NATIONAL FORMULARY
QUESTIONS
Q1: Why aren’t dosage forms and strengths listed on the National Formulary?
A1: VISN Leaders feed back to allow flexibility at facility/VISN level. Q2: Why are dosage forms and strengths listed for Dermatology, Neurology and OTC products? A2: Dosage forms and strengths are listed for dermatologic products per the National Dermatology Work Group. Dosage forms for certain neurological agents are listed from input by the National Directors of Neurology. Q3: Why can’t I locate a brand name product on the National Formulary? A3: All items are listed by alpha-generic entity or pharmacologic (VA) class. Q4: Why are certain brand name drugs listed on the National Formulary? A4: Only products that cannot be substituted due to narrow therapeutic index, including Lanoxin®, Tegretol®, Dilantin®, Coumadin®, Antabuse® are listed both generically and by trade name. Q5: What is the VA Class? A5: It is a therapeutic classification system similar to other common classification systems (i.e., AHFS Class System). Q6: What does "R" mean? A6: National Restrictions (e.g., per PBM-MAP Pharmacologic Treatment Guidelines, specific service/specialty) except in the case of antibiotics, local or VISN guidelines should be made. Q7: Where can I obtain a copy of the PBM-MAP Pharmacologic Treatment Guidelines?
A7: Web Site Address: www.pbm.va.gov or within the VA the PBM Intranet
Q8: What does "*" mean?
A8: Restrictions and/or criteria for use should be considered at the facility or local level.
Q9: Can agents be added on the VISN/local level?
A9: Yes, as long as the class is not closed by a National Contract (PPIs, LHRH Agonist Analogues, HMG CoA-RI, ACE Inhibitors).
Q10: How do I know if a drug is on a National Contract?
A10: Refer to the PBM Web Page at www.pbm.va.gov or within the VA the PBM Intranet
Q11: Can agents listed on the National Formulary be deleted on the VISN/local level?
A11: No. Items listed on the National Formulary shall be made available throughout the
VA Healthcare System.
Q12: How do I know if an agent is on the National Formulary?
A12: Agents are listed by VA class or alphabetically by generic name.
Q13: How is the National Formulary updated?
A13: The National Formulary is periodically updated by the PBM. Refer to the PBM Web Page at www.pbm.va.gov or within the VA the PBM Intranet
Q14: Where can I obtain a current copy of the National Formulary?
A14: Web Site Address: www.pbm.va.gov or within the VA the PBM Intranet
Q15: Where can I obtain updates to the National Formulary?
A15: Web Site Address: www.pbm.va.gov or within the VA the PBM Intranet
Q16: How do the VISNs and local facilities request addition of drugs to the National Formulary?
A16: Fill out a National Formulary request form completely. This form can be found on the web page (www.pbm.va.gov or within the VA the PBM Intranet)
Q17: What is the purpose of the National Formulary?
A17: The purpose of the National Formulary is to provide high quality, best value
pharmaceutical products while assuring the portability and standardization of the
pharmacy benefit to eligible veterans accepted by VA for care.
Q18: What is the non-formulary use procedure?
A18: A non-formulary request process must exist at each VA facility. The process
should assure that decisions are evidence-based and timely. Non-formulary drugs
should be approved under the following circumstances:
1. Contraindication(s) to the formulary agent(s).
2. Adverse reaction to the formulary agent(s).
3. Therapeutic failure of all formulary alternatives.
4. No formulary alternative exists.
5. The patient has previously responded to a non-formulary agent and risk is associated with a change to a formulary agent.
Non-formulary approvals should require a reevaluation of the approval based upon clinical response. Each VISN will identify key non-formulary approval components and establish a process to analyze and trend the information at the VISN and local level. In therapeutic classes where national contracts have been awarded, VISNs will report to the PBM quarterly the justifications for non-formulary drug utilization.
Q19: Can I use a non-formulary agent if I am involved in a clinical trial?
A19: Drugs will not be added to the FORMULARY solely for the purpose of performing
a clinical trial. However, the FORMULARY is not intended to hinder the use of
any pharmaceutical agent in legitimate scientific studies.
Q20: How was the original National Formulary compiled?
A20: By combining the VISN formularies for matches, and then field review for comment.
Q21: When was the original National Formulary issued?
A21: May 1997.
Q22: When was the 1st update to the National Formulary issued?
A22: December 1997.
Q23: How will drug classes be reviewed?
A23: The PBM will determine which drug therapeutic classes will be reviewed in
preparation of awarding national contracts. Literature-based drug
class reviews will be the basis for such determinations by the PBM.
Q24: What is the responsibility of the VISN formulary committee?
A24: The VISN Formulary Committee is responsible for identifying and requesting
drugs for inclusion to or deletion from the FORMULARY, providing input to the
PBM on the impact of national formulary decisions on VISNs, and reporting VISN
and local restrictions to the PBM.
Q25: What is the responsibility of the PBM-MAP?
A25: The PBM is responsible for supporting, implementing, maintaining, and distributing editions of the FORMULARY. The MAP is the Medical Advisory Panel to the PBM.
Q26: Can the VISN or facility level restrict National Formulary agents?
A26: Restrictions can be established at the National, VISN, or local level for formulary items that require close monitoring to ensure appropriate use (???)
Q27: Where can I look up drug prices?
A27: Drug prices are available on the DPPM Bulletin Board (708) 202-7947 and on the PBM Web Page at www.pbm.va.gov or within the VA the PBM Intranet
Q28: What does it mean when a drug class is listed as "Class Review"?
A28: The PBM is engaged in a review of the drug class at this time for possible national contract solicitation.