DESCRIPTION AND ANALYSIS OF THE VA National Formulary -- Copyright -- Preface -- REVIEWERS -- Contents -- Executive Summary -- SUMMARY AND CONCLUSIONS -- Restrictiveness -- Cost -- Quality -- Comparisons -- Recommendations -- 1 Introduction -- LEGISLATIVE AND EXECUTIVE BRANCH HISTORY -- History of the IOM Study -- The IOM Committee -- FORMULARIES AND FORMULARY SYSTEMS: HISTORY AND DEFINITIONS -- Modern Formularies and Formulary Systems -- Economic Focus of Formularies -- Types of Formularies and Their Restrictiveness -- Formulary Control -- GENERIC SUBSTITUTION -- THERAPEUTIC INTERCHANGE -- LOCAL VA FACILITY AND VISN FORMULARIES AND THE NATIONAL FORMULARY -- History of VA Formulary Management Prior to the National Formulary -- Reorganization of the VA -- Impact of the VA Fixed Budget -- Establishing the VA National Formulary -- Evolution of the National Formulary -- Medical Staff Input -- National Formulary Classes -- Formulary Relationship to Pharmaceutical Companies -- REPORT OUTLINE -- 2 Is the VA National Formulary Overly Restrictive and Does It Prevent Physicians from Meeting the Health Care Needs of… -- BACKGROUND -- Elements of Restrictiveness -- SIZE AND COVERAGE OF THE NATIONAL FORMULARY -- Adequacy of the VA National Formulary -- Closed and Preferred Drug Classes in the VA -- Restrictiveness of Class Closure -- Excluded Drugs and Other Limits -- National Formulary Effects on Drug Use -- ADDITION OF NEW DRUGS AND FORMULARY REAPPRAISAL -- National Policy Regarding New Drugs -- VISN Addition of New FDA Approvals -- Evaluation of the VA Process for Adding New FDA-Approved Priority Drugs -- Addition of Existing Drugs by the VA -- Addition of Newly Approved or Existing Drugs in Other Health Care Systems -- THE NONFORMULARY PROCESS -- THERAPEUTIC INTERCHANGE -- OTC DRUG COVERAGE, GENERIC SUBSTITUTION, AND PHYSICIAN SATISFACTION.

Generic Substitution -- Veterans' Complaints -- VA Physician Satisfaction -- SUMMARY -- 3 What Are the Potential Costs to VA Health Care Associated with the National Formulary for Drugs? -- INTRODUCTION -- THE VHA NATIONAL FORMULARY AS IT AFFECTS COSTS -- Background -- Basic Economics of the VA National Formulary -- Features of the National Formulary -- VISN Implementation Issues -- Other Influences on VHA Pharmaceutical Spending -- ANALYTICAL FRAMEWORK -- DATA -- EMPIRICAL METHODS -- RESULTS OF THE IOM COMMITTEE ANALYSIS OF COST EFFECTS -- How Have the VHA and the Veteran User Population Changed During the Study Period? -- How Has the National Formulary Affected Prices for Closed and Preferred Classes? -- How Has the National Formulary Affected Prescribing Patterns Within the Closed and Preferred Classes? -- How Has the National Formulary Affected Pharmaceutical Spending per Veteran User for Closed and Preferred Classes? -- IS THERE EVIDENCE THAT CHANGES IN FORMULARY POLICY HAVE RESULTED IN INCREASED UTILIZATION ELSEWHERE IN THE VHA SYSTEM? -- Exploration of Changes in Hospital Discharges per VHA User -- COSTS ASSOCIATED WITH IMPLEMENTING AND MANAGING THE NATIONAL FORMULARY -- Estimated National Formulary Savings -- CONCLUSIONS -- 4 What Are the Effects of the National Formulary and Related Policies on Quality of Care? -- BACKGROUND INFORMATION -- Sources of Quality Data -- QUALITY OF CARE IN THE VHA AND EFFECTS OF THE NATIONAL FORMULARY -- PHARMACY, CLINICAL, AND FORMULARY PROGRAM ELEMENTS RELEVANT TO QUALITY OF CARE -- Clinical Pharmacy -- P&T COMMITTEES -- THE VA PBM COMPLEX -- Additions to, and Quality of, the National Formulary -- POLICIES AND PROCEDURES -- Drug Class Reviews -- Clinical Guidelines and Drug Utilization Reviews -- The Nonformulary Process -- Therapeutic Interchange, Policy, and Results.

EFFECTS OF THE NATIONAL FORMULARY ON USE OF DRUGS BY THE VA -- ADVERSE DRUG EVENTS -- Changes in Inpatient Hospital Discharges Associated with the National Formulary -- PATIENT COMPLAINTS-ADVOCATE, VETERANS OF FOREIGN WARS, AND SURVEY DATA -- PHYSICIAN COMPLAINTS AND SURVEY DATA -- SUMMARY STATEMENT -- 5 How Does the VA National Formulary Compare with Private Insurance Formularies for Drugs and Devices and with Other… -- INTRODUCTION -- IMPLEMENTATION OF DRUG MANAGEMENT STRATEGIES IN MANAGED CARE -- IMPACT OF STATE LEGISLATION ON MCO PRACTICE -- PUBLIC-SECTOR PROGRAMS -- Medicaid -- Medicaid Fee for Service -- Medicaid Prescription Drug Benefit -- Medicaid Controls Prior Approval and Formulary Systems -- Comparison to the VA -- Effects of Medicaid Formularies and Formulary Systems -- Effects of Medicaid Prior Approval Systems -- Effects of Medicaid Prescription Limits -- Medicaid Managed Care: Background -- Drug Benefit in Medicaid Managed Care -- DEPARTMENT OF DEFENSE -- Health Care System and Pharmacy Benefit -- DOD Formulary and Formulary System -- GENERAL COMMENTS ON COMPARISONS -- 6 The VA National Formulary and Veterans Health Care -- INTRODUCTION -- BACKGROUND AND CONTEXT -- THE VETERANS HEALTH ADMINISTRATION -- RESTRICTIVENESS -- COSTS -- QUALITY -- COMPARISONS -- References -- Acronyms -- APPENDIX A Interim Report of the Committee on VA Pharmacy Formulary Analysis to the Department of Veterans Affairs and the… -- JANUARY 28, 2000 -- APPENDIX B Academy of Managed Care Pharmacy's Managed Care Formulary and Pharmacy Benefit Design Survey -- AMCP MANAGED CARE FORMULARY AND PHARMACY BENEFIT DESIGN SURVEY (JANUARY 2000) -- The P&T Committee -- Exclusion of Coverage -- Closed Formularies -- Open-Preferred Formularies -- Open-Passive Formularies -- Other Types of Formularies -- Drug Restrictions -- Generic Drugs -- Access to Nonformulary Drugs.

Cost-Containment Measures -- Addition of New FDA-Approved Drugs -- Appeals Process -- Continuation of Care -- APPENDIX C Additional Cost Information -- APPENDIX D Glossary -- APPENDIX E Drug Classes and Drug Index -- DRUG CLASSES -- OTHER DRUGS -- Committee Biographies.