Getting Non-VA Prescriptions Filled by the VA

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By Christopher Somoza

In addition to obtaining care through the U.S. Department of Veteran Affairs (VA), many veterans may also obtain health coverage through other programs, such as Medicare, TRICARE and employer-based plans. As a result, veterans often have questions about how VA benefits interact with other benefits. One big topic that is among veterans’ concerns is filling prescriptions.

About two-thirds of respondents from a 2010 survey of VA patients reported having at least one chronic condition, and many of these veterans are prescribed medications in the treatment for these conditions.[1] As such, veterans are commonly faced with figuring out how to get a prescription from a non-VA provider filled through the VA pharmacy.

It certainly makes sense for veterans to get their medications filled at the VA, as it has proven cost-effective when compared to private market costs for prescriptions.[2] Filling prescriptions through the VA also helps veterans avoid coverage gaps in their private drug plans, commonly referred to as “donut holes,” and other catastrophic caps.

It is important to note that ONLY the VA can prescribe medications dispensed by the VA pharmacy system, and the VA will not fill or rewrite prescriptions prescribed by your private physician.[3]

However, there is a procedure for veterans enrolled in VA health care to follow if they have medications prescribed by a non-VA provider:

  1. Be assigned a primary care provider by the VA.
  2. Provide the VA health care provider with their medical records from the non-VA provider.
  3. The VA health care provider needs to agree with the medication prescribed by the non-VA provider.

Although the VA health care provider is under no obligation to prescribe a medication recommended by a non-VA provider, in many cases the VA provider may agree with the non-VA provider, in which case, the VA provider would prescribe a medication based on the original recommendation.

However, the VA prefers to prescribe generic medications when possible, or may treat an ailment with a particular drug that may differ from what a non-VA provider may initially prescribe. For example, a veteran with frequent heartburn who receives a prescription for Nexium from a non-VA doctor might ultimately receive Pantoprazole for his/her treatment from the VA.

Veterans who are concerned or unsure as to how to obtain their prescriptions through the VA should simply make one additional appointment at the VA clinic to make sure they make the right decision. It may also save them money in the long run.

Humana is a Medicare Advantage HMO, PPO, and PFFS organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.

  1. Veterans Health Administration presentation – https://www.sbm.org/UserFiles/file/Symposium11_Haibach.pdf
  2. U.S. Department of Veterans Affairs: Comparing VA vs. Non-VA Costs – https://www.herc.research.va.gov/include/page.asp?id=va-vs-non-va
  3. U.S. Department of Veterans Affairs: Medication Copayments brochure – https://www.va.gov/healthbenefits/resources/publications/IB10-971_medication_copayment_brochure.pdf