and medicines under this subsection as the Secretary considers appropriate to inform the veteran of the benefits and costs of being furnished drugs and medicines under this subsection, including materials and information on the consequences of making an election under paragraph (1) and on the fees, copayments, or other amounts required under section 1722A(b) of this title for drugs and medicines furnished under this subsection. (c)(1)In order to assist the Secretary of Health and Human Services in carrying out national immunization programs under other provisions of law, the Secretary may authorize the administration of immunizations to eligible veterans who voluntarily request such immunizations in connection with the provision of care for a disability under this chapter in any Department health care facility. (2)Any immunization under paragraph (1) shall be made using vaccine furnished by the Secretary of Health and Human Services at no cost to the Department. For such purpose, notwithstanding any other provision of law, the Secretary of Health and Human Services may provide such vaccine to the Department at no cost. (3)Section 7316 of this title shall apply to claims alleging negligence or malpractice on the part of Department personnel granted immunity under such section. (d)Drugs and medicines may be furnished under subsections (a) and (b) only if included on the National Prescription Drug Formulary of the Department, except that the Secretary may authorize the furnishing of a drug or medicine not included on that formulary under such circumstances as the Secretary determines warranted.

(b)

Copayment requirements

(1)

In general

Section 1722A of such title is amended— (A)in subsection (a)(1), by inserting (other than a veteran covered by subsection (b)) after require a veteran; (B)by redesignating subsections (b) and (c) as subsections (c) and (d), respectively; and (C)by inserting after subsection (a) the following new subsection (b):

(b)(1)In the case of a veteran who is furnished medications on an out-patient basis under section 1710C(b) of this title, the Secretary shall require the veteran to pay, at the election of the Secretary, one or more of the following: (A)An annual enrollment fee in an amount determined appropriate by the Secretary. (B)A copayment for each 30-day supply of such medications in an amount determined appropriate by the Secretary. (C)An amount equal to the cost to the Secretary of such medications, as determined by the Secretary. (2)(A)In determining the amounts to be paid by a veteran under paragraph (1), and the basis of payment under one or more subparagraphs of that paragraph, the Secretary shall ensure that the total amount paid by veterans for medications under that paragraph in a year is not less than the costs of the Department in furnishing medications to veterans under section 1710C(b) of this title during that year, including the cost of purchasing and furnishing medications, and other costs of administering that section. (B)The Secretary shall take appropriate actions to ensure, to the maximum extent practicable, that amounts paid by veterans under paragraph (1) in a year are equal to the costs of the Department referred to in subparagraph (A) in that year. (3)In determining amounts under paragraph (1), the Secretary may take into account the following: (A)Whether or not the medications furnished are generic medications or brand name medications. (B)Whether or not the medications are furnished by mail. (C)Any other matters the Secretary considers appropriate. (4)The Secretary may from time to time adjust any amount determined by the Secretary under paragraph (1), as previously adjusted under this paragraph, in order to meet the purpose specified in paragraph (2).

(2)

Deposit of collections in medical care collections fund

Paragraph (4) of section 1729A(b) of such title is amended to read as follows:

(4)Subsection (a) or (b) of section 1722A of this title.

(c)

Conforming amendments

(1)

Enrollment ineligibility

Section 1707 of such title is amended by adding at the end the following new subsection:

(c)Notwithstanding any other provision of law, a veteran who makes an election authorized by section 1710C(b) of this title (other than a veteran covered by paragraph (4)(B) of that section) shall not, for the period of such election, be eligible for care and services under this chapter, except as provided in that section.

(2)

Repeal of restated provisions

Section 1712 of such title is amended by striking subsections (d) and (e). (d)

Clerical amendments

(1)

Section heading

The heading for section 1712 of such title is amended to read as follows:

1712.

Dental care

(2)

Table of sections

The table of sections at the beginning of chapter 17 of such title is amended— (A)by inserting after the item relating to section 1710B the following new item:

1710C. Drugs and medications; vaccines.

; and

(B)by striking the item relating to section 1712 and inserting the following new item:

1712. Dental care.