Who doesn’t like the VA drug benefit?

If I had known about the following passage from Phil Longman’s book Best Care Anywhere (pages 56-57), I might have cited it in my paper with Steve Pizer and Roger Feldman on the VA’s drug benefit.

Predictably, many drug companies hate the power the VA has over them. They fund studies claiming to find some inadequacy in its formulary, with the usual complaint being that the VA does not include enough “new and improved” drugs. One such study, for example, published by the drug industry-funded Manhattan Institute, purported to find a two-month decline in life expectancy among VA patients because the VA formulary included a lower fraction of new drugs than those typically in use by the rest of the health-care sector.[6]

Yet the independent and prestigious Institute of Medicine has debunked the claim, finding that “the VA National Forumulary is not overly restrictive.”[7] As the millions of Americans who took Vioxx and other COX-2 inhibitors have learned all too painfully in recent years: just because the Food and Drug Administration approves a drug doesn’t mean it is a superior therapy, or even a safe one. It only means that in some short-run trials, usually financed by the manufacturer, the new drug proved more effective than a placebo.

According to William Korchik, a VA doctor who has participated in the VA’s drug review process, another big benefit of this policy over the years has been avoiding dangerous drugs [like Vioxx].

We did cite [6] in our paper to make similar point that Longman makes, that the VA is pressured by some to open up its formulary. As is the custom in academic publications, we didn’t draw attention to the source of funding for [6], as Longman does. This difference between academic and journalistic writing and culture is worth pondering.


[6] Lichtenberg F. 2005. Older drugs, shorter lives? An examination of the health effects of the veterans health administration formulary, No. 2, Center for Medical Progress, The Manhattan Institute, October.

[7] Blumenthal D, Herdman R, eds. 2000. VA Pharmacy Formulary Analysis Committee, Division of Health Care Services. Description and Analysis of the VA National Formulary, executive summary. Washington DC: Institute of Medicine, National Academies Press.

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