Hon. Michael H. Michaud, Chairman, Subcommittee on Health

The Subcommittee on Health will now come to order.  I would like to thank everyone for attending this hearing. 

The goal of today’s hearing is to determine whether the VA is meeting the pharmaceutical needs of our veterans.  We are conducting this hearing because of the concerns that I have heard from our veterans about proper access to non-formulary prescription drugs, concerns about adverse drug interactions and patient safety, and recent reports by the Office of Inspector General citing the need to better manage certain aspects of the VA’s pharmacy benefits program. 

When properly designed and implemented, formularies can promote drug therapy that is rational, clinically appropriate, safe, and cost-effective.  However, patient care may be compromised if a formulary system is not developed and administered so that individuals can access the drugs that they need.  I have heard from veterans who have voiced their frustration with the VA national formulary as being too restrictive to the point that accessing appropriate drugs is a barrier. Some veterans have pointed to a flawed, subjective system for securing non-formulary drugs.  For example, a veteran who is denied access to a non-formulary drug at one VA medical center may be approved in another medical center, which suggests that the decision may not be based entirely on clinical factors. 

I also have concerns about patient safety and whether we are doing enough to prevent adverse drug events.  Among the medication errors leading to adverse drug events are missed doses, duplicate therapy, drug to drug interaction, inadequate monitoring, and preparation error.  For example, what is the VA doing to prevent adverse drug events and are they coordinating well with the FDA?  What steps is the VA taking to ensure that veterans do not accidentally take their prescribed medicine in wrong doses or do not forget to take their medicine at the right times?  Also, how does the VA make sure that they catch potentially adverse drug interactions when veterans get their prescriptions filled both at the VA and at private pharmacies? 

Finally, the recently released audit reports from the Office of Inspector General raise concerns about the VA’s management of non-controlled drugs and the Consolidated Mail Outpatient Pharmacy (CMOP) contract.  Efficient management of the CMOP contract is critical because almost 80 percent of all VA pharmaceuticals are dispensed using the CMOP.

We have our panels of expert witnesses to help us explore these issues today.  I look forward to hearing their testimonies.