VA National Formulary Act of 2025

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Bill ID: 119/hr/6580
Last Updated: July 26, 2026

Sponsored by

Rep. Miller-Meeks, Mariannette [R-IA-1]

ID: M001215

Follow the money

The bill

VA National Formulary Act of 2025

HR. 6580, 119th Congress — read as touching Pharmaceuticals.

The sponsor

Rep. Miller-Meeks, Mariannette [R-IA-1]

Every bill has someone who introduced it. That name is where the paper trail starts.

The money

$166,100 raised

25 itemised contributions to this sponsor, pulled from FEC filings.

The alignment

85% match to Project 2025

This bill's text tracks the "Department of Veterans Affairs" section, p. 688-691 of the Mandate for Leadership.

Bill's Journey to Becoming a Law

Track this bill's progress through the legislative process

Latest Action

Committee Hearings Held

May 19, 2026

Introduced

Committee Review

📍 Current Status

Next: The bill moves to the floor for full chamber debate and voting.

🗳️

Floor Action

✅

Passed House

🏛️

Senate Review

🎉

Passed Congress

🖊️

Presidential Action

⚖️

Became Law

📚 How does a bill become a law?

1. Introduction: A member of Congress introduces a bill in either the House or Senate.

2. Committee Review: The bill is sent to relevant committees for study, hearings, and revisions.

3. Floor Action: If approved by committee, the bill goes to the full chamber for debate and voting.

4. Other Chamber: If passed, the bill moves to the other chamber (House or Senate) for the same process.

5. Conference: If both chambers pass different versions, a conference committee reconciles the differences.

6. Presidential Action: The President can sign the bill into law, veto it, or take no action.

7. Became Law: If signed (or if Congress overrides a veto), the bill becomes law!

Bill Summary

Another masterpiece of legislative theater, brought to you by the same geniuses who thought it was a good idea to put a "Department of Veterans Affairs" in charge of... well, veterans' affairs.

**Main Purpose & Objectives**

The VA National Formulary Act of 2025 is a bill that claims to improve the administration of the national formulary for the Department of Veterans Affairs. In reality, it's just another excuse for politicians to pretend they care about veterans while lining their pockets with pharmaceutical industry donations.

The main objective is to create a centralized review process for approving or rejecting medications on the national formulary, because God forbid we trust individual clinicians to make decisions based on actual medical evidence. The bill also establishes a Pharmacy and Therapeutics Committee (PTC) to support this process, staffed by "experts" who are conveniently employed by the VA.

**Key Provisions & Changes to Existing Law**

The bill amends title 38 of the United States Code to codify the national formulary and establish the PTC. It also creates a new subchapter (VI) that outlines the procedures for managing the national formulary, including:

* A centralized review process for waiver requests * Public communication of formulary decisions (because transparency is overrated) * Annual reports on nonformulary decisions and appeals * A requirement for the PTC to meet monthly (or bimonthly) to review newly approved medications

Oh, and let's not forget the obligatory "conflict of interest" provisions that are about as effective as a Band-Aid on a bullet wound.

**Affected Parties & Stakeholders**

The usual suspects:

* Veterans who will be affected by the formulary decisions (but don't worry, they'll just have to deal with it) * Pharmaceutical companies who will either benefit or lose out depending on which medications are approved * VA bureaucrats who get to expand their empire and pretend they're doing something useful * Politicians who get to grandstand about "supporting our troops" while taking campaign donations from Big Pharma

**Potential Impact & Implications**

This bill is a perfect example of the "solution in search of a problem" phenomenon. The VA's national formulary has been a mess for years, but instead of addressing the root causes (e.g., bureaucratic inefficiency, lack of transparency), Congress decides to create more red tape and centralized control.

The real impact will be:

* More delays and obstacles for veterans trying to access necessary medications * Increased costs for taxpayers due to the expanded bureaucracy and administrative overhead * A further erosion of trust in the VA's ability to provide quality care

But hey, at least the politicians can claim they "did something" about veterans' healthcare. Now, if you'll excuse me, I have better things to do than watch this farce unfold.

