ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, September 23, 1996 TAG: 9609230105
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
The Veterans Affairs Medical Center in Salem has routinely provided outpatients with over-the-counter medicines such as aspirin for free. VA doctors wrote "prescriptions" for cough and cold medicines, Dimetapp, and even saline nasal spray, and the pharmacy handed out the products.
The service was mandatory for former prisoners of war and veterans with disabilities that were at least 50 percent service-connected. It was extended to any former servicemen who had income below $30,000, which made them also eligible for treatment.
However, effective Sept.1, the Salem VA stopped supplying most over-the-counter products where it was not required to do so.
The exceptions are supplies for those with diabetes or who have special needs for items such as feeding tubes, according to letters sent to patients such as Jim Guthrie in Roanoke County.
Guthrie has been getting about $30 worth of over-the-counter medications free each month. He says his budget is too strained to absorb that amount. He also says he's worried that because his stomach problems are not considered a primary service-related ailment, he eventually will lose coverage for the prescription medicine he takes to treat it.
That medicine is worth another $90 a month, he said.
Guthrie traces the stomach ailment to when he caught a tropical bug while stationed in Panama, even though records confirming that diagnosis can't be found, he said.
Guthrie, who is 64 , served in the Air Force in the 1950s. He said he and his wife, Barbara, survive on about $1,100 a month from disability payments from Social Security and his $91-a-month government pension.
"I can't believe the government is so poor that they have to rip off the sick and poor," he said.
Last week, Guthrie mailed a letter to President Clinton protesting the change and sent copies to politicians and the head of the VA.
"If all the veterans had quit on you all like you are quitting on us, the country wouldn't be enjoying the freedom we have today," Guthrie wrote. He also said that he would be glad to purchase the medicines if he didn't have such a "meager" pension.
A VA official said the money the hospitals save from the over-the-counter drugs will give it more money to spend on treatment of low-income veterans.
With an increasing number of patients coming from that group, something had to give, said Dan Varalli, chief of pharmacy at the Salem center. He said the centers wanted to help these patients, who typically lack health insurance but aren't eligible for government health care programs because they own their homes.
The number of patients under continuous care increased by 2,000 since 1993, he said.
More than 20 percent of the 3,000 prescriptions the Salem VA fills each day are for over-the-counter medications, Varalli said.
The Salem VA pharmacy has a mail-order service that sends medications and medical supplies to veterans all over Virginia and West Virginia.
Patients understand the change, but "are disappointed," Varalli said.
The Salem VA also discontinued a pilot program called "Medicine Cabinet," where patients could pick up over-the-counter medicines by just showing their service ID card.
"We were proud of that program," Varalli said.
The idea for trimming the drug benefit came out of a General Accounting Office report, which said the VA spent $165 million on over-the-counter drugs, according to a story that ran in the Army Times newspaper.
Medications accounted for 73 percent of the over-the-counter products. Medical supplies such as chemical test strips, alcohol prep pads, bandages and diapers accounted for 26 percent. Dietary supplements such as Ensure accounted for less than 1 percent.
At the time of the study, policies regarding over-the-counter products varied from facility to facility, Army Times reported.
The GAO suggested VA hospitals could reduce costs by increasing a veteran's co-payment for over-the-counter products, by streamlining its policies for handling such products, or by limiting over-the-counter drugs and supplies available to veterans.
Testimony during Congressional hearings on the issue warned, however, that removal of the over-the-counter benefits could lead to more visits to doctors and an increase in hospitalizations.
It also could lead to higher drug costs if drugs that can only be obtained by prescription - and which are paid for by the VA - are substituted for over-the-counter medicines, a VA official testified.
Regulations are expected to be standardized nationally by next spring. In the meantime, Varalli said the Veterans Integrated Service Network, to which the Salem center belongs, decided to go ahead with the change it made this month.
The Salem facility is in a network of eight centers in North Carolina, Virginia and West Virginia.
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