The VA National Formulary generated controversy, which motivated congressional scrutiny and a directive to the VA to commission this report reviewing the experience with the National Formulary and formulary system. This Institute of Medicine committee was pleased to assist the Congress with this review, in part because the committee saw in the VHA example an opportunity to understand and anticipate problems that all publicly funded programs are likely to encounter in this new age of pharmaceuticals. The Congress asked the committee to review the restrictiveness of the National Formulary, its impact on the costs and quality of care in the VHA, and how it compared to formularies and drug management practices in the private sector and in other public programs, especially Medicaid. Detailed in the pages that follow, the committee's findings and conclusions on these questions are, the committee believes, highly instructive, though not always in the ways that we anticipated.
Table of Contents
|Is the VA National Formulary Overly Restrictive and Does it Prevent Physicians from Meeting the Health Care Needs of Veterans?||37-71|
|What are the Potential Costs to VA Health Care Associated with the National Formulary for Drugs?||72-119|
|What are the Effects of the National Formulary and Related Policies on Quality of Care?||120-148|
|How Does the VA National Formulary Compare with Private Insurance Formularies for Drugs and Devices and with Other Government Formularies?||149-182|
|The VA National Formulary and Veterans Health Care||183-200|
|Appendix A: Interim Report of the Committee on VA Pharmacy Formulary Analysis to the Department of Veterans Affairs and the Congress of the United States||221-226|
|Appendix B: Academy of Managed Care Pharmacy's Managed Care Formulary and Pharmacy Benefit Design Survey||227-230|
|Appendix C: Additional Cost Information||231-249|
|Appendix D: Glossary||250-253|
|Appendix E: Drug Classes and Drug Index||254-258|
|Appendix F: Committee Biographies||259-262|
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