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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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hfsess

Anyone Obtaining Non Formulary Prescriptions?

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I need advice on the possibility of obtaining non Formulary prescription drugs. I am 100% service connected. I was taking the VA Formulary drugs for colestrol control until my private doctor switched me the crestor and zeita. My cholesterol went from 200+ to 88 and my triglycerides went from 500 range to under 100. My wife recently had to retire because of health problems and my other medical insurance went with her job. Can I request the VA provide me with these drugs and has anyone had any experience with requesting non Formulary drugs.

Thanks for your input.

Howard Sessions RVN 69/70

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hf,

Welcome to hadit !

I get 3 non VA formulary drugs. My neurologist gets over-rides for 2 and my PCP for 1.

Basically they need to be able to show that the Va formulary drugs do not either, get the proper

results (could even be negative side effects) with a patient and/or a non formulary drug would be

more cost effective for the Va.

just my opinion.

carlie

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hf,

Here's the link I think you're looking for

carlie

http://www.pbm.va.gov/natform/fequentlyasked.htm

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.

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Howard:

Welcome to Hadit. Carlie gave you the right answer. You really need to have a Doc write that the formulary drugs are not what you need. It usually is not that hard and you can ask to see the Pharmacy Manager they usually try to be helpful.

Good Luck those are expensive drugs. If you are 100% you should get SSD so if you have not apply. If you have Medicare you can get help paying for meds up to 2250. I have a Medicare HMO and so far I have paid about 300 for drugs outside the VA and my Insurance has paid 1600.

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I need advice on the possibility of obtaining non Formulary prescription drugs. I am 100% service connected. I was taking the VA Formulary drugs for colestrol control until my private doctor switched me the crestor and zeita. My cholesterol went from 200+ to 88 and my triglycerides went from 500 range to under 100. My wife recently had to retire because of health problems and my other medical insurance went with her job. Can I request the VA provide me with these drugs and has anyone had any experience with requesting non Formulary drugs.

Thanks for your input.

Howard Sessions RVN 69/70

Welcome.

I get 2 non-formulary drugs myself; the doctor tried every drug on the VA formulary without result, so he told me that the department had group meeting and the Dept. head would approve it for me since nothing else worked for me as well.

BoonDoc

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