The Formulary

A formulary is a listing of medicines allowed by a health insurer (in this case, the VHA is your insurer) for use by its beneficiaries. Like most modern health care provider entities, the VHA uses a national formulary to accomplish cost controls while allowing providers and patients a choice of quality medications for the treatment of various conditions. Detailed information about the way this works and what drugs are on the VHA formulary may be found here.

Almost all providers and payers of health care in America use a formulary. Formulary committees are usually made up of pharmacists, physicians and administrators and they spend a great deal of time ensuring that affordable medicines are available to their patients.

The concept of the formulary seems simple. To develop and administer a formulary is a complex task. Each organization will develop its own reasoning for what is allowed, what is prohibited, an appeals process and any associated fees or co-pays. An example of just how complex this can be may be found at The Fingertip Formulary.

The VA often approves medicines that aren't on the VHA  formulary. The rationale for approving prescriber requests for non-formulary medications may be found here.

To ask your VA doctor to prescribe a drug that isn't on VA's formulary, you must have already failed with the approved treatments or experienced adverse effects from them. If the prescription is still denied, an appeal process is usually available.

Generic Drugs

A generic drug is a less expensive version of a brand name medication.

Pharmaceutical manufacturers spend a lot of money to develop a drug. If the drug is approved and if it becomes popular, the manufacturer may reap a large reward in terms of profits. Eventually the patent on the drug runs out and generic manufacturers are then allowed to duplicate the medication and sell it for far less cost.

The popularity of generic drugs continues to grow as our health care systems search for ways to control costs. The FDA maintains an Office of Generic Drugs with a specific focus on maintaining the quality of generics.

The Food and Drug Administration requires that a generic medicine is "therapeutically equivilant" to the original drug. packaging, the delivery (pill, capsule, etc.) and some inert ingredients may change but the basic part of the medication is required to be exactly the same as the original. A letter to prescribers that explains how FDA views therapeutic equivalence may be found here.

Copays and Pharmacy Charges

Many veterans will find that they are required to pay a "copay" amount for their prescribed medications. This usually depends on the Priority Group that the veteran is assigned to.