Update the VA national formulary

Parity, Coverage, & Equitable Access
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social determinants of health
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Active Military
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Veterans Affairs
Health and Human Services
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The Department of Veterans Affairs should update its National Formulary to make all clinically appropriate non-opioid therapies available to patients.


Active duty military, reserve service members, and veteran populations have unique physical and mental health challenges related to their service that can contribute to and exacerbate pain conditions. Combat-related injuries are commonly accompanied by post-traumatic stress disorder and traumatic brain injury. Nearly half of combat-wounded veterans report misusing prescription opioids, and drug overdose mortality rates among veterans increased by 53 percent from 2010-2019.[1]

Yet, the Department of Veterans Affairs (VA) National Formulary (VANF) currently does not include several Food and Drug Administration (FDA)-approved non-opioid analgesic products while covering a wide range of opioid-based analgesic products to manage acute pain symptoms. The exclusion of these safe and effective products results in VA patients having little choice in how they manage their pain. Clinically appropriate non-opioid therapies include products that are (1) Approved by the FDA and therefore deemed to be safe and effective; (2) Indicated for use in providing analgesic support for acute, postsurgical pain; and (3) Proven to reduce quantities of opioids prescribed.[2]

In 2022, Congress passed the Non-Opioids Prevent Addiction in the Nation Act (“NOPAIN Act”) to ensure non-opioid therapies are widely available to Medicare recipients who receive outpatient surgical procedures. The Centers for Medicare and Medicaid Services (CMS) must move quickly to fully implement this law to ensure Medicare access to non-opioid therapies is available. Additionally, the VA should ensure that all FDA-approved  non-opioid therapies are included in the VANF.[3]


1. U.S. Department of Health and Human Services. Pain Management Best Practices Inter-Agency Task Force Final Report. Last Updated December 16, 2022.

2. Voices for Non-Opioid Choices. Expand Access to Safe, Non-Opioid Options Now. Last Accessed May 23, 2023.

3. Voices for Non-Opioid Choices. Protect Service Members & Veterans from Opioid Addiction. Last Accessed August 1, 2023.