When you’re a veteran relying on VA healthcare, your prescriptions don’t work like they do at a regular pharmacy. The VA formulary is the rulebook that decides which drugs you can get, how much you pay, and whether you get the brand name or the generic version. And here’s the key thing: if a generic version exists, the VA will almost always give you that first - no questions asked.
How the VA Formulary Works
The VA National Formulary isn’t just a list. It’s a mandatory, nationwide standard that every VA clinic and hospital must follow. Since 1998, this system has been designed to make sure every veteran gets the same access to medications, no matter where they live. There are over 9 million veterans enrolled in VA care, and the formulary covers them all through 1,293 facilities.
The formulary has three parts: the main list of approved drugs, monthly updates (called VA National Formulary Changes), and the Urgent/Emergent Formulary - which lets you get emergency meds through community pharmacies when you can’t wait for a VA appointment.
What makes the VA system different? It’s built on one simple idea: use the generic version unless there’s a medical reason not to. And it works. In 2025, VA pharmacies filled over 92% of prescriptions with generic drugs - higher than any other major U.S. health system, including Medicare Part D and private insurers.
Tiered Copays: What You Pay
VA doesn’t use five tiers like Medicare. It uses three. And the lower the tier, the less you pay.
- Tier 1: Preferred generics. These cost $5-$10 for a 30-day supply. Most common medications fall here.
- Tier 2: Non-preferred generics or some brand-name drugs with generic alternatives. Copays are $15-$25.
- Tier 3: Brand-name drugs with no generic version, or specialty drugs. Copays can hit $50 or more.
For example, in 2025, alendronate (for osteoporosis), atorvastatin (for cholesterol), fluoxetine (for depression), and ibuprofen (for pain) are all on Tier 1. You pay next to nothing.
Compare that to a commercial pharmacy: the same generic sertraline might cost you $15 out of pocket. At the VA? Often $0 if you use Meds by Mail.
What’s Covered: Real Examples
The VA formulary covers hundreds of generic drugs across all major health needs. Here’s what’s included in 2025:
- Heart & Blood Pressure: Hydrochlorothiazide, furosemide, lisinopril
- Diabetes: Metformin, glimepiride, insulin glargine
- Cholesterol: Pravastatin, ezetimibe, simvastatin
- Mental Health: Sertraline, trazodone, fluoxetine, citalopram
- Pain & Arthritis: Aspirin, naproxen, acetaminophen, allopurinol
Some newer drugs are still restricted. For example, weight-loss medications like Wegovy and Ozempic are only covered if you have type 2 diabetes, obstructive sleep apnea, or specific heart conditions. If your provider wants to prescribe them for weight loss alone, you’ll need prior authorization - and even then, it’s not guaranteed.
How to Check If Your Drug Is Covered
You don’t have to guess. The VA gives you tools to check coverage before you even walk into a pharmacy.
- Use the VA Formulary Advisor online. Just type in the drug name and it tells you the tier, copay, and if a generic is available.
- Download the monthly VA Product Name List in Excel or CSV format. It’s updated every month and includes NDC codes for pharmacy use.
- Call the VA Pharmacy Benefits call center at 1-800-877-8339. They handle 18,000 calls a day and can check your specific drug.
Pro tip: If you’re switching from a brand-name drug to a generic, ask your VA provider for a copy of the formulary page showing the change. That way, you know exactly why you’re getting a different pill - and that it’s safe.
Meds by Mail: Free Delivery, No Copay
If you take maintenance meds - drugs you use every day - the VA’s Meds by Mail program is the easiest way to get them. You order online or by phone, and they ship directly to your home. No trips to the pharmacy. No copay. No deductible.
For CHAMPVA beneficiaries (spouses and dependents of veterans), this is especially valuable. You pay nothing for Tier 1 and Tier 2 drugs through Meds by Mail. Even refrigerated medications like insulin are shipped with special packaging.
Over 87% of users in the VA’s 2024 Pharmacy Satisfaction Survey said they preferred Meds by Mail. Why? It’s reliable, free, and saves time.
Prior Authorization: When You Need It
Not every drug is automatically approved. If your doctor wants to prescribe something not on the formulary - like a newer specialty drug or a brand-name version when a generic exists - you’ll need prior authorization.