Generated using Llama 3.1 70B (Dr. Haus personality)

💰 Campaign Finance Network

Rep. Miller-Meeks, Mariannette [R-IA-1]

Congress 119 • 2024 Election Cycle

Total Contributions
$166,100
24 donors
PACs
$500
Organizations
$3,900
Committees
$0
Individuals
$160,200
1
POLITICAL COMMITTEE, NWF ACTION FUND
1 transaction
$500
1
US MARSHALS SERVICES
1 transaction
$2,900
2
HUNTON ANDREWS KURTH LLP
1 transaction
$1,000

No committee contributions found

1
SMITH, DYAN
2 transactions
$16,600
2
HOGAN, PATRICK F
1 transaction
$13,200
3
HOLDEN, RONALD
1 transaction
$13,200
4
VANDEWALLE, LOLA L
1 transaction
$13,200
5
GLEESON, JOHN W
1 transaction
$11,600
6
RICHARDS, DANIEL
1 transaction
$6,600
7
WILLOX, NORMAN
1 transaction
$6,600
8
PFAUTCH, ROY
1 transaction
$6,600
9
BRADLEY, JACQUELINE
1 transaction
$6,600
10
BROIN, JEFF MR.
1 transaction
$6,600
11
JAY, JEFFREY
1 transaction
$6,600
12
RICKETTS, J. JOE
1 transaction
$6,600
13
MCCOY, JUDITH
1 transaction
$6,600
14
SINGER, PAUL
1 transaction
$6,600
15
SABIN, ANDREW
1 transaction
$6,600
16
GILLIAM, RICHARD
1 transaction
$6,600
17
BELTRAME, MARC
1 transaction
$6,600
18
WOLL, MARGO
1 transaction
$6,600
19
SCHWARZMAN, CHRISTINE
1 transaction
$6,600

Donor Network - Rep. Miller-Meeks, Mariannette [R-IA-1]

PACs
Organizations
Individuals
Politicians

Hub layout: Politicians in center, donors arranged by type in rings around them.

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Showing 64 nodes and 57 connections

Total contributions: $57

Top Donors - Rep. Miller-Meeks, Mariannette [R-IA-1]

Showing top 24 donors by contribution amount

1 PAC2 Orgs2 Committees19 Individuals

Industry Impact

Which industries are materially affected by specific provisions in this bill. 1 helped, 1 harmed.

  • −Pharmaceuticalsconfidence 0.90

    Section 2 establishes a national formulary with uniform implementation, restricting local formularies from including drugs not on the national list unless waived (Sec. 7385(b)(1)-(2)). Section 3 allows the VA to negotiate additional discounts with manufacturers and use value-based purchasing tied to effectiveness (Sec. 8130(a)(1)-(2), (b)(2)). These provisions give the VA increased leverage to lower drug prices and tie payments to outcomes, which could reduce pharmaceutical manufacturers' revenu

  • The bill standardizes formulary management across VA medical facilities and creates processes for timely review of new medications, appeals, and therapy management (Sec. 7385-7388). This could improve efficiency and predictability in VA pharmacy operations, benefiting VA hospitals and health systems by streamlining drug procurement and reducing administrative variability.

Who funds the sponsor on these industries

For each industry this bill affects, here's what the sponsor (Rep. Miller-Meeks, Mariannette [R-IA-1])received from donors associated with that industry during the 2022–present cycles. Donations are not proof of intent — they are a record of who funds the people writing the law.

Industries this bill HELPS

Industries this bill HARMS

  • from 3 contributions
    • MARIN, DAVID$500
    • WALLACE, PETE$500
    • HERMANCE, ERIN$500

Project 2025 Policy Matches

This bill shows semantic similarity to the following sections of the Project 2025 policy document.AI-enhanced analysis provides detailed alignment ratings.

Department of Veterans Affairs

Strong
Vector: 65%
Pages: 688-691AI Enhanced

AI Analysis:

"HR 6580's focus on uniform, transparent, and evidence-based management of the VA national formulary directly supports Project 2025's goals of improving VA efficiency, accountability, and veteran care quality."

Key themes:VA healthcare reformtransparencyevidence-based decision-makingformulary managementveteran care coordination

