Republicans criticize VA drug benefits

In the days leading up to Thursday’s House vote on a bill to require that Medicare negotiate drug prices, House Republicans cautioned that the step would weaken the program by making it more like the drug coverage offered to military veterans.

GOP members characterized the latter coverage as inadequate, but organizations representing veterans stood behind the drug benefit provided by the Department of Veterans Affairs (VA), saying that the vast majority of former military-service members are satisfied with their VA coverage.

During the debate over the Medicare bill, House Republicans issued strong criticisms of the VA’s drug benefit, which is utilized by 4.4 million veterans.

While Democrats pointed to the lower prices paid by the VA than Medicare Part D plans for many commonly used drugs, many Republicans decried the VA program for covering fewer new and brand-name medicines. Republicans also maintained that VA enrollees have access to fewer pharmacies to fill their prescriptions and must rely on mail-order service to get their drugs.

Unlike Medicare, the benefits managed by the VA’s Veterans Health Administration are provided in a closed system in which physicians, pharmacists and other caregivers are employees of the department. Medicare, on the other hand, reimburses private-sector healthcare providers for treating its beneficiaries. Among veterans using the VA’s benefit, 2.5 million are also eligible for Medicare, according to the VA.

“We understand that the VA does not serve the best interest of seniors in this country,” Rep. Pete Sessions (R-Texas) said.

“Do we want to have Medicare look like the VA?” asked Rep. Paul Ryan (R-Wis.), who noted that veterans must visit VA doctors rather than choose their own and that most VA prescriptions are filled by mail. “Do we want to replicate that kind of a system for Medicare? I think the answer is no.”

Rep. Charles Boustany Jr. (R-La.) said, “I can tell you, in my district, patients who are veterans complain all the time about having to … travel miles to get to a VA pharmacy.”

Veterans groups have a more favorable view of the VA’s drug benefit. “We think it serves veterans well,” said Dennis Cullinan, the director of the Veterans of Foreign Wars’s National Legislative Service. “It’s a vital benefit for a lot of veterans. A lot of veterans would not have access to their drugs” without it, he said.

Veterans’ groups acknowledged that the list of drugs covered by the VA is shorter than those used by Medicare Part D plans. “The VA’s formulary is very, very limited,” the director of legislative affairs at the American Legion, Steve Robertson, said.

Still, Robertson expressed satisfaction with the department’s appeals process, which was established to enable patients to get drugs that are not on the formulary when necessary.

“Until people start complaining about the formulary, maybe they’re pretty pleased with the way the process is set up,” Robertson said.

The national legislative director for Disabled American Veterans, Joe Violante, said that although his group has had to intervene to help some veterans get the drugs prescribed by their doctors, most veterans are happy with their coverage.

House Veterans’ Affairs Committee Chairman Bob Filner (D-Calif.) described the VA’s pharmacy benefit as “one of the great advantages of this system” and said, “I’ve heard a lot of complaints but I haven’t heard anything about the pharmacy [benefit].”

Despite its support for the current VA drug benefit, the American Legion came out against the Medicare bill, an opposition House Minority Leader John Boehner (Ohio) highlighted.

In a Jan. 11 letter to Speaker Nancy Pelosi (D-Calif.), American Legion National Commander Paul Morin expressed concern that legislation guaranteeing Medicare the best price on a drug would lead to higher charges for the VA.

“Every time the Federal government has enacted pharmaceutical price control legislation, the Department of Veterans Affairs (VA) experienced significant increases in its pharmaceutical costs as an unintended consequence,” Morin wrote.

Other veterans’ groups stayed out of the fight. “This legislation doesn’t actually do that,” Violante said, referring to the establishment of price controls or pegging of Medicare drug prices to the VA’s. Cullinan also noted that the House bill does not call for Medicare to link its drug payments to the VA’s prices.