HR1970-119

What This Bill Does

The Providing Veterans Essential Medications Act changes how VA handles expensive medications for veterans in State home nursing care. In addition to the ordinary payment to a covered State home, VA must either reimburse the State home for a costly medication or furnish the medication directly, at the State home's election. A costly medication is a drug or medicine whose average wholesale price for one month's supply, plus a 3 percent transaction fee, exceeds 8.5 percent of the VA payment to that covered State home for the veteran's care during that month. A covered State home is one providing nursing home care to the veteran under a VA contract or agreement. The bill targets situations where a flat VA payment may not cover high-cost drugs needed by a veteran in State home care.

Who Benefits and How

Veterans in State home nursing care benefit because high-cost medications are less likely to threaten admission, retention, or continuity of treatment. State veterans homes benefit because VA must reimburse or furnish costly medications when the statutory threshold is met. State home pharmacy managers benefit from a clearer payment route for drugs whose monthly cost exceeds 8.5 percent of VA's care payment. Families of veterans in nursing homes benefit if medication costs no longer pressure facilities to avoid complex patients.

Who Bears the Burden and How

The Department of Veterans Affairs must reimburse covered State homes or furnish costly medications directly. VA pharmacy and payment offices must determine average wholesale price, apply the 3 percent transaction fee, and compare costs to the 8.5 percent threshold. Federal taxpayers and VA medical accounts bear the added medication reimbursement or furnishing cost. State homes must elect reimbursement or direct furnishing and document qualifying medication costs.

Key Provisions

• Requires VA to reimburse or furnish costly medications for veterans in covered State home nursing care.
• Defines costly medication using average wholesale price for one month's supply plus a 3 percent transaction fee.
• Sets the cost threshold at more than 8.5 percent of VA's payment for that veteran's care during the month.
• Provides State homes an election between reimbursement and direct furnishing by VA.