VA National Formulary Covers 16 Percent Fewer Top Prescription Drugs than Medicare Part D Plans

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New Avalere analysis finds that the VA National Formulary covers 163 of the top 200 most prescribed Medicare Part D drugs, compared to an average of 191 drugs for Medicare prescription drug plans (PDPs) and 194 drugs for Medicare Advantage prescription drug plans (MA-PDs).
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The VA National Formulary does not offer access to nearly one-fifth of the top 200 most commonly prescribed Medicare Part D drugs. Among the 37 drugs not covered by the VA, PDPs cover 19 medications at least 90 percent of the time. The vast majority of these 19 medicines predominately fall on either the generic tier or the preferred brand tier of PDP plans, with the exception of Lovaza, which is most often placed on the non-preferred brand tier.

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Among the top 200 drugs, the VA National Formulary does not cover any of the top drugs in the following three classes.

    Beta-Adrenergic Agonists (2 drugs: Asthma, COPD)

    Dipeptidyl Peptidase IV (DPP-4) Inhibitors (1 drug: Type 2 diabetes)
    Estrogen Agonist-Antagonists (1 drug: Osteoporosis)

The full analysis is available below.

Funding support for this research came from the Pharmaceutical Research and Manufacturers of America. Avalere maintained full editorial control over the content in this issue brief.


Avalere used the Medicare Fee-For-Service Provider Utilization & Payment Data Public Use File’s Part D Prescriber National Summary Table to determine the top 200 medications by prescription volume among Part D plan enrollees in 2013. Avalere then examined coverage and tier placement for these medications among 2015 PDPs and MA-PDs using its proprietary DataFrame® database, which contains over 3,000 Medicare prescription drug plan formularies, cost-sharing requirements, and benefit structures. Finally, Avalere analyzed the March 2015 VA National Formulary to determine the coverage status for the same list of medications.

Avalere used all PDPs for the PDP-related analyses and excluded Medicare-Medicaid Plans and Special Needs Plans for the MA-PD analyses. For all analyses, the results were enrollment-weighted to appropriately account for higher versus lower-enrollment plans.

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