Pharmacy benefits management in the Veterans Health Administration: 1995 to 2003.

Pharmacy Benefits Management Strategic Healthcare Group, Department of Veterans Affairs, 1st Ave, 1 Blk N of Cermak Rd, Bldg 37, Room 139, Hines, IL 60141, USA.
The American journal of managed care (Impact Factor: 2.17). 03/2005; 11(2):104-12.
Source: PubMed

ABSTRACT The Department of Veterans Affairs (VA) Pharmacy Benefits Management Strategic Healthcare Group (VA PBM) oversees the formulary for the entire VA system, which serves more than 4 million veterans and provides more than 108 million prescriptions per year. Since its establishment in 1995, the VA PBM has managed pharmaceuticals and pharmaceutical-related policies, including drug safety and efficacy evaluations, pharmacologic management algorithms, and criteria for drug use. These evidence-based practices promote, optimize, and assist VA providers with the safe and appropriate use of pharmaceuticals while allowing for formulary decisions that can result in substantial cost savings. The VA PBM also has utilized various contracting techniques to standardize generic agents as well as specific drugs and drug classes (eg, antihistamines, angiotensin-converting enzyme inhibitors, alpha-blockers, and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors [statins]). These methods have enabled the VA to save approximately dollar 1.5 billion since 1996 even as drug expenditures continued to rise from roughly dollar 1 billion in fiscal year (FY) 1996 to more than dollar 3 billion in FY 2003. Furthermore, the VA PBM has established an outcomes research section to undertake quality-improvement and safety initiatives that ultimately monitor and determine the clinical impact of formulary decisions on the VA system nationwide. The experiences of this pharmacy benefits program, including clinical and contracting processes/procedures and their impact on the VA healthcare system, are described.


Available from: Michael A Valentino, Jun 13, 2015
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    ABSTRACT: The Veterans Administration health care system (VA) is one of the largest integrated delivery systems in the United States. The VA provides a rich central data base repository that includes detailed medication data, historical information about patient morbidities, clinical data, and inpatient and outpatient utilization information from claims data and health status information derived directly from the patient. The Veterans Health Study (VHS), a large-scale prospective study following patient's health outcomes for up to six years, derived and validated a number of patient questionnaires for wide-scale use in the VA as part of its quality monitoring and research programs. Chief among these assessments are the Veterans Rand 36 item and 12 item health surveys (VR-36 and VR-12); other assessments include measures of illness and their associated severity, health-related quality of life, and utilization of health care services. This report reviews the methodologies developed in the VHS and their subsequent applications in the VA system for conducting medication effectiveness studies based upon non-randomized prospective quasi-experimental designs that approximate real world clinical conditions. Study cohorts are described that link the patient questionnaire data with administrative, clinical, and pharmacy data to address questions about medication effectiveness. Statistical models include comprehensive risk adjustments in order to better understand the association between medications that are being compared and their associated patient outcomes. Applications of this approach are presented for medication studies in those diagnosed with hypertension, osteoarthritis, low back pain, depression, and schizophrenia. Future implications of this work are described for purposes of quality improvement. Drug Dev. Res. 67:217–226, 2006. © 2006 Wiley-Liss, Inc.
    Drug Development Research 03/2006; 67(3):217 - 226. DOI:10.1002/ddr.20080 · 0.73 Impact Factor
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    11/2014; 66(11). DOI:10.1002/acr.22341
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    08/2014; 67(4). DOI:10.1002/acr.22463