,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #fehj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #aj1         
#bjbe,mrs4 ,mill]-,meeks introduc$ !    
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,vet]ans' ,affairs  ,a    
,,bill  ,to am5d title #ch1 ,unit$      
,/ates ,code1 to make c]ta9 improvem5ts 
9 ! adm9i/ration ( ! national =mul>y ( !
 ,dep>tm5t ( ,vet]ans ,affairs1 & = o!r 
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,,va ,national ,=mul>y ,act
 ( #bjbe4  #b4 ,codification &          
improvem5t ( ,dep>tm5t ( ,vet]ans       
,affairs national =mul>y  7a7 ,9 g5]al  
,*apt] #gc ( title #ch1 ,unit$ ,/ates   
,code1 is am5d$ by add+ at ! end !      
foll[+ new sub*apt]3  ,,vi ,national    
,=mul>y  #gche4 ,national =mul>y  7a7   
,e/abli%m5t ,! ,secret>y %all ma9ta9 a  
national =mul>y t %all consi/ ( a li/ ( 
all drugs & supplies t %all be available
 by prescription ?r\gh all m$ical       
facilities ( ! ,dep>tm5t4 ,! ,ph>macy   
,b5efits ,managem5t ,s]vice ( !         

,dep>tm5t %all be responsible = manag+ !
 national =mul>y4  7b7 ,local =mul>y    
re/rictions  7#a7 ,! national =mul>y    
%all be implem5t$ uni=mly across all    
,dep>tm5t m$ical facilities4 ,except z  
provid$ 9 p>agraph 7#b71 no ,vet]ans    
,integrat$ ,s]vice ,network or          
individual m$ical c5t] may ma9ta9 a     
local =mul>y t includes a drug or       
m$ication n li/$ on ! national =mul>y4  
7#b7 ,a drug t is n on ! national =mul>y
 may be provid$ to a vet]an if-- 7,a7 ! 
drug is provid$ "u ! non=mul>y m$ication
 reque/ process "u section #gchg ( ?is  
title2 or  7,b7 ! ,"u ,secret>y = ,heal?
 7or ! ,"u ,secret>y's designee at !    
national level7 has explicitly approv$ a
 waiv] all[+ a ,vet]ans ,integrat$      
,s]vice ,network or facility to c>ry !  
drug = a def9$ pati5t population or     
cl9ical program4  7#c7 7,a7 ,! ,director
 ( a ,vet]ans ,integrat$ ,s]vice        
,network or ( a m$ical facility may     
reque/ a waiv] "u p>agraph 7#b77;,b7    
?r\gh ! ,ph>macy ,b5efits ,managem5t    

,s]vices4  7,b7 ,! ,secret>y %all       
e/abli% a c5traliz$ review process =    
consid]+ su* waiv] reque/s1 :i* %all    
include an assessm5t ( cl9ical ne$1     
safety1 & co/-effectiv5ess4 ,a waiv]    
issu$ "u ?is p>agraph %all be "t-limit$ 
& review$ p]iodically = cont9u+         
necessity4  7,c7 ,no?+ 9 ?is subsection 
%all be con/ru$ to limit ! ability ( a  
cl9ician to prescribe a non=mul>y drug =
 a vet]an :5 m$ically necess>y 9        
accordance ) section #gchg ( ?is title4 
7c7 ,public communication ( =mul>y      
decisions  7#a7 ,! ,secret>y %all       
communicate regul>ly ) ! g5]al public   
reg>d+ ! managem5t ( ! national =mul>y4 
,su* communication may include public   
brief+s or onl9e ann\ncem5ts to expla9  
=mul>y decisions4  7#b7 ,9 ! case ( any 
*ange to ! national =mul>y t ! ,secret>y
 det]m9es may significantly affect      
vet]an c>e or access 7includ+ !         
exclusion ( a m$ication t 0 previ\sly   
commonly us$1 or ! addition ( a new     
high-co/ !rapy ) usage re/rictions71 !  

