VA’s Urgent Care Benefit: New Details on Prescriptions and More
Veterans seeking to use their new private-sector urgent care benefit can fend off some potential headaches by printing out a three-page guide for themselves and their prospective providers.
TriWest, the contractor responsible for the benefit network, has posted the guide (PDF) on its website. Beneficiaries are asked to print out the pages and take them along when they seek care and when they pick up related prescriptions.
The new urgent care benefit, effective June 6, includes three free in-network urgent care visits per year for some VA beneficiaries, and a $30-per-visit copay for others. Get full eligibility and payment details here. That link also includes VA guidance on the difference between urgent care and emergency care; VA strongly encourages beneficiaries to err on the side of emergency care if their condition is unclear. Learn more about the VA emergency care benefit
The three-page printout includes information previously available at the VA website as well as from other sources, including MOAA. However, some of the details either are new or are worth emphasis:
Phone numbers to know. Veterans who want to verify their urgent care eligibility can call (833) 4VETNOW (483-8669). Veterans who experience “challenges” at either the urgent care facility or the pharmacy, per the guide, can call TriWest at (866) 620-2071.
No on-site payment. The VA will bill veterans directly for any applicable copayment. Providers should not require any payment under the benefit, but if the veteran is determined to be ineligible for the care received or the provider is out of the VA urgent care network, the veteran will be billed for the entire cost of care.
Drug facts. Beneficiaries can receive up to a 14-day supply of prescription medication related to the visit (seven days or less for opiates, depending on state laws). These can be filled at VA medical facilities or pharmacies in the Express Scripts network. Drugs must be in the Urgent Care Formulary (Excel file) or the VA National Formulary.
A note on refills. The three-page guide warns pharmacy providers that “no refills are allowed at retail” and that “a prescription for the same drug within 30 days will reject as a refill.”