Prime vendor purchasing of pharmaceuticals in the Veterans Affairs health care system.

The development of a prime vendor system of pharmaceutical procurement and distribution in the Department of Veterans Affairs (VA) is described. The traditional system of pharmaceutical procurement and distribution in the VA required large stockpiles of the pharmaceuticals that had been needed the previous year, a system that was inefficient and full of hidden markups and other unnecessary fees. In late 1991, the VA began a pilot test of a prime vendor system, in which three wholesalers were selected to provide pharmaceuticals to 33 VA medical centers. Under the new system, pharmacies placed orders electronically, directly with the prime vendor, and payments were taken from funds obligated in advance. The benefits of the new system included reduced costs, faster turnaround of orders, higher fill rates, and higher satisfaction among users. In 1994, the VA ceased operation of its traditional depot system for pharmaceuticals. The implementation of a prime vendor procurement system for pharmaceuticals within the VA improved system responsiveness, increased satisfaction of system users, and reduced expenses.

Pharmaceutical services in the Department of Veterans Affairs.

The status of pharmaceutical services in the Department of Veterans Affairs (VA) is described. The VA health care system is transforming itself from a hospital-based organization into 22 health care networks that emphasize primary and ambulatory care. The impact on VA pharmacy has been substantial. Roles of VA pharmacists and technicians have been enhanced, and a clinical career ladder for pharmacists was created. VA pharmacy officials and leaders from the University of Tennessee College of Pharmacy have been partnering since 1988 in strategic planning to determine how VA pharmacy can do business and serve patients better. Areas targeted for implementation or improvement include staff development, prescribing authority for pharmacists, automation, the physical design of VA pharmacies, residency programs, and a pharmacy benefit management (PBM) product line. The VA PBM is working to enhance the appropriate use of pharmaceuticals in the veteran population, reduce overall health care expenditures, and provide a more consistent quality of care. Specific PBM programs involve the implementation of drug treatment guidelines, a national formulary, and national contracts. There are plans for pharmacoepidemiologic and pharmacoeconomic research in the geriatric veteran population. The VA health care system and its pharmacy service are changing in ways intended to bring about easier access to care, higher quality, and increased responsiveness to patients' needs.

Drug information resources in the Veterans Affairs healthcare system.

Results of a survey characterizing drug information services and resources from a defined practice area are presented. At the end of 1992, a questionnaire was mailed to 167 Veterans Affairs Medical Centers and Outpatient Clinics. One hundred fifty-one of the surveys (> 90%) were completed and analyzed. The knowledge obtained from this survey may provide a basis for future development of an essential clinical service within the Veterans Affairs health care system.

Drug information service for drug product procurement in the Veterans Affairs health-care system: preliminary experience.

The preliminary experience of the drug information service of the Department of Veterans Affairs (VA) central office is described. The drug information service assists the drug and pharmaceutical product management section of the pharmacy service for the VA central office. The purpose of the drug information service is to promote efficacious drug therapy while meeting cost containment goals for pharmaceutical products. The pharmacist coordinator of this service has experience in both patient care and drug information service. The drug information service is involved in the following activities: (1) making recommendations for contract bidding on therapeutically equivalent products, (2) identifying prescription duplication within the system, (3) reporting product defects, (4) planning drug procurement in unique situations, such as during war, (5) developing gender-specific therapy, (6) evaluating the appropriateness of brand-name-only purchasing of certain products, (7) evaluating new drug products, (8) compiling national drug-use data, and (9) projecting drug price increases. The VA drug information service has diverse responsibilities meant to optimize drug therapy and reduce pharmacy costs in the VA health-care system.