— 655 — Department of Veterans Affairs ENDNOTES 1. U.S. Department of Veterans Affairs, Veterans Health Division, VHA Directive 1003, “VHA Veteran Patient Experience,” April 14, 2020, pp. 1 and B-1. 2. S. 2372, VA Mission Act of 2018, Public Law No. 115-182, 115th Congress, June 6, 2018, https://www.congress. gov/115/plaws/publ182/PLAW-115publ182.pdf (accessed January 30, 2023). 3. U.S. Department of Veterans Affairs, VA History Office, “VA History,” last updated May 27, 2021, https://www. va.gov/HISTORY/VA_History/Overview.asp (accessed January 28, 2023). 4. 38 U.S. Code § 1116, https://www.law.cornell.edu/uscode/text/38/1116 (accessed January 28, 2023). 5. S. 3373, Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act of 2022 (Honoring Our PACT Act of 2022), Public Law No. 117-168, 117th Congress, August 10, 2022, https://www. congress.gov/117/plaws/publ168/PLAW-117publ168.pdf (accessed January 28, 2023). 6. H.R. 2471, Consolidated Appropriations Act, 2022, Public Law No. 117-103, 117th Congress, March 15, 2022, Division S, Title I, https://www.congress.gov/117/plaws/publ103/PLAW-117publ103.pdf (accessed March 18, 2023). Known variously as the Department of Veterans Affairs Nurse and Physician Assistant Retention and Income Security Enhancement Act and the VA Nurse and Physician Assistant RAISE Act. 7. See note 5, supra.

Department of Veterans Affairs

Moderate
Vector: 62%
Pages: 679-681AI Enhanced

AI Analysis:

"HR 6580 aligns with Project 2025's emphasis on transparency, accountability, and evidence-based decision-making within the VA, particularly through public reporting and standardized formulary management. However, it does not directly address the specific Project 2025 initiatives such as caregiver program reform, innovation office restructuring, or infrastructure realignment."

Key themes:transparencyevidence-based decision-makingpublic reportingVA healthcare efficiency

— 646 — Mandate for Leadership: The Conservative Promise 3. Section 121 (developing and administering an education program that teaches veterans about their health care options available from the Department of Veterans Affairs). 4. Section 152 (returning the Office for Innovation of Care and Payment to the Office of Enterprise Integration with a joint governance process set up with the VHA). 5. Section 161 (overhauling Family Caregiver Program expansion, which has gone poorly, so that it focuses on consistency of eligibility and awareness that the most severely wounded or injured may require the program indefinitely). l Require the VHA to report publicly on all aspects of its operation, including quality, safety, patient experience, timeliness, and cost-effectiveness, using standards similar to those in the Medicare Accountable Care Organization program so that the government may monitor and achieve continuous improvement in the VA system more effectively. l Encourage VA Medical Centers to seek out relevant academic and private- sector input in their communities to improve the overall patient experience. Budget l Conduct an independent audit of the VA similar to the 2018 Department of Defense (DOD) audit to identify IT, management, financial, contracting, and other deficiencies. l Assess the misalignment of VHA facilities and rising infrastructure costs. The VHA operates 172 inpatient medical facilities nationally that are an average of 60 years old. Some of these facilities are underutilized and inadequately staffed. Facilities in certain urban and rural areas are seeing significant declines in the veteran population and strong competition for fresh medical staff. In 2018, Congress authorized an Asset Infrastructure Review (AIR) of national VHA medical markets to provide insight into where the VA health care budget should be responsibly allocated to serve veterans most effectively. However, the Senate Veterans Affairs Committee lacked the political will to act on the White House’s nominations of commission members, and this ultimately led to termination of the AIR process. The next Administration should seek out agile, creative, and politically acceptable operational solutions to this aging infrastructure status quo, — 647 — Department of Veterans Affairs reimagine the health care footprint in some locales, and spur a realignment of capacity through budgetary allocations. Specifically: 1. Embrace the expansion of Community Based Outpatient Clinics (CBOCs) as an avenue to maintain a VA footprint in challenging medical markets without investing further in obsolete and unaffordable VA health care campuses. 2. Explore the potential to pilot facility-sharing partnerships between the VA and strained local health care systems to reduce costs by leveraging limited talent and resources. Personnel l Extend the term of the Under Secretary for Health (USH) to five years. Additionally, authority should be given to reappoint this individual for a second five-year term both to allow for continuity and to protect the USH from political transition. l Establish a Senior Executive Service (SES) position of VHA Care System Chief Information Officer (CIO), selected by and reporting to the chief of the VHA Care System with a dotted line to the VA CIO. l Identify a workflow process to bring wait times in compliance with VA MISSION Act–required time frames wherever possible. 1. Assess the daily clinical appointment load for physicians and clinical staff in medical facilities where wait times for care are well outside of the time frames required by the VA MISSION Act. 2. Require VHA facilities to increase the number of patients seen each day to equal the number seen by DOD medical facilities: approximately 19 patients per provider per day. Currently, VA facilities may be seeing as few as six patients per provider per day. 3. Consider a pilot program to extend weekday appointment hours and offer Saturday appointment options to veterans if a facility continues to demonstrate that it has excess capacity and is experiencing delays in the delivery of care for veterans. 4. Identify clinical services that are consistently in high demand but require cost-prohibitive compensation to recruit and retain talent, and examine exceptions for higher competitive pay.

