Description and analysis of the VA National Formulary / David Blumenthal and Roger Herdman, editors ; VA Pharmacy Formulary Analysis Committee, Division of Health Care Services, Institute of Medicine.

Format:

Book

Contributor:

Blumenthal, David, 1948-

Herdman, Roger.

United States. Department of Veterans Affairs.

Institute of Medicine (U.S.)

Language:

English

Subjects (All):

United States. Veterans Health Administration.

United States.

Drugs--United States.

Drugs.

Drug utilization--Government policy--United States.

Drug utilization.

Medicine--Formulae, receipts, prescriptions.

Medicine.

Veterans--Medical care--United States--Quality control.

Veterans.

Physical Description:

xvi, 262 pages : illustrations.

Edition:

1st ed.

Other Title:

VA National Formulary

Veterans Administration National Formulary

Place of Publication:

Washington, D.C. : National Academy Press, c2000.

Language Note:

English

Summary:

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.

Contents:

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

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&amp

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…

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

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&amp

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.

Notes:

Bibliographic Level Mode of Issuance: Monograph

Includes bibliographical references (p. 201-216).

ISBN:

9786610185511

9780309183536

0309183537

9781280185519

1280185511

9780309569644

0309569648

OCLC:

697624774