,secret>y %all publi% a summ>y ( !      
rationale = ! *ange 7includ+            
consid]ation ( cl9ical evid5ce &        
outcomes7 &1 :5 feasible1 hold a public 
brief+ or /akehold] call to discuss !   
*ange & address que/ions4  7d7 ,report+ 
requirem5ts  7#a7 ,! ,secret>y %all     
submit to ! ,committees on ,vet]ans'    
,affairs ( ! ,s5ate & ,h\se (           
,repres5tatives an annual appeals report
 t includes a detail$ description (     
non=mul>y decisions & appeals made dur+ 
! ye> cov]$ by ! report4  7#b7 ,n less  
frequ5tly ?an annually dur+ ! five-ye>  
p]iod beg9n+ on ! date ( ! enactm5t (   
?is section1 ! ,secret>y %all submit to 
! ,committees on ,vet]ans' ,affairs ( ! 
,s5ate & ,h\se ( ,repres5tatives1 & make
 publicly available1 a report t includes
 a summ>y ( any *anges made to !        
national =mul>y ( ! ,dep>tm5t dur+ !    
prec$+ ye>4 ,ea* su* report %all include
 a li/ ( all drugs add$ to or remov$ f !
 =mul>y1 & any modifications to usage   
crit]ia or prior au?orization           

requirem5ts1 dur+ ! ye> cov]$ by !      
report4  #gchf4 ,ph>macy & ,!rapeutics  
,committee  7a7 ,e/abli%m5t ,!re is     
e/abli%$ )9 ! ,vet]ans ,heal?           
,adm9i/ration a ,ph>macy & ,!rapeutics  
,committee 79 ?is section ref]r$ to z ! 
,committee7 to support ! ,ph>macy       
,b5efits ,managem5t ,s]vices 9 manag+ ! 
national =mul>y ( ! ,dep>tm5t4  7b7     
,composition ,! memb]s ( ! ,committee   
%all be select$ by ! ,secret>y & %all be
 physicians f major cl9ical specialties1
 cl9ical ph>maci/s1 & ph>macoeconomi/s  
:o are employees ( ! ,dep>tm5t4 ,9      
select+ memb]s ( ! ,committee1 !        
,secret>y %all ensure ! inclusion (     
individuals ) exp]tise 9 g]iatric c>e & 
m5tal heal? c>e = vet]ans4  7c7         
,conflicts ( int]e/  7#a7 ,! ,secret>y  
%all ensure t ea* memb] ( ! ,committee  
is free ( any conflict ( int]e/ ) !     
ph>maceutical indu/ry4  7#b7 ,!         
,secret>y %all-- 7,a7 require ea* memb] 
( ! ,committee to annually disclose     
f9ancial int]e/s2 &  7,b7 prohibit !    

p>ticipation by any memb] 9 =mul>y      
decisions = :i* ! memb] has a f9ancial  
conflict ( int]e/4  7d7 ,timely review (
 new m$ications ,! ,committee %all meet 
n less (t5 ?an mon?ly 7or bimon?ly7 to  
review newly approv$ drugs by ! ,food & 
,drug ,adm9i/ration4 ,! goal ( !        
,committee ) respect to ea* su* newly   
approv$ drug %all be to make a national 
=mul>y inclusion or exclusion decision  
by n lat] ?an #abj days aft] ! date on  
:i* ! drug is approv$1 to ! ext5t       
practicable4  7e7 ,evid5ce-,bas$        
decision mak+ ,! ,committee %all make   
decisions ) respect to ! national =mul>y
 ( ! ,dep>tm5t bas$ on evid5ce-bas$ drug
 monographs1 cl9ical data 7includ+ data 
on real-_w use & outcomes71 &           
ph>macoeconomic analyses (              
co/-effectiv5ess4 ,9 mak+ su* decisions1
 ! ,committee %all consid] ! applicable 
cl9ical practice guidel9es ( ! ,dep>tm5t
 & ( ! ,dep>tm5t ( ,def5se to ensure    
alignm5t ) be/ practices 9 vet]an c>e4  
7f7 ,transp>5cy ( decisions ,= ea*      

significant addition to or removal f !  
national =mul>y ( ! ,dep>tm5t1 !        
,secret>y %all make publicly available  
on an appropriate website ( ! ,dep>tm5t 
a summ>y ( ! cl9ical rationale = !      
addition or removal1 includ+ a          
description ( ! evid5ce & guidel9es     
consid]$4 ,su* summ>ies may n include   
propriet>y pric+ in=mation or trade     
secrets4  #gchg4 ,non=mul>y drug reque/ 
process  7a7 ,electronic reque/ sy/em ,!
 ,secret>y %all acquire or develop &    
implem5t a /&>diz$ electronic sy/em =   
h&l+ reque/s by cl9icians ( ! ,dep>tm5t 
= drugs n includ$ 9 ! national =mul>y ( 
! ,dep>tm5t4 ,?is sy/em %all be         
integrat$ ) ! electronic heal? record   
sy/em ( ! ,dep>tm5t to all[ treat+      
cl9icians to submit non=mul>y drug      
reque/s z "p ( ! prescrib+ workfl[4  7b7
 ,timel9ess ( decisions ,! ,secret>y    
%all e/abli% a process to ensure t any  
reque/ by a ,dep>tm5t cl9ician = a      
non=mul>y drug is decid$ ^u promptly4   
,"u su* process1 an initial decision on 

