The Department of Veteran Affairs National Formulary

Like other health systems, the Department of Veterans Affairs (VA) maintains a formulary of approved medications available to eligible veterans through VA pharmacy services. Understanding how the VA National Formulary (VANF) works is incredibly useful to pharmaceutical manufacturers for analyzing access issues and, potentially, finding new solutions that advance market utilization.

The VANF is not a traditional multi-tiered formulary, separating medications into tiers based on a variety of factors, and, instead, a product is either on or off formulary. While products are not tiered, patient co-pays are tiered and generally tied to the level of the individual’s VA disability status. These co-pays, however, are considered low compared to most commercial insurances, which culminates in the VANF being a more affordable option for many veterans and highlights the importance of formulary status.

Managed by the VA's Pharmacy Benefits Management (PBM) Services, decisions to include or exclude a product from the formulary based on published policies and procedures reside with this program office. Committees providing input on formulary additions, changes, and deletions are comprised of members from the local, regional, and national level. As appropriate, committee members may also include clinicians, such as specialty providers. During review, factors such as effectiveness, safety, and cost are weighed. In addition, other evidence-based information and clinical guidelines may be considered at the discretion of the review committee. The PBM continuously monitors and adjusts the VANF to ensure the most effective products are available to meet the challenges found in the veteran population. The PBM transparently lists the formulary status for medications, nutritional supplements, and specific types of medical supplies as well as any associated prior authorizations on a publicly accessible website. Conveniently located next to the product listing, the VANF also includes links to any associated criteria for use (CFU) and monographs. The VANF does not specify product strengths, which allows local facilities to stock variants based on the needs of its served population.

The goal of the VANF is to provide high-quality, cost-effective options available nationwide at all VA facilities. The PBM can choose to prioritize the review of medications with high rates of prevalence among veterans (such as musculoskeletal conditions like MS), which leads to the VANF offering broader access to certain products compared to other commercial formularies.

The VANF presents an important opportunity for manufacturers. It is critical to understand both formulary placement and other related factors for both the manufacturer’s product as well as its competitors. Variations between each will result in utilization differences between products in the same class as well as overall market penetration.