Most – Not All – Veterans Getting Prescription Drugs They Need

From: Chairman Bob Filner House Committee on Veteran’s Affairs

Washington, D.C. – On Tuesday, September 22, 2009, the House Veterans’ Affairs Health Subcommittee, led by Chairman Michael Michaud (D-ME), held a hearing to assess whether the Department of Veterans Affairs (VA) meets the pharmaceutical needs of veterans.  Specifically, the hearing focused on the VA national formulary, or list of prescription drugs covered by VA, which was created in 1996 with the intent to lower drug costs by allowing bulk purchasing.  The hearing also addressed patient safety and what VA can do to prevent adverse drug events due to missed doses, drug to drug interaction, and preparation errors.      “I have heard from veterans who have voiced their frustration with the VA national formulary as being too restrictive to the point that accessing appropriate drugs is a barrier,” said Chairman Michaud.  “Some veterans have pointed to a flawed, subjective system for securing non-formulary drugs.  For example, a veteran who is denied access to a non-formulary drug at one VA medical center may be approved in another medical center, which suggests that the decision may not be based entirely on clinical factors.”

Within the VA system, drugs are dispensed to patients through either facility inpatient and outpatient pharmacies or through the Consolidated Mail Outpatient Pharmacy (CMOP), which mails medication directly to the veteran.  The CMOP distributes the majority of VA pharmaceuticals, having dispensed 97.4 million of 125.9 million (or 77.4%) total VA prescriptions in Fiscal Year 2008.

The effort to centralize decision-making on the availability of drugs within the VA system has led to debate over whether the national formulary is too restrictive.  Panelists at the hearing argued that the national formulary limits access to specific drugs that veterans need and that getting prescriptions for drugs not on the formulary is an extremely time intensive process.  Witnesses also noted that the process used by VA to add drugs to the formulary is unclear and ambiguous.  Further, veterans report that innovative drugs are not added to the list in a timely manner.

Michael Valentino, Chief Consultant of the Pharmacy Benefits Management Services at VA, offered the following explanation of the process used to update the national formulary: “PBM [Pharmacy Benefits Management] pharmacists support the MAP [Medical Advisory Panel] and VPEs [VISN Pharmacist Executives] by monitoring the medical literature, scientific research and VA outcomes data to identify evidence that may support adding drugs to or deleting drugs from the VANF [VA National Formulary] and by drafting evidence-based prescribing guidance.  VA develops guidance on the pharmacologic management of common and high-cost diseases and collaborates with clinical experts within the Department to develop or refine guidance when necessary.  VA disseminates the guidance throughout the Department for peer-review prior to being presented to the MAP and VPEs for consideration.  PBM has also developed mechanisms for system-wide collection, analysis, trending and reporting of ADEs [Adverse Drug Event].”

“Most veterans get most of the drugs they need,” commented Bob Filner, Chairman of the House Committee on Veterans’ Affairs.  “The job of the VA, however, is to ensure that all veterans have access to all components of the care they need.  The Committee will continue to work with VA until it is determined that the pharmaceutical needs of all veterans have been met.”