a non=mul>y reque/ %all be communicat$  
to ! reque/+ cl9ician )9 #if h\rs aft] !
 reque/ is submitt$4 ,9 any case :]e a  
non=mul>y reque/ is d5i$1 ! vet]an 7& ! 
reque/+ cl9ician7 %all be in=m$ ( !     
d5ial & ( ! "r to appeal "u subsection  
7e74 ,if an appeal is fil$1 a decision )
 respect to ! appeal %all be r5d]$ n    
lat] ?an sev5 days aft] ! date on :i* ! 
appeal is submitt$4  7c7 ,consi/5t      
crit]ia & approval /&>ds ,! ,secret>y   
%all e/abli% uni=m crit]ia = evaluat+   
non=mul>y drug reque/s1 :i* %all be     
appli$ across all ,vet]ans ,integrat$   
,s]vice ,networks 7h]9aft] ref]r$ to z  
,v,i,s,ns7 & m$ical facilities ( !      
,dep>tm5t to ensure consi/5cy4 ,su*     
crit]ia %all be evid5ce-bas$ & %all be  
made available to ,dep>tm5t cl9icians4  
7d7 ,portability ( approvals ,an        
approval = a non=mul>y drug "u ?is      
section %all be valid ?r\gh\t ! ,vet]ans
 ,heal? ,adm9i/ration4 ,9 ! case ( a    
vet]an = :om a non=mul>y drug has be5   
approv$ & :o *ooses to receive hospital 

c>e or m$ical s]vices at a diff]5t      
m$ical c5t] or ,,visn ( ! ,dep>tm5t1 !  
non=mul>y approval 7includ+ any e/abli%$
 r5ewal date or duration ( approval7    
%all rema9 9 effect at ! new location1  
subject to ! same cl9ical conditions or 
monitor+ requirem5ts t 7 orig9ally      
impos$4  7e7 ,appeals process  7#a7 ,!  
,secret>y %all e/abli% a ti]$ appeals   
process = non=mul>y drug decisions4 ,at 
a m9imum1 su* process %all provide--    
7,a7 an opportunity = review ( an       
initial d5ial by a second>y cl9ical     
review] or ph>macy committee at !       
regional or ,,visn level2 &  7,b7 a     
fur!r opportunity = appeal to a         
national-level au?ority )9 ! ,ph>macy   
,b5efits ,managem5t ,s]vices ( !        
,dep>tm5t1 ^: decision %all be f9al )9 !
 ,dep>tm5t4  7#b7 ,! ,secret>y %all     
ensure t all cl9icians ( ! ,dep>tm5t are
 in=m$ ( ! appeals process & t appeals  
are resolv$ )9 ! timeframe specifi$ 9   
subsection 7b74  #gchh4 ,=mul>y         
managem5t & drug !rapy programs  7a7    

,p]iodic !rapeutic class reviews ,9 ord]
 to ma9ta9 a cl9ically appropriate &    
up-to-date =mul>y1 ! ,secret>y %all     
require regul> reviews ( gr\ps ( drugs  
by !rapeutic class4  7b7 ,m$ication     
!rapy managem5t & drug use review  7#a7 
,! ,secret>y %all provide drug !rapy    
managem5t = vet]ans1 ) a p>ticul> focus 
on polyph>macy & high-risk m$ications4  
7#b7 ,z "p ( su* drug !rapy managem5t1  
cl9ical ph>macy speciali/s %all provide 
compreh5sive drug reviews = vet]ans :o  
are on complex regim5s ( drugs or are at
 increas$ risk ( adv]se drug ev5ts4     
7#c7 ,! ,secret>y %all-- 7,a7 conduct   
regul> reviews ( drug use to id5tify    
tr5ds1 includ+ inappropriate prescrib+1 
drug duplication1 or ne$ = dose         
optimization2 &  7,b7 provide           
int]v5tions1 includ+ provid] education  
or pati5t outrea*1 bas$ on ! results (  
su* reviews 9 ord] to improve !rapeutic 
outcomes & promote drug safety &        
adh]5ce4  4  7b7 ,cl]ical am5dm5t ,!    
table ( sections at ! beg9n+ ( su* *apt]

