Bottom Line: |
The VA formulary balances quality of care with cost-effectiveness by considering clinical evidence, veteran needs, and budget constraints to ensure best and appropriate access to affordable medications for the veteran population. |
The Department of Veterans Affairs (VA) formulary is a detailed list of medications approved for use in the VA healthcare system to optimize pharmaceutical care for veterans by promoting safety, effectiveness, and cost-efficiency. Formulary management involves assessing clinical research, analyzing pharmaceutical costs, and monitoring new treatment options.
The VA Pharmacy and Therapeutics (P&T) committee is essential to the management of the VA formulary. A team within the VA comprised of a variety of healthcare providers meet, generally, on a monthly basis to make formulary recommendations and develop clinical practice guidelines on the most pressing needs of the beneficiaries this health system serves. The VA P&T manage both the primary National Formulary as well as a sub-formulary, the Urgent/Emergent formulary, which is strictly intended to usher quick access to a specific list of products available for fulfillment at approved VA Community Care Retail Pharmacies.
The VA formulary includes both pharmacy benefit and medical benefit drugs based on a binary system of being “on” formulary or “off” formulary. However, even if a product is “on” formulary, the P&T Committee may deem it appropriate to include certain access barriers by associating a “Criteria-for-Use” (CFU) to a specific product. Several key factors drive changes in the VA formulary including:
Regulatory Changes: New federal regulations or policies
Clinical Evidence: New studies and clinical trials continuously inform decisions on drug inclusion or removal based on safety and effectiveness
Veteran Needs: The veteran population faces different and diverse health challenges and priorities compared to the general population
Manufacturers should be aware that cost-effectiveness has significant influence on VA formulary status. As a government agency, the VA is allocated taxpayer dollars to execute its mission of providing the highest quality healthcare to the maximum number of veterans. Relevant budget constraints and budget limitations must be properly understood. Population scoping and analysis of current treatment algorithms can help a manufacturer glean insights into the VA P&T reasoning and prioritization decisions.
Since the healthcare product landscape is continuously evolving, grasping the VA formulary management process is crucial. It is equally important to understand the VA formulary is intentionally shaped in consideration of conditions with high prevalence within the veteran population (e.g., traumatic brain injury, substance use disorder, etc.). Manufacturers can prepare and execute right-sized strategies for this market by recognizing the influences of the formulary and understanding the role of the P&T committee.