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The VA's updated presumptive conditions list expanding coverage for Gulf War and Post-9/11 veterans necessitates pharmaceutical manufacturers understand potential formulary impacts as well as address access barriers. |
The Department of Veterans Affairs (VA) maintains a presumptive list of conditions that lower the burden of proof on a veteran to show one of these conditions developed due to their military service. More than a policy document, the inclusion of an illness as a presumptive condition streamlines healthcare access within the VA and grants veterans the specialized care they deserve from a health system that differently understands the unique needs of the veteran population. Most recently, in January 2025, the VA updated its presumptive conditions list for Gulf War Veterans and Post-9/11 Veterans to include: acute and chronic leukemias, multiple myelomas, myelodysplastic syndromes, myelofibrosis, urinary bladder, and ureter and related genitourinary cancers.
Aside from the obvious understanding of how changes in the presumptive list of conditions rapidly evolves product relevance in the VA health system as the number of veterans being served increases, the most immediate, concrete, and tangible need for any pharmaceutical manufacturer is a renewed forecast of future drug demands within the VA health system to avoid the dreaded non-availability of the product. This analysis is fundamentally based on a pharmaceutical manufacturer having a current understanding how the VA health system functions, how a product’s current placement on the VA formulary impacts utilization, how expansions to the presumptive conditions policy can impact changes to a product’s formulary status, and how any current (and potential revisions to) a Criteria For Use (CFU) attached to a product impact access. In addition, pharmaceutical manufacturers must examine how any self-imposed distribution-associated barrier potentially create access burdens that are difficult for this health system to overcome.
Inclusion of an illness on the presumptive conditions list also expands the collaborative research opportunities both within the VA and VA-associated academic institutions as the VA evaluates and refines therapies to better treat and differently meet the needs of its unique patient population. The VA both prefers and relies on real-world evidence and real-world data specific to veteran health outcomes to shape its treatment protocols. Pharmaceutical manufacturers can have the opportunity to better serve both the nation’s veterans and play a vital role in improving veteran cancer care through participation and engagement in these research efforts.
The VA presumptive list of conditions is not static and follows a scientific understanding of how veteran health has been directly impacted by service to the country. Pharmaceutical manufacturers can contribute to better veteran health outcomes through new, active engagement with the VA health system.