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Opportunities To Reduce Fee-Basis Pharmacy Costs

HRD-83-83 Published: Sep 27, 1983. Publicly Released: Sep 27, 1983.
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Highlights

GAO reviewed the Veterans Administration's (VA) efforts to reduce the number and cost of prescriptions filled by private pharmacies on a VA-reimbursable fee-for-service basis.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Veterans Administration The Administrator of Veterans Affairs, through the Chief Medical Director, should direct VA clinics of jurisdiction to have pharmacists review fee pharmacy prescriptions to identify duplicate prescriptions, excessive quantities of drugs, and prescriptions that should have been filled by the VA pharmacy.
Closed – Implemented
The VA MPI Manual, part I, was revised to incorporate this recommendation. The manual was issued to the field on February 12, 1986.
Veterans Administration The Administrator of Veterans Affairs, through the Chief Medical Director, should revise the fee-basis manual to direct VA clinics of jurisdiction to instruct veterans to send prescriptions for nonemergencies to VA for filling and to deny payment for subsequent prescriptions of veterans disregard the request.
Closed – Implemented
Available VA data indicates that, while some improvement has been made, at least 19 of the 80 clinics still do not fill enough fee-basis prescriptions in-house.
Veterans Administration The Administrator of Veterans Affairs, through the Chief Medical Director, should revise VA drug reimbursement policies to incorporate Medicaid maximum allowable cost (MAC) provisions.
Closed – Implemented
VA postponed a decision on this recommendation until the Department of Health and Human Services (HHS) decides on the future of the Medicaid MAC program. Although an internal HHS group recommended action, the Secretary, HHS, had not yet accepted that recommendation as of January 1985.
Veterans Administration The Administrator of Veterans Affairs, through the Chief Medical Director, should direct VA clinics of jurisdiction to fill prescriptions for non-service-connected conditions only if the clinic's staff and facilities are not needed to fill prescriptions for veterans with service-connected conditions, including those fee-basis prescriptions for nonemergencies.
Closed – Not Implemented
VA contends the administrative burden of prioritizing based on the veterans' service-connected classification would more than offset the savings. This is consistent with its philosophy, discussed in the report, that once a non-service-connected veteran is deemed eligible for care, VA is obligated to provide all needed services, including prescriptions.
Veterans Administration The Administrator of Veterans Affairs, through the Chief Medical Director, should reemphasize, to clinics of jurisdiction, the importance of having Medical Administration Service clerks review fee pharmacy prescriptions to ensure that payments do not exceed the limits established by the VA prescription schedule.
Closed – Implemented
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
Veterans Administration The Administrator of Veterans Affairs, through the Chief Medical Director, should establish priorities for providing outpatient prescriptions to veterans with no service-connected conditions based on the veterans ability to pay for prescriptions from private sources.
Closed – Not Implemented
VA contends that this recommendation is contrary to its policy to provide eligible veterans full outpatient care and services appropriate to their needs.
Veterans Administration The Administrator of Veterans Affairs, through the Chief Medical Director, should establish a system for periodically monitoring clinics of jurisdiction compliance with fee-basis pharmacy policies and procedures.
Closed – Implemented
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

Full Report

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Topics

Cost analysisDrugsHealth care cost controlMedical feesOverpaymentsPharmaceutical industryPolicy evaluationPrivate sectorVeterans benefitsVeterans