H.R. 6580 — VA National Formulary Act of 2025

This section establishes a national formulary for the Department of Veterans Affairs (VA), to be maintained by the Secretary of Veterans Affairs and managed by the Pharmacy Benefits Management Service, consisting of all drugs and supplies available by prescription at VA medical facilities; requires uniform implementation across all facilities, prohibiting local formularies with non-national drugs except through a nonformulary request process, or time-limited waivers approved nationally after centralized review of clinical need, safety, and cost-effectiveness; mandates regular public communication on formulary management, including rationales and briefings for significant changes; and requires (1) annual reports to congressional Veterans' Affairs Committees on nonformulary appeals and (2) public annual reports for five years summarizing formulary changes, including additions, removals, and modifications to usage or prior authorization criteria. This section further establishes a Pharmacy and Therapeutics Committee within the Veterans Health Administration, composed of VA physicians from major specialties, clinical pharmacists, and pharmacoeconomists (including experts in geriatric and mental health care for veterans), with conflict-of-interest safeguards including annual disclosures and recusals; directs the committee to meet at least monthly or bimonthly to review new FDA-approved drugs and recommend formulary inclusion or exclusion within 120 days using evidence-based criteria such as clinical data, pharmacoeconomics, and VA/DoD guidelines; and requires public website summaries of clinical rationales for significant formulary additions or removals.

This section amends VA copayment requirements for outpatient prescription drugs for non-service-connected conditions under 38 U.S.C. §1722A (currently a $2 charge per 30-day supply, subject to exceptions for veterans with 50% or higher service-connected disability ratings, former prisoners of war, low-income veterans, Medal of Honor recipients, and those receiving opioid antagonists) to (1) require a tiered copayment schedule under which the copayment for a 30-day supply of a generic drug or drug on the VA national formulary is lower than for a brand-name drug or nonformulary drug, to encourage clinically appropriate, cost-effective medications while maintaining access to medically necessary nonformulary drugs; and (2) correct a cross-reference in the Medal of Honor exemption to 14 U.S.C. §2732 (from §491). This section also adds new §8130 to title 38, U.S. Code, authorizing the VA Secretary to (1) negotiate supplemental discounts or rebates with drug manufacturers beyond existing price limits under §8126, including agreements linking discounts to preferred formulary placement if they yield clinical benefits and net savings; (2) use flexible purchasing practices such as blanket purchase agreements, volume-leveraging contracts, and value-based arrangements tying payments to a drug's or biological product's effectiveness for veterans (with monitoring mechanisms); and (3) conduct periodic reviews of formulary changes or major initiatives (with reports to congressional Veterans' Affairs Committees within 180 days) and evaluations of significant actions such as adding high-cost drugs or removing clinically used ones (with findings provided within one year to inform future decisions).

This section establishes the Veterans Formulary Advisory Committee to provide veteran and clinician input on the Department of Veterans Affairs' national formulary (i.e., the list of drugs covered under the VA health care system). The committee consists of not more than 10 members, including front-line clinical providers or pharmacists of the VA who are not involved in national formulary decision-making and other stakeholder representatives; meets at least semiannually to review proposed formulary changes; and provides advisory recommendations to the Secretary and the Pharmacy and Therapeutics Committee on proposed additions, removals, and restrictions to the formulary, including potential effects on veteran patients. The committee terminates two years after its establishment.