As with schizophrenia, bipolar disorder can impair a patient’s  ability to function. VA Prescribing Guideline for Atypical Antipsychotic Drugs Is Sound

VA’s guideline for prescribing atypical antipsychotic drugs is consistent  with published clinical practice guidelines commonly used by public and  private health care systems. Like most other practice guidelines, VA’s  guideline recommends that physicians use their best medical judgment,  based on clinical circumstances and patients’ needs, when choosing among  the atypical drugs. In addition, formulary leaders, psychiatrists, and pharmacists in five VISNs  told us that several facilities require physicians to follow additional policies  and procedures for prescribing atypical antipsychotic drugs. This policy  conflicts with the prescribing guideline, because cost has greater weight  than physicians’ clinical judgment. While these procedures help the  facility manage pharmaceutical use, they have the potential to  overemphasize cost-containment if they put pressure on physicians to  prescribe the less expensive drugs.
What GAO Found

The Department of Veterans Affairs (VA) provides health care services to veterans who have been diagnosed with psychosis--primarily schizophrenia, a disorder that can substantially limit their ability to care for themselves, secure employment, and maintain relationships. These veterans also have a high risk of premature death, including suicide. Effective treatment, especially antipsychotic drug therapy, has reduced the severity of their illnesses and increased their ability to function in society. VA's guideline for prescribing atypical antipsychotic drugs is sound and consistent with published clinical practice guidelines used by public and private health care systems. VA's prescribing guideline, recommends that physicians use their best clinical judgment, based on clinical circumstances and patients' needs, when choosing among the atypical drugs. Most Veterans Integrated Service Networks and facilities use VA's prescribing guideline; however, five VISNs have additional policies and procedures for prescribing atypical antipsychotic drugs. Although these procedures help manage pharmaceutical cost, they also have the potential to result in more weight given to cost than clinical judgment which is not consistent with the prescribing guideline.