[Congressional Record (Bound Edition), Volume 149 (2003), Part 5]
[Extensions of Remarks]
[Pages 6516-6518]
[From the U.S. Government Publishing Office, www.gpo.gov]




INTRODUCTION OF H.R. 1309, ``VETERANS PRESCRIPTION DRUG BENEFITS ACT OF 
                                 2003''

                                 ______
                                 

                            HON. LANE EVANS

                              of illinois

                    in the house of representatives

                        Tuesday, March 18, 2003

  Mr. EVANS. Mr. Speaker, today I am introducing H.R. 1309, ``The 
Veterans Prescription Drug Benefits Act of 2003'', legislation which 
will provide a revolutionary change in veterans' medical care.
  ``The Veterans Prescription Drug Benefits Act of 2003'' would allow 
veterans to be the first among America's seniors and disabled people to 
have a real, meaningful Medicare outpatient drug benefit. If our nation 
is serious about implementing a drug benefit for seniors, the 
legislation I am introducing today would speed the availability of a 
prescription drug benefit and could even result in savings for the 
Medicare trust fund by allowing VA to employ its considerable 
prescription drug purchasing and benefit management skills in 
administering the benefit for veterans who are Medicare eligible. 
Additionally, this legislation would realign VA health care, allowing 
VA to concentrate its health care assets on the many veterans who rely 
upon it for the majority of their care needs.
  ``The Veterans Prescription Drug Benefits Act of 2003'' would, for 
the first time, allow veterans to bring prescriptions ordered by 
physicians who are not affiliated with the Department of Veterans 
Affairs to the VA to be filled. It would also require the Medicare 
trust fund to pay the cost of this new benefit for veterans who choose 
it and who are also eligible for Medicare Part A and enrolled in 
Medicare Part B.
  Recently the Secretary of Veterans Affairs has decided to restrict 
enrollment of higher income veterans to those who were enrolled prior 
to January 17, 2002. Consequently, this legislation would allow 
veterans who no longer have the option of receiving a full continuum of 
health care services to receive subsidized prescription drug coverage 
from VA.
  Providing, this new drug benefit to Medicare eligible veterans could 
also have the effect of eliminating the enormous queues that have 
developed as higher income veterans have flooded the system to seek 
inexpensive prescription drugs. As of the end of January, about 202,000 
veterans had waited longer than six months for a first primary care 
visit or for necessary follow up care. Many of these veterans are 
likely to be Priority 7 or 8 veterans who constituted more than 75 
percent of VA's new users in 2002. Offering these veterans an 
opportunity for new drug coverage without first obtaining an 
appointment with a VA provider could have the effect of significantly 
reducing or entirely eliminating these waiting times. In fiscal year 
2002, VA estimates almost 900,000 veterans used the VA health care 
primarily or exclusively to fill drug prescriptions who would also be 
likely to take advantage of a new prescription drug benefit.
  At the end of 2000, VA's Office of Inspector General (IG) advised 
``VHA can reduce the cost impact of providing prescriptions to priority 
group 7 veterans, make additional resources available for veterans 
healthcare, and enhance the delivery of prescription services to 
veterans.'' (Audit of Veterans Health Administration (VHA) Pharmacy Co-
Payment Levels and Restrictions on Filling Privately Written 
Prescriptions for Priority Group 7 Veterans, Report No. 99-00057-4, 
December 20, 2000) This report suggested that VA could have saved more 
than $1.3 billion in fiscal year 2001 by eliminating the need for VA to 
re-examine veterans who have already received examinations and tests to 
receive prescriptions from private physicians. These savings were 
projected only for Priority 7 veterans, who were, at that time the 
group with the lowest priority for care. For all veterans, the IG might 
project even higher savings.
  While cognizant of his IG's finding, Secretary Anthony J. Principi 
testified before the Committee on Veterans Affairs that he believed 
that the IG did not factor in the additional costs of new demand for 
the prescription drug benefit. His response when asked about a 
prescription drug bill introduced in the 107th Congress by Mr. Wicker 
was:

       I would like nothing, better than to be able to provide 
     prescriptions for all of our veterans. And I very, very 
     seldom disagree with my IG about cost.
       There is no question that the IG is right that we would 
     save money if we did not have to do the medical evaluation, 
     like Mr. Simmons said earlier. . . . I think the doors would 
     come tumbling down by 25 million veterans or whatever 
     percentage are on prescriptions, seeking to get their 
     prescriptions filled at the VA. So I think yes, on the one 
     hand we would save money. But how do you control the workload 
     increase?
       If you just increase by 25 percent the number of veterans 
     who are coming to us for prescriptions--and that is not a 
     large number--the bill would be $9.2 billion. Fifty percent, 
     it would be $15.9 billion. Again, where do we get the money?