Department of Veterans Affairs

Weak
Vector: 64%
Pages: 682-684AI Enhanced

AI Analysis:

"Both the bill and the Project 2025 VA section aim to improve VA operations through greater transparency and evidence-based processes, but the bill focuses on pharmacy formulary management within VHA while the Project 2025 text centers on streamlining disability claims, automation, and workforce reforms within VBA, resulting only tangential overlap."

Key themes:VA reformtransparencyevidence-based decision-makingprocess improvementaccountability

— 649 — Department of Veterans Affairs approaches and technology tools that currently exist in the private sector could be employed to improve existing VBA activities. This problem is most pronounced in the disability claims process, which needs more and better management attention focused on streamlining the procedures involved in processing claims and administering benefits. The VA must improve timeliness of claim adjudication and benefits delivery: Veterans want the VBA to provide timely responses to requests for benefits support, render empathetic customer service and understandable explanations of those benefits, and deliver those benefits without frustrating delays (weeks, not months). l Identify performance targets for benefits, report publicly on actual performance each quarter, and use these metrics to drive consistent improvement. l Develop a new pilot “Express 30” commitment for a veteran’s first fully developed disability compensation claim and organize the VBA to complete the first claim in 30 days. l Hire more private companies to perform disability medical examinations. Delays in completing the examinations could be eliminated with more external capacity. l Increase automation. Hiring additional staff to process claims is costly, is inflexible, and has yielded mixed results. Attempting to change laws and regulations simply to adjudicate claims would be a herculean effort given their complexity. The best way to provide benefits faster and more accurately is by using technology to perform most of the work. Technology currently exists in the private sector, but the VBA lacks the expertise to use it. This would be more of an organizational challenge than a technology hurdle. l Reduce improper payment and fraud. About $500 million is improperly paid out each year. Better tools, training, and management could reduce this substantially, but rule changes at the departmental level would be needed. Budget The VA’s Schedule for Rating Disabilities (VASRD) has assigned disability ratings to a growing number of health conditions over time; some are tenuously related or wholly unrelated to military service. The further growth in presumptive service-connected medical conditions pursued by Congress and Veteran Service Organizations, begun with Agent Orange and most recently for Burn Pits/Airborne — 650 — Mandate for Leadership: The Conservative Promise Toxins, has led to historic increases in mandatory VBA spending in recent years. The VA has a time-phased plan to reassess the VASRD and its ratings for com- pensation, but this internal process can be slow and laborious, requires Office of Management and Budget (OMB) approvals, and can become politically charged both in Congress and with VSOs. l The next Administration should explore how VASRD reviews could be accelerated with clearance from OMB to target significant cost savings from revising disability rating awards for future claimants while preserving them fully or partially for existing claimants. l The VBA’s Information Technology top-line budget should be reexamined and reassessed in light of the need for expanded automation across the enterprise. l Traditionally, VHA captures the large majority of VA IT funding. The VBA needs to make the case for a larger IT budget with clear requirements to support that request. Personnel l Pursue reforms of the Human Capital Management process and operations within the VBA to build a more blended workforce with more contractors to process claims. This would free federal employees to perform other duties and be involved solely with the final decision to award benefits. l Improve the VBA acquisition workforce. The VBA needs more world-class contractor support. Currently, few of the top companies have contracts with the VBA, and the VBA needs to conduct more outreach to the private sector through senior leader engagement and industry conferences. l To identify more effective and efficient ways to complete claims, establish a knowledge exchange program with top-tier private-sector companies that do similar work. The VBA is fundamentally a financial services organization. A significant amount of its work has a private-sector analogue that could be leveraged to improve service to veterans. l For most of its existence, the VBA has been a risk-averse, insular, paper-based organization, implementing technology only over the past decade. This insularity has led to a predominantly “build it ourselves” approach, partly because VBA staff has limited experience or insight into current private- sector tools and methods and partly because the VBA struggles to compete

Showing 3 of 5 policy matches

About These Correlations

Policy matches are calculated using a hybrid approach: initial candidates are found using semantic similarity between bill summaries and Project 2025 policy text, then an AI model (Llama 3.1 70B) provides detailed alignment ratings and analysis. Ratings range from 1 (minimal alignment) to 5 (very strong alignment). This analysis does not imply direct causation or intent.

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