As prescription drug prices rise, the steady stream will become a flood, he predicts.
In West Virginia, 53,000 veterans have signed up for the program. Two-thirds of them have no billable insurance, said Debbie Bramer, spokeswoman for the Huntington VA hospital.
There are 79,000 veterans in the state. So 26,000 — one third — are not signed up. Some may make too much money, Fedele said.
In February, the national VA —swamped with new enrollees — imposed income criteria. For now, veterans in "higher income" brackets cannot sign up, she said. In West Virginia, higher income is defined as above $24,644 for single veterans and $29,506 for a veteran with a single dependent.
Many younger vets may not need the program. Others may simply not know about it. The VA is not allowed to advertise the program, Finlay said. "We really rely on word of mouth and veterans organizations to get the word out."
Veterans who want to sign up can find information at: www
.va.gov/elig/. Click on the Enrollment button.
Three categories of veterans are automatically eligible, no matter how much money they make:
(1) veterans whose injuries have been rated at least fifty percent service-connected;
(2) veterans who have been out of the service less than a year, who have illness or injury incurred in the line of duty, but have not yet been "rated" by the VA, and
(3) veterans who are seeking care from the VA for service-connected medical problems only.
A veteran can keep his or her family doctor, but must have a prescription from a VA doctor, to get the free or low-cost prescriptions. So some veterans go to both doctors.
A primary care visit to the VA in West Virginia costs $15, and specialty visits cost $50.
There are 25 million veterans in the United States. What will the VA do if 5 or 10 million more sign up next year?
Fedele hesitated before she answered.
"I guess we'd have to figure out some way to take care of them," she said.
If that happens, Valentino sees a potential financial problem. "We may represent 3 percent of a pharmaceutical company's sales right now," he said. "So it's a little easier for them to offer deep discounts in small markets.
If all of the sudden, this were 20 to 30 percent of their sales, then we might see a different reaction from the pharmaceutical companies.
"We don't know what might happen. All we can really tell you is what's happening in our system today."