Description and Analysis of the VA National Formulary (2000) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-10
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From page 1... ...
Specifically, the study should be completed within 6 months and should provide the Committee with an estimate of potential costs to VA health care associated with the National Formulary for drugs, biologic products, devices, prosthetics and pharmaceutical treatment guidelines. The study should also include a comparison of the new VA Formulary to private insurance formularies for drugs and devices and other government formularies, such as Medicaid.
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From page 2... ...
The VA National Formulary is partially closed, that is, some drug classes are closed or subject to restrictions, limiting choice to certain preferred or committed-use agents as a way of supporting VA negotiations for lower drug prices and meeting VHA market share objectives. Generic prescribing, generic substitution, and therapeutic interchange (that is, substitution of a Formulary for a nonformulary drug within a drug class)
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From page 3... ...
New data on restrictions in private health care formularies and Formulary systems were collected for the IOM by the Academy of Managed Care Pharmacy. The VA National Formulary is not as inclusive as many Medicaid formularies, but it rarely designates drugs or drug classes as absolutely excluded or requires prior authorization of drugs as Medicaid and managed care Formulary systems frequently do, nor does it impose absolute limits on numbers of prescriptions as some Medicaid formularies have done, or tiered copayments as is often the practice in managed care.
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From page 4... ...
Because of inconsistencies across the VA and lack of information, judgments of the quality of other structural elements were not so reassuring. For example, problems, including national inconsistency, inaccurate reporting, and variable implementation, among others, were identified in the nonformulary exceptions and therapeutic interchange programs and in other areas that could affect quality of care.
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From page 5... ...
The National Formulary should continue to close classes prudently and to practice generic substitution and therapeutic interchange of branded drugs to meet its particular quality and price objectives. Formularies (scientifically constructed lists of drugs and drug products)
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From page 6... ...
Compared to managed care, the VA National Formulary also often lists fewer drugs in some classes or one drug choice in closed classes and imposes a fixed waiting period for adding new drugs, but it does not require prior approval, charge relatively costly copayments, or exclude categories of drugs or individual drugs. The objectives of restrictions or controls in managed care are similar to those of the VA National Formulary.
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From page 7... ...
Since the VA National Formulary is in its early stages, changes in the drugs with volume commitments have not yet become a problem, but the VA has not evaluated the frequency or number of interchanges that are acceptable in the care of a veteran on long-term drug treatment in such instances. Therapeutic interchange standards should go hand in hand with an improved nonformulary exceptions process.
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From page 8... ...
Improving acceptance might include representation in formulary discussions above the local POT committee level, strengthened formulary committee participation by physicians, and a consistent policy of educating veterans about therapeutic interchanges and other formulary matters. Veteran consumers might be involved in input to the VA on the National Formulary, either in some advisory capacity, as is now required for the DOD Uniform Formulary, or as members of POT or formulary committees.
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From page 9... ...
Although the VHA reports improvements in ensuring and assessing quality of veterans' health care in general, convincing reassurance regarding quality effects of the VA National Formulary requires data relating formulary and formulary system elements to veterans' health outcomes. With rare exceptions, such data are not available for either process or outcomes.
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From page 10... ...
Absent the National Formulary, the VA would lose the ability to select drugs and negotiate price differentials below the Federal Supply Schedule differentials that have probably produced aggregate savings approximating $100 million and VHA drug costs would presumably escalate by this amount leading to equivalent reductions in other VHA services to veterans.
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