  Offering veterans an opportunity to receive subsidized drug coverage 
from VA through Medicare and receive the rest of their care from their 
choice of private providers is one possible solution to the Secretary's 
dilemma. My bill requires a veteran to choose between a VA benefit and 
a Medicare benefit. I do not believe it is likely that thousands of 
satisfied veterans would disenroll from VA to receive this new 
benefit--those with satisfactory access can receive even cheaper drugs 
as VA beneficiaries. However, particularly since Priority 8 veterans 
are being told they can no longer enroll for all health care services 
and waiting times make access to VA services difficult for some 
veterans, I believe some lower priority veterans might opt to receive 
the new Medicare benefit administered by VA. In addition, it would 
present a new option for subsidized drug coverage to Medicare--eligible 
veterans that might interest veterans who have never attempted to 
access the VA system.
  My bill also provides an option for veterans who have highly rated 
service-connected disabilities to have this coverage at VA expense to 
fill private sector physician written prescriptions. I believe this 
option might only be attractive to veterans that have serious access 
problems due to their distance from VA medical centers or other factors 
that make even the rare visits to physicians necessary for pharmacy 
refills extremely difficult.
  The yearly option to choose one system or the other--Medicare or VA--
for health care benefits offers the federal government an opportunity 
to assess the effect of coordinating multiple eligibilities without 
compelling veterans to choose between services to which they currently 
have open access. Because this is a new benefit, veterans' choice to 
enroll for that benefit would not be easily characterized as a 
dimunition--but rather would be an enhancement--to existing choices.
  Mr. Chairman, I believe the ``Veterans Prescription Drug Benefits Act 
of 2003'' offers a solution to many of the problems confronting VA 
today. It will allow VA to offer some benefit to veterans who have been 
``locked out'' of VA for the indefinite future and a more convenient 
choice for the many veterans currently in long queues for their first 
appointment for VA provided health care.
  I have letters of support from several of our major service 
organizations that I would like to insert into the Congressional 
Record.

                                            American Veterans,

                                       Lanham, MD, March 17, 2003.
     Hon. Lane Evans,
     Ranking Member, House Veterans' Affairs Committee, 
         Washington, DC.
       Dear Representative Evans: On behalf of the members of 
     AMVETS, I write to express our gratitude and support for your 
     leadership in proposing legislation to permit veterans to 
     obtain prescriptions from veterans' hospitals using 
     prescriptions written by hometown doctors.
       Currently, veterans are eligible to receive prescription 
     medications from the VA only if a VA physician prescribes the 
     medication. While insisting that a VA doctor see the patient 
     may not seem like too great an imposition, many of the more 
     than 200,000 veterans waiting over six months for a doctor's 
     appointment are waiting to have a prescription written and 
     filled.
       Your legislation would allow VA to fill veterans' 
     prescriptions written by hometown doctors under special 
     circumstances. First, the veteran would accept VA solely for 
     the purpose of filling prescriptions. Second, the veteran 
     would be required to make a copay based on the type of drug 
     treatment requested. And, third, the cost of the prescription 
     would be partially offset through Medicare reimbursement.
       This change would provide an avenue for many veterans to 
     receive timely access to prescription drugs and reduce the 
     number of veterans waiting to see a VA physician as well.

[[Page 6517]]

       Again, we appreciate your creative approach to solving an 
     issue facing many veterans and thank you for taking a very 
     big step toward helping veterans receive access to 
     prescription medications.
           Sincerely,
                                                 Richard A. Jones,
     National Legislative Director.
                                  ____



