S-2981-119
Committee on Veterans' Affairs. Ordered to be reported without amendment favorably.
Sponsored by Jerry Moran (R-KS)
What it does
This bill would require the Department of Veterans Affairs (VA) to create a formal, publicly available list — called a "Formulary" — of approved prosthetic and rehabilitative items and services available to veterans. The VA would be required to solicit input from veterans and the public, ensure all listed items are available at every VA facility, publish and regularly update the list online, train VA staff on its use, and establish a process for clinicians to request items not on the list when medically necessary.
Who benefits
Veterans who use prosthetics or need rehabilitative services, particularly those with limb loss or mobility impairments from service-related injuries. Veterans in rural or underserved areas who may currently face inconsistent access across VA facilities. VA clinicians who would have clearer guidance on available items. Veterans' advocacy organizations that have sought greater transparency in VA care. Prosthetics manufacturers and suppliers who secure VA contracts under the new formulary system.
Who is hurt
Prosthetics and medical device suppliers whose products are not included on the Formulary may lose VA business. VA administrative staff who would bear the workload of developing, maintaining, and communicating the Formulary. Veterans whose preferred or previously prescribed devices are not included on the Formulary and who may face additional steps to obtain them through the exceptions process. Taxpayers could bear costs if the contracting and administrative requirements increase VA overhead.
Supporters argue
Supporters argue that the VA currently lacks a standardized, transparent system for prosthetics and rehabilitative items, leading to inconsistent access depending on which facility a veteran uses. They contend that a formulary modeled on the VA's existing Pharmacy Benefits Management system — which has a proven track record of improving consistency and cost efficiency — would ensure that every veteran receives the same quality of care regardless of geography, while the exceptions process preserves clinical flexibility for individual needs.
Opponents argue
Opponents argue that applying a formulary model to prosthetics is fundamentally different from pharmaceuticals, because prosthetic needs are highly individualized and a standardized list may not capture the full range of devices required for veterans with complex or unique injuries. They contend that the exceptions process could create bureaucratic delays that leave veterans waiting for medically necessary equipment, and that the administrative burden of building and maintaining the Formulary could divert VA resources away from direct patient care.
Constitutional context
No significant constitutional issues are raised by this bill. Congress has broad authority to structure and fund veterans' benefits programs under Article I, and the VA's administration of those programs falls within the Executive's Take Care Clause obligations. No active constitutional tension areas are implicated.
Checks and balances
The VA Secretary (Executive Branch) gains new administrative authority to define and manage the Formulary; Congress retains oversight through the Veterans' Affairs committees and appropriations power, and veterans retain appeal rights under existing VA adjudication processes.
Historical precedent
The VA's Pharmacy Benefits Management (PBM) formulary system, established in the 1990s, is a directly analogous precedent — it standardized drug availability across VA facilities and is explicitly referenced in this bill as the model for the prosthetics formulary.