HR-4509-119
Subcommittee Hearings Held
Sponsored by Greg Landsman (D-OH)
What it does
This bill would require the Department of Veterans Affairs (VA) to add FDA-approved non-opioid pain management drugs and biological products to its national formulary within one year of those drugs becoming eligible for certain Medicare payment categories. It would also require those drugs to be included on the VA's drug standardization list, which governs which medications are available system-wide. The bill explicitly prohibits using funds from the Cost of War Toxic Exposures Fund to pay for these additions, and requires the VA to begin implementing the changes within 90 days of enactment.
Who benefits
Veterans who experience post-surgical or postoperative pain and would gain access to non-opioid alternatives through the VA system. Veterans with a history of opioid use disorder or addiction who need pain management options that do not act on opioid receptors. VA clinicians who would have a broader set of tools to manage patient pain. Pharmaceutical manufacturers of FDA-approved non-opioid pain drugs, who would gain a guaranteed pathway into the VA formulary. Taxpayers and the VA system broadly, if non-opioid alternatives reduce downstream costs associated with opioid dependency treatment.
Who is hurt
Opioid manufacturers and distributors whose VA market share could shrink if non-opioid alternatives become more readily available. The VA's pharmacy budget, which may face increased costs from adding newer, potentially more expensive non-opioid drugs — costs that cannot be offset by the Toxic Exposures Fund. Veterans who do not need surgical pain management would not be directly affected. Taxpayers who bear any net increase in VA pharmaceutical spending. VA administrators who must implement the changes within a tight 90-day window, potentially straining operational capacity.
Supporters argue
Supporters argue that veterans suffer from chronic pain at disproportionately high rates and that the VA's formulary has historically lagged in adopting newer non-opioid alternatives, leaving clinicians with limited options and patients at elevated risk of opioid dependency. They contend that tying formulary inclusion to Medicare's existing payment eligibility criteria creates a clear, evidence-based trigger that avoids bureaucratic delay, and that expanding access to non-opioid options is a direct, measurable step toward reducing opioid misuse among veterans — a population with well-documented higher rates of opioid-related harm compared to the general public.
Opponents argue
Opponents argue that mandating formulary inclusion based on Medicare payment eligibility — rather than the VA's own clinical evidence review process — bypasses the VA's established Pharmacy Benefits Management system, which evaluates drugs for safety, efficacy, and cost-effectiveness specific to the veteran population. They contend that this approach could force the VA to add drugs that have not been independently validated for veteran-specific conditions, potentially increasing costs without a corresponding clinical benefit, and that the 90-day implementation window is operationally unrealistic for a system serving millions of patients across hundreds of facilities.