The VA National Formulary generated controversy, which motivated congressional scrutiny and a directive to the VA to commission this report reviewing the experience with the National Formulary and formulary system. This Institute of Medicine committee was pleased to assist the Congress with this review, in part because the committee saw in the VHA example an opportunity to understand and anticipate problems that all publicly funded programs are likely to encounter in this new age of pharmaceuticals. The Congress asked the committee to review the restrictiveness of the National Formulary, its impact on the costs and quality of care in the VHA, and how it compared to formularies and drug management practices in the private sector and in other public programs, especially Medicaid. Detailed in the pages that follow, the committee's findings and conclusions on these questions are, the committee believes, highly instructive, though not always in the ways that we anticipated.

During the last three years, the Department of Veterans Affairs (VA) has made significant progress in establishing its national drug formulary, which has generally met with the prescriber acceptance. Most veterans are receiving the drugs the need and rarely register complaints about prescription drugs. However, VA has not been sufficient to ensure that the Veterans Integrated Service Networks (VISN) and medical centers comply with formulary policies and that the flexibility given to them does not compromise VA's goal of formulary standardization. Contrary to VA formulary policy, some facilities omitted national formulary drugs or modified the closest drug classes. Although a limited number of drugs to supplement the national formulary is permitted, formulary differences among facilities are likely to become more pronounced, as more drugs are added by VISNs, decreasing formulary standardization. VA recognizes the trade-off between local flexibility and standardization, but it lacks criteria for determining the appropriateness of adding drugs to supplement the national formulary and therefore may not be able to determine whether the decrease in standardization is acceptable.

This is a print on demand edition of a hard to find publication. In 2009, VA spent nearly $4 billion on prescriptions for vets. In general, VA provides drugs on its national formulary. However, all VA medical centers must have a non-formulary drug request process that is overseen by their regional Veterans Integrated Service Network (VISN). This report reviewed: (1) the process VA uses to review drugs for its national formulary; (2) the approaches VISNs and medical centers take to implementing the non-formulary drug request process; (3) the extent to which VA ensures the timely adjudication of non-formulary drug requests; and (4) the mechanisms VA has in place to obtain beneficiary input on the national formulary and make the drug review process transparent. Includes recommendations. Charts and tables.

"In 2009, the Department of Veterans Affairs (VA) spent nearly $4 billion on prescriptions for veterans. In general, VA provides drugs on its national formulary. However, all VA medical centers must have a nonformulary drug request process that is overseen by their regional Veterans Integrated Service Network (VISN). This report responds to a House Committee on Appropriations report directing GAO to review VA's formulary process and to an additional congressional request. Specifically, GAO reviewed (1) the process VA uses to review drugs for its national formulary, (2) the approaches VISNs and medical centers take to implementing the nonformulary drug request process, (3) the extent to which VA ensures the timely adjudication of nonformulary drug requests, and (4) the mechanisms VA has in place to obtain beneficiary input on the national formulary and make the drug review process transparent. GAO reviewed VA policy guidance and VA's pharmacy-related information technology (IT) initiatives, analyzed 2008 and 2009 drug review data and 2009 nonformulary drug request data, and interviewed VA officials from the national level, each VISN, and a judgmental sample of four medical centers."

The Department of Veterans Affairs (VA) spent more than $1.8 billion to provide pharmacy benefits to veterans in fiscal year 1999. To help manage its pharmacy benefit, VA maintains a list of drugs--known as the national formulary--that its doctors are expected to use when prescribing drugs for veterans. VA provides free outpatient pharmacy services to veterans receiving medications for the treatment of service-connected conditions and to veterans whose income does not exceed the maximum VA pension, regardless of a drug's formulary status. Other veterans may be charged $2 for each 30-day supply of medication. This report discusses how VA manages its national formulary and how drugs other than those on the national formulary are made available to veterans.