This bill creates a standardized system for managing prescription drugs available to veterans through the VA. Right now, different VA medical centers can maintain their own local drug lists, which means a veteran might get one drug at one facility but not at another. This bill changes that by requiring all VA facilities to use the same national formulary—a single approved list of medications.

The bill sets up a formal process for deciding which drugs go on this list. A new Pharmacy and Therapeutics Committee made up of VA doctors, pharmacists, and specialists will review new medications and decide whether to include them, aiming to make decisions within 120 days of FDA approval. If a doctor thinks a patient needs a drug that's not on the list, there's now a streamlined electronic request system with a 96-hour decision deadline, and if denied, veterans can appeal within seven days.

The bill also creates financial incentives to encourage veterans to use cheaper, equally effective medications. Veterans will pay lower copayments for generic drugs and formulary drugs compared to brand-name or non-formulary drugs. Additionally, the VA gets new tools to negotiate better prices with drug manufacturers, including value-based deals where the VA only pays full price if the drug actually works as promised. Finally, the bill establishes a Veterans Formulary Advisory Committee to give frontline doctors and veterans a voice in these decisions, and requires the VA to publicly explain major formulary changes and report annually to Congress.