 is am5d$ by add+ at ! end ! foll[+ new 
items3  ,sub*apt] ,,vi--,national       
,=mul>y#gche4 ,national =mul>y4#gchf4   
,ph>macy & ,!rapeutics ,committee4#gchg4
 ,non=mul>y drug reque/ process4#gchh4  
,=mul>y managem5t & drug !rapy programs4
  4  #c4 ,dep>tm5t ( ,vet]ans ,affairs  
ph>maceutical pur*as+ agreem5ts  7a7    
,=mul>y-,bas$ pric+ & value-,bas$       
agreem5ts  7#a7 ,9 g5]al ,sub*apt] ,,ii 
( *apt] #ha ( title #ch1 ,unit$ ,/ates  
,code1 is am5d$ by ins]t+ aft] section  
#habi ! foll[+ new section3  #hacj4     
,ph>maceutical pur*as+ agreem5ts &      
value-bas$ initiatives  7a7             
,negotiation ( supplem5tal disc\nts     
7#a7 ,9 addition to ! limitations on !  
prices ( drugs 9 effect pursuant to     
section #habf ( ?is title1 ! ,secret>y  
may negotiate additional disc\nts or    
price concessions ) manufactur]s ( drugs
 procur$ by ! ,dep>tm5t4  7#b7 ,9       
conduct+ negotiations "u ?is p>agraph1 !
 ,secret>y may-- 7,a7 take into         
consid]ation ! placem5t or ti]$ /atus ( 

a drug on ! national =mul>y ( !         
,dep>tm5t2 &  7,b7 ent] into an agreem5t
 ) a manufactur] "u :i* ! manufactur]   
(f]s a disc\nt$ price or rebate = a drug
 9 ex*ange = pref]r$ /atus = ! drug on !
 national =mul>y ( ! ,dep>tm5t1 if !    
,secret>y det]m9es ! agreem5t w provide 
cl9ically appropriate outcomes = vet]ans
 & net co/ sav+s or value to !          
,dep>tm5t4  7#c7 ,no?+ 9 ?is subsection 
%all be con/ru$ to sup]s$e ! price      
limitations "u section #habf ( ?is      
title4 ,! ,secret>y %all ensure t any   
agreem5t ent]$ into "u ?is subsection ) 
respect to a drug t is a cov]$ drug "u  
su* section results 9 prices t are l[]  
?an ! maximum price all[$ "u su* section
 = su* drug4  7b7  ,use ( flexible      
pur*as+ arrangem5ts  7#a7 ,to ! ext5t   
practicable1 ! ,secret>y %all use       
indu/ry be/ practices 9 ! procurem5t (  
drugs & m$ical supplies1 includ+ ! use (
 blanket pur*ase agreem5ts1 ord]+       
agreem5ts1 & o!r volume-lev]ag+         
contracts to a*ieve favorable pric+4    

7#b7 ,! ,secret>y may pursue value-bas$ 
pur*as+ arrangem5ts ) manufactur]s (    
drugs & biological products to be       
includ$ on ! national =mul>y4 ,su*      
arrangem5ts may include contracts "u :i*
 ! manufactur] agrees to provide ! drugs
 or biological products to ! ,secret>y 9
 ex*ange = paym5t 9 an am\nt t is       
det]m9$ bas$ ^u ! effectiv5ess ( ! drug 
or biological product = vet]ans to :om !
 drug or biological product is          
prescrib$4 ,if ! ,secret>y ent]s into   
su* a contract "u ?is p>agraph1 !       
,secret>y %all ensure t ! contract      
includes a me*anism to monitor !        
effectiv5ess ( ! drug or biological     
product & to adju/ paym5ts or rebates   
accord+ly4  7c7  ,outcome &             
co/-,effectiv5ess evaluations  7#a7 ,!  
,secret>y %all conduct p]iodic reviews (
 ! outcomes & budget>y effects associat$
 ) major *anges to ! national =mul>y or 
ph>maceutical initiatives ( ! ,dep>tm5t4
 ,n lat] ?an #ahj days aft] conclud+ a  
p]iodic review "u ?is p>agraph1 !       