                                          The American Legion,

                                   Washington, DC, March 17, 2003.
     Hon. Lane Evans,
     Ranking Democratic Member, Committee on Veterans Affairs, 
         House of Representatives, Cannon House Office Building, 
         Washington, DC.
       Dear Representative Evans: The American Legion looks 
     forward to working with you and your staff on the draft 
     legislation, Veterans Prescription Drug Benefits Act of 2003. 
     This is a proposed new benefit program for Medicare-eligible 
     veterans that choose only to use the Department of Veterans 
     Affairs' (VA's) pharmaceutical services. The legislative 
     intent is to provide a new option for certain Medicare-
     eligible veterans; however, there are concerns:
       The American Legion does not agree with Priority Group 1 
     veterans paying any enrollment or co-payments for this 
     service.
       What is the impact on Medicare-eligible veterans in 
     Priority Groups 2-8 with service-connected medical 
     conditions? Would they have to disenroll to participate in 
     this program? If the Centers for Medicare and Medicaid 
     Services (CMS) funding fails to cover the actual cost of the 
     program, how will VA be reimbursed? Is CMS willing to adopt 
     this as a new Medicare program? Will this be scored as third-
     party reimbursements, an offset against annual discretionary 
     appropriations? Why must VA collect the enrollment fees and 
     co-payments, transfer these collections to CMS, then CMS 
     transfer funds back to VA?
       Will VA be staffed with qualified pharmaceutical personnel 
     to meet increased pharmaceutical demands?
       The American Legion applauds your efforts to solve one of 
     many challenges facing the VA health care system. The VA 
     health care system is a comprehensive program that addresses 
     the total range of veterans' health needs. Likewise, Congress 
     must address the overall problem of delivery and demand for 
     services from a growing patient population.
       Thank you for your continued leadership on behalf of 
     America's veterans.
       Sincerely,

                                              Steve Robertson,

                                                         Director,
     National Legislative Commission.
                                  ____



                                 Blinded Veterans Association,

                                    Washington DC, March 14, 2003.
     Hon. Lane Evans,
     Ranking Democratic Member, House Veterans Affair Committee, 
         Cannon House Office Building, Washington, DC.
       Dear Congressman Evans: On behalf of the Blinded Veterans 
     Association (BVA), the only Congressionally chartered 
     veterans service organization exclusively dedicated to 
     serving the needs of our Nation's blinded veterans, thank you 
     for your initiative to create a prescription drug benefit for 
     veterans. BVA supports your proposed legislation Offering 
     Medicare-eligible veterans an opportunity to fill their non-
     VA prescriptions at a VA facility in lieu of enrollment into 
     the VA health care system is the right approach to take. Over 
     900,000 veterans indicate they use the VA system primarily 
     for prescription drugs. BVA believes this bill as written, 
     will alleviate some of the unnecessary waiting time backlog 
     created by veterans scheduling appointments exclusively to 
     receive a prescription from a VA doctor. In many cases, a 
     non-VA physician has previously prescribed the prescription 
     they are seeking. Provision of a funding mechanism that will 
     not further erode the already insufficient funding levels for 
     VA Health Care is the most attractive aspect to this 
     proposal.
       VA supports inclusion of Priority 1 veterans in this 
     benefit. Offering a prescription drug benefit to veterans who 
     choose not to fully use the VA health care system because of 
     distance or personal preference, is the right action to take. 
     We caution you to be very clear in your explanation of 
     prescription coverage as an ADDITIONAL benefit that does not 
     take away a Priority 1 veterans access to any other VA 
     service.
           Sincerely,
                                                 Thomas H. Miller,
     Executive Director.
                                  ____

                                                    Military Order


                                          of the Purple Heart,

                                  Springfield, VA, March 14, 2003.
     Hon. Lane Evans,
     Ranking Minority Member, House Committee on Veterans Affairs, 
         Cannon Building, Washington, DC.
       Dear Congressman Evans: First, on behalf of the members of 
     the Military Order of the Purple Heart (MOPH) I want to thank 
     you for your unwavering support for combat wounded veterans, 
     indeed your support for all veterans.
       Second, we are aware that you are going to introduce 
     legislation that would create a prescription drug benefit for 
     veterans. MOPH supports your efforts in this endeavor and 
     looks forward to passage of the legislation.
           Respectfully,
                                               William A. Wroolie,
     National Commander.
                                  ____



