Conclusions

Over the past 3½ years, VA has made significant progress in establishing its  national formulary, which has generally met with prescriber acceptance. Prescribers reported that veterans are generally receiving the drugs they  need and that veterans rarely register complaints concerning prescription  drugs. VA has not provided sufficient oversight, however, to ensure that VISNs and  medical centers comply with formulary policies and that the flexibility  given to them does not unduly compromise VA’s goal of formulary  standardization. Contrary to VA formulary policy, some facilities omitted  national formulary drugs or modified the closed drug classes. While adding  a limited number of drugs to supplement the national formulary is  permitted, as more drugs are added by VISNs, formulary differences among  facilities are likely to become more pronounced, decreasing formulary  standardization. While VA recognizes the trade-off between local flexibility  and standardization, it lacks criteria for determining the appropriateness of  adding drugs to supplement the national formulary. Consequently, VA  cannot determine whether the resulting decrease in standardization is  acceptable.
What GAO Found

During the last three years, the Department of Veterans Affairs (VA) has made significant progress in establishing its national drug formulary, which has generally met with the prescriber acceptance. Most veterans are receiving the drugs the need and rarely register complaints about prescription drugs. However, VA has not been sufficient to ensure that the Veterans Integrated Service Networks (VISN) and medical centers comply with formulary policies and that the flexibility given to them does not compromise VA's goal of formulary standardization. Contrary to VA formulary policy, some facilities omitted national formulary drugs or modified the closest drug classes. Although a limited number of drugs to supplement the national formulary is permitted, formulary differences among facilities are likely to become more pronounced, as more drugs are added by VISNs, decreasing formulary standardization. VA recognizes the trade-off between local flexibility and standardization, but it lacks criteria for determining the appropriateness of adding drugs to supplement the national formulary and therefore may not be able to determine whether the decrease in standardization is acceptable.