HR6580-119

What This Bill Does

The VA National Formulary Act of 2025 writes a detailed formulary governance system into title 38. It requires the Secretary of Veterans Affairs to maintain one national list of drugs and supplies available through VA medical facilities, limits local formularies unless a drug is approved through the nonformulary process or a national waiver, and makes Pharmacy Benefits Management Services responsible for centralized management. It creates a Pharmacy and Therapeutics Committee with VA physicians, clinical pharmacists, and pharmacoeconomists; requires conflict-of-interest disclosures; sets a 120-day goal for decisions on newly FDA-approved drugs; requires public clinical rationales for significant additions or removals; creates a standardized electronic nonformulary request system with 96-hour initial decisions and seven-day appeals; requires therapeutic-class reviews and medication-therapy management for veterans at high risk from complex drug regimens; and authorizes supplemental discounts, rebates, value-based purchasing, outcome monitoring, and congressional reporting. A temporary Veterans Formulary Advisory Committee would add front-line clinician and veteran input for two years.

Who Benefits and How

Veterans benefit from more uniform access to covered drugs across VA facilities, portable nonformulary approvals when they move between medical centers or VISNs, clear denial and appeal rights, faster deadlines, and drug-therapy reviews focused on polypharmacy and high-risk medications. VA clinicians benefit from standardized criteria and an electronic workflow for requesting nonformulary drugs. VA taxpayers and the Department may benefit if supplemental discounts, rebates, blanket purchase agreements, and value-based contracts lower net drug costs while preserving clinical outcomes.

Who Bears the Burden and How

The Department of Veterans Affairs bears substantial administrative burdens: Pharmacy Benefits Management Services must run a national formulary, centralized waiver review, public communications, conflict-of-interest processes, electronic request systems, appeals, therapeutic-class reviews, drug-use interventions, purchasing reviews, and reports to Congress. VA Pharmacy and Therapeutics Committee members must make evidence-based decisions and disclose financial interests. Drug manufacturers may face stronger price concessions, rebate demands, preferred-status negotiations, and outcome-based payment terms tied to VA formulary placement.

Key Provisions

• Establishes a uniform VA national formulary and restricts local formulary deviations unless a nonformulary request or national waiver applies.
• Creates a VA Pharmacy and Therapeutics Committee with conflict-of-interest rules, public clinical rationales, and a 120-day goal for reviewing newly FDA-approved drugs.
• Requires a standardized electronic nonformulary request system with 96-hour initial decisions, seven-day appeals, portable approvals, and uniform clinical criteria.
• Authorizes supplemental discounts, rebates, value-based purchasing arrangements, outcome monitoring, and periodic reports on budgetary and clinical effects.
• Requires therapeutic-class reviews, medication-therapy management for high-risk veterans, and a two-year Veterans Formulary Advisory Committee for veteran and clinician feedback.