                                Paralyzed Veterans of America,

                                   Washington, DC, March 18, 2003.
     Hon. Lane Evans,
     Ranking Democratic Member, Committee on Veterans' Affairs, 
         House of Representatives, Cannon House Office Building, 
         Washington, DC.
       Dear Representative Evans: On behalf of the Paralyzed 
     Veterans of America (PVA), I am writing to offer our support 
     for the ``Veterans Prescription Drug Benefits Act of 2003,'' 
     By providing a new Medicare drug benefit to veterans, your 
     measure would begin to address a vital need and concern of 
     our elderly citizens--the need for affordable 
     pharmaceuticals.
       The increasing use of prescription drugs for medical 
     treatment options has revolutionized the provision of medical 
     care. Every year pharmaceuticals represent an ever-growing 
     percentage of health-care expenditures. Medicare has not kept 
     up with this revolution. By providing veterans with this 
     benefit, facilitated through the Department of Veterans 
     Affairs (VA) and ensuring that VA does not spend scarce and 
     inadequate resources, we can begin the process of reflecting 
     the manner in which health care is delivered in this Nation.
       This measure, unlike others, would not force the VA alone 
     to bear the burden of addressing this national policy 
     failure. The VA would merely be acting to facilitate a 
     benefit offered to veterans, a benefit that would provide 
     substantial pharmaceutical savings to the federal government 
     because of VA's statutorily mandated discounts. In addition, 
     this measure would reimburse the VA for expenses relating to 
     the implementation of this benefit as well as costs incurred 
     in administering it.
       Although veterans seeking treatment for a service-connected 
     condition, and veterans with service-connected disabilities 
     rated at 50 percent or more are expressly exempted from the 
     requirement of enrolling in order to receive care by Medicare 
     benefit, and foregoing their VA health care options are 
     always able to seek treatment for service-connected 
     conditions at VA facilities. Additionally we request that 
     other veterans needing specialized services be afforded 
     access to care.
       Again, thank you for introducing the ``Veterans 
     Prescription Drug Benefits Act of 2003.'' We look forward to 
     working with you closely in order to pass, and ultimately 
     enact, this important measure.
           Sincerely,
                                               Delatorro L. McNeal
     Executive Director.
                                  ____



                                  Vietnam Veterans of America,

                                Silver Spring, MD, March 18, 2003.
     Hon. Lane Evans,
     Ranking Democrat, Committee on Veterans Affairs, House of 
         Representatives, Cannon House Office Building, 
         Washington, DC.
       Dear Congressman Evans: Vietnam Veterans of America (VVA) 
     strongly supports the ``Veterans Prescription Drug Benefit 
     Act of 2003'' that you plan to soon introduce to the House of 
     Representatives.
       As you know, VVA reluctantly supported Secretary Principi's 
     decision to temporarily suspend new enrollments of Category 8 
     veterans only because the Veterans Health Administration 
     (VHA) medical facilities were in such a dire under-funded 
     state. While the approach that you have taken in moving to 
     relieve this pressure might not be what VVA would choose in a 
     perfect world, in the real world of a veterans health care 
     system that is so grossly under funded this is a similarly 
     sensible, responsible, and effective approach to provide 
     relief to the system.
       While VVA has not favored such plans to allow VA to so 
     provide pharmaceuticals in the past because they included no 
     way to fully fund VA honoring prescriptions written by non-VA 
     physicians, your proposal does allow for payment of such from 
     both Part A and Part B of Medicare in addition as well as and 
     annual enrollment fee and co-payments that are reasonable. As 
     long as such prescriptions are provided at a net negligible 
     additional cost to the system, VVA does favor this proposal 
     for Medicare eligible veterans who are not service connected 
     disabled.
       In regard to the provision that would accord priority group 
     1 (70 percent or greater service connected disabled) veterans 
     the opportunity to have non-VA prescription drug orders 
     filled by VA via mail fulfillment, VVA favors such mail 
     fulfillment as a convenience for veterans who sometimes have 
     to travel great distances to reach a VHA each time they renew 
     their prescription, imposing a hardship.
       As the primary purpose of the Veterans Health 
     Administration is to be a ``veterans health care system'' and 
     not just a general health care system that happens to be for 
     veterans, VVA urges that you amend this bill at mark up to 
     require that there is a complete physical, including blood 
     draw tests annually performed on at least the Priority 1 
     veterans covered under this proposal. While VHA continues 
     (inexplicably to VVA) to fail to ensure that a complete 
     military history be taken on every single veteran

[[Page 6518]]

     seeking health care services from VHA, and that VHA 
     clinicians use this key data to do a proper assessment of 
     overall health of the veteran, including conditions or 
     illnesses that may be due to exposures or other factors 
     during his/her military service, there is still a need for 
     VHA to fulfill their responsibilities for medical oversight 
     of significantly and or profoundly disabled veterans.
       If this proposed legislation reduces the utilization of VHA 
     services primarily or only to secure pharmaceuticals by only 
     a proportion of the 900,000 veterans reported seeking 
     services for this reason, then it will help relieve the 
     pressure that is crushing the VHA system without leaving any 
     veteran without alternative services.
       Again, VVA thanks you for your strong leadership on behalf 
     of America's veterans.
           Sincerely,
                                               Richard F. Weidman,
     Director of Government Relations.

                          ____________________