VA National Formulary Act of 2025
Sponsored By: Representative Miller-Meeks, Mariannette [R-IA-1]
In Committee
Summary
Creates a single, national VA (Department of Veterans Affairs) drug formulary to standardize which medicines the VA covers across all facilities. It centralizes decisions, limits local variation, creates an electronic nonformulary request and fast appeals process, and requires public reporting and expert review.
Show full summary
- Veterans and families: Veterans get consistent drug coverage across VA locations, nonformulary approvals are portable, and initial decisions must occur within 96 hours. The bill sets lower copays for generic or formulary drugs than for brand-name or nonformulary drugs.
- Clinicians and VA staff: Clinicians work with a new Pharmacy and Therapeutics Committee made up of physicians, clinical pharmacists, and pharmacoeconomists who must be free of industry conflicts and meet regularly. The committee must use evidence, review drugs quickly, and aims to decide on newly FDA-approved drugs within 120 days.
- Drug purchasing and manufacturers: The VA can negotiate supplemental discounts, use value-based contracts tied to drug outcomes, and adopt flexible purchasing agreements. Major formulary changes must be evaluated for health outcomes and costs and reported to congressional veterans committees within 180 days.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 4 benefits, 0 costs, 1 mixed.
Expanded medication therapy and reviews
If enacted, VA would expand medication therapy management with a focus on polypharmacy and high‑risk drugs. Clinical pharmacy specialists would review complex regimens and identify unsafe or duplicative prescribing. The VA would run regular drug‑use reviews and use interventions like provider education and patient outreach to improve safety and adherence.
Faster nonformulary requests and appeals
If enacted, VA would add an electronic nonformulary request system linked to the VA medical record so clinicians can request drugs not on the national list during prescribing. Initial nonformulary decisions would be required within 96 hours. Denials would carry a right to appeal, and appeal decisions would be required within seven days. Approvals, including appeals outcomes, would be portable across VA facilities and VISN or facility directors could get time‑limited waivers that are centrally reviewed.
One VA national drug list
If enacted, VA would keep one national list of prescription drugs for all VA hospitals and clinics. A new Pharmacy and Therapeutics Committee would pick drugs using clinical evidence and cost analysis. Committee members would have to disclose financial interests and be barred from voting when conflicted. The committee would try to decide on newly FDA‑approved drugs within 120 days when practicable and the VA would publish public summaries and annual reports for five years after enactment.
VA value-based drug purchasing
If enacted, the VA Secretary would be able to negotiate extra discounts and value‑based contracts with drug makers in exchange for preferred formulary status. Agreements could tie payments to drug outcomes and include monitoring and payment adjustments. The Secretary must keep negotiated prices below statutory maximums and is encouraged to use bulk buying tools like blanket purchase agreements.
New tiered VA drug copays
If enacted, VA would set tiered copayments so a 30‑day supply of a generic drug or a drug on the national formulary would cost less than a 30‑day supply of a brand‑name drug or a drug not on the national formulary. The tiering is designed to encourage use of formulary and generic options. Veterans who need medically necessary nonformulary drugs could still obtain them under the bill's nonformulary rules, but their copay could be higher.
Sponsors & CoSponsors
Sponsor
Miller-Meeks, Mariannette [R-IA-1]
IA • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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