VA Drug Formulary: Better Oversight Is Required, but Veterans Are Getting Needed Drugs
Highlights
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.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | In order to ensure more effective management of the national formulary, the Secretary of Veterans Affairs should direct the Under Secretary for Health to establish a mechanism to ensure that VISN directors comply with national formulary policy. |
In July 2001, VA assigned responsibility for ensuring that the directive is carried out to officials in headquarters and the networks offices. In addition, the Pharmacy Benefits Management Group (PBM)has access to comparative network formulary usage data that it will examine for outliers.
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| Department of Veterans Affairs | In order to ensure more effective management of the national formulary, the Secretary of Veterans Affairs should direct the Under Secretary for Health to establish criteria that VISNs should use to determine the appropriateness of adding drugs to supplement the national formulary and monitor the VISNs' application of these criteria. |
VA's Pharmacy Benefits Management group (PBM)has been charged with responsibility to develop and distribute criteria for addition of drugs to and removal of drugs from network formularies. Draft criteria has been discussed with the network formulary leaders. In addition, the PBM is developing a template for quarterly reporting of drugs added to or removed from the network formularies.
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| Department of Veterans Affairs | In order to ensure more effective management of the national formulary, the Secretary of Veterans Affairs should direct the Under Secretary for Health to establish a nonformulary drug approval process for medical centers that ensures appropriate and timely decisions and provides that veterans for whom a nonformulary drug has been approved will have continued access to that drug, when appropriate, across VA's health care system. |
In July 2001, VA directed that a non-formulary request process must exist at each VA medical treatment facility. The process should assure that decisions are evidenced-based and timely. Normally, non-formulary requests will be reviewed and decisions made within 96 hours of receipt. In addition, VA established a policy that if a patient has pharmacotherapy initiated by an authorized VA provider at one VA medical treatment facility and transfers his or her care to a second VA medical facility, the pharmacotherapy will be continued when clinically appropriate, regardless of difference in network formularies.
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| Department of Veterans Affairs | In order to ensure more effective management of the national formulary, the Secretary of Veterans Affairs should direct the Under Secretary for Health to enforce existing requirements that VISNs collect and analyze the data needed to determine that nonformulary drug approval processes are implemented appropriately and effectively in their medical centers, including tracking both approved and denied requests. |
VA's Pharmacy Benefits Management Group has been given responsibility to develop a template for quarterly reporting of non-formulary approvals and disapprovals by networks. Each network will establish a process to analyze and trend non-formulary utilization data at the network and local facility level. Information to be reported includes the number of non-formulary requests received, the number of non-formulary requests approved and denied, and the average time taken to approve requests.
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