,secret>y %all submit to ! ,committees  
on ,vet]ans' ,affairs ( ! ,s5ate & ,h\se
 ( ,repres5tatives ! results ( ! review4
  7#b7 ,n lat] ?an "o ye> aft] implem5t+
 any significant action affect+ !       
national =mul>y1 includ+ add+ a high-co/
 drug ) usage crit]ia or remov+ a       
cl9ically us$ drug f ! =mul>y1 !        
,secret>y %all evaluate ! effects ( t   
action on vet]an heal? outcomes1 drug   
use patt]ns1 & ov]all co/s to !         
,dep>tm5t4 ,! ,secret>y %all make f9d+s 
f su* evaluations available to !        
,committees on ,vet]ans' ,affairs ( !   
,s5ate & ,h\se ( ,repres5tatives & use !
 f9d+s to in=m future =mul>y decisions &
 pur*as+ agreem5ts4  7d7  ,biological   
product def9$  ,9 ?is section1 ! t]m    
biological product has ! mean+ giv5 su* 
t]m 9 section #cea7;i77#a7 ( ! ,public  
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bfb7;i77#a774  4  7#b7  ,cl]ical       
am5dm5t  ,! table ( sections at ! beg9n+
 ( su* *apt] is am5d$ by add+ at ! end !
 foll[+ new item3  #hacj4 ,ph>maceutical

 pur*as+ agreem5ts & value-bas$         
initiatives4  4  7b7 ,e/abli%m5t ( ti]$ 
s*$ule = copaym5ts  7#a7 ,9 g5]al       
,section #agbb;,a ( title #ch1 ,unit$   
,/ates ,code1 is am5d$ by add+ at ! end 
! foll[+ new subsection3  7d7 7#a7 ,= ! 
purpose ( enc\rag+ ! use ( cl9ically    
appropriate1 co/-effective drugs by     
vet]ans :ile ma9ta9+ access to non=mul>y
 drugs t are m$ically necess>y1 !       
,secret>y %all e/abli% a ti]$ s*$ule = !
 am\nt ( ! copaym5ts *>g$ to vet]ans =  
drugs furni%$ "u ?is *apt]4  7#b7 ,"u ! 
ti]$ s*$ule e/abli%$ "u ?is subsection1 
! am\nt ( a copaym5t = a #cj-;day supply
 ( a g5]ic drug or a drug li/$ on !     
national =mul>y ( ! ,dep>tm5t %all be   
l[] ?an am\nt ( a copaym5t a #cj-;day   
supply ( a br&-"n drug or a drug n      
includ$ on su* national =mul>y4  4  7#b7
 ,update ( cross-ref]5ce ,subsection    
7a77#c77;,d7 ( su* section is am5d$ by  
/rik+ section #dia & ins]t+ section     
#bgcb4  #d4 ,vet]ans ,=mul>y ,advisory  
,committee  7a7 ,e/abli%m5t ,! ,secret>y

 ( ,vet]ans ,affairs %all e/abli% an    
advisory committee1 to be kn[n z !      
,vet]ans ,=mul>y ,advisory ,committee 79
 ?is section ref]r$ to z ! ,advisory    
,committee74 ,! ,advisory ,committee    
%all provide vet]an & cl9ician input on 
! national =mul>y ( ! ,dep>tm5t (       
,vet]ans ,affairs4  7b7 ,memb]%ip ,!    
,advisory ,committee %all consi/ ( n m  
?an t5 memb]s & %all include front-l9e  
cl9ical provid]s or ph>maci/s ( !       
,dep>tm5t :o are n involv$ 9 national   
=mul>y decision-mak+ & o!r /akehold]    
repres5tatives z ! ,secret>y consid]s   
appropriate4  7c7 ,meet+s ,! ,advisory  
,committee %all meet at regul> int]vals 
7at lea/ semiannually7 & %all review    
propos$ =mul>y *anges4  7d7             
,responsibilities ,! ,advisory          
,committee may provide to ! ,secret>y & 
to ! ,ph>macy & ,!rapeutics ,committee  
e/abli%$ "u section #gchf ( title #ch1  
,unit$ ,/ates ,code1 ! indep5d5t fe$back
 or recomm5dations ( ! ,advisory        
,committee reg>d+ propos$ additions1    

removals1 & re/rictions p]ta9+ to !     
national =mul>y1 includ+ ) respect to   
any pot5tial effects on vet]an pati5ts4 
,recomm5dations ( ! ,advisory ,committee
 %all be advisory 9 nature4  7e7        
,t]m9ation ,! ,advisory ,committee %all 
t]m9ate on ! date t is two ye>s aft] !  
date ( ! e/abli%m5t ( ! ,advisory       
,committee4