This isn’t a red flag. It’s a safety step. The VA wants to make sure you’re getting the right drug for your condition, at the lowest cost. But it can be frustrating.
Some veterans report delays getting approval for GLP-1 drugs (like Wegovy) when used for weight loss outside of diabetes. Others have waited weeks for cancer meds or rare disease treatments. The VA’s National Drug Formulary Committee reviews these requests monthly, but it takes time.
Best practice: Ask your provider to submit the request early. Keep a copy of the denial letter. And if you’re denied, you can appeal - the VA has a formal process for that too.
Why VA Formulary Costs Less Than Other Plans
The VA spends about $1,850 per veteran on medications each year. Medicare Part D spends $2,300. Private insurers spend $2,700.
That’s not luck. It’s strategy. The VA buys drugs in bulk, negotiates hard with manufacturers, and refuses to pay for brand-name drugs when generics are available. That’s why they saved $2.8 billion in 2024 alone.
Experts say the VA’s approach is so effective, commercial insurers are starting to copy it. Some health plans now use VA-style tiering and generic-first policies to cut costs.
What Veterans Say
Reddit threads and VA forums are full of veteran stories. One user, ArmyVet2010, wrote in September 2025: “Switched to generic sertraline through VA Mail Order - same as Zoloft, costs me $0. My local pharmacy wanted $15.”
Another, NavyDoc88, said: “I needed Wegovy for weight loss, not diabetes. Took three months and three appeals to get it approved.”
There are frustrations - especially with newer drugs. But most veterans agree: the system works. When they get their meds, they work. And they cost almost nothing.
What’s Changing in 2026
The VA is upgrading its formulary system. By late 2026, electronic health records will start suggesting generic alternatives automatically when a prescriber types in a brand-name drug. It’s called AI-driven therapeutic interchange - and it’s meant to reduce human error and speed up approvals.
They’re also expanding access to oncology and rare disease drugs. The 2025-2027 Pharmacy Strategic Plan says they’ll prioritize drugs that save lives, even if they’re expensive - as long as the clinical evidence supports it.
And they’re making formulary changes more visible. Soon, you’ll see real-time status tags in your e-prescription: “Generic Preferred,” “Prior Auth Required,” or “Available in Meds by Mail.”
What You Need to Do Now
If you’re a veteran using VA benefits:
- Check your current prescriptions on the VA Formulary Advisor. Are they Tier 1?
- Switch to Meds by Mail for any maintenance meds. It’s free and easier.
- If your drug isn’t covered, ask your provider for a generic alternative - or help with prior authorization.
- Keep the VA Pharmacy Benefits number (1-800-877-8339) saved in your phone. They’re there to help.
You don’t need to be an expert to use the VA formulary. You just need to know it exists - and that you have the right to ask questions.
Are all VA prescriptions generic?
No, but the VA defaults to generics when they’re available and equally effective. Brand-name drugs are only prescribed if there’s a documented medical reason - like an allergy, intolerance, or lack of response to the generic version. About 8% of VA prescriptions are brand-name, mostly for specialty drugs or complex conditions.
Can I get my VA prescription filled at a regular pharmacy?
Yes, but only under specific conditions. If you’re enrolled in Community Care and your VA pharmacy can’t fill your prescription, or if you’re traveling and need an emergency refill, you can use a network pharmacy. You’ll pay the VA’s copay rate, not the pharmacy’s retail price. Always check with VA first - some drugs require prior authorization even for community pharmacies.
Why is my VA drug cheaper than my Medicare drug?
The VA negotiates drug prices directly with manufacturers and only covers drugs that pass strict cost-effectiveness reviews. Medicare Part D lets private insurers set their own formularies and pricing, often resulting in higher copays and more tiers. The VA’s single-payer system gives it more power to drive down prices - and it uses that power to save veterans money.
What if my VA-prescribed generic doesn’t work for me?
Talk to your VA provider. The VA recognizes that some people respond differently to generics. If you report side effects or lack of effectiveness, your provider can request a brand-name drug through prior authorization. Studies show 94% of veterans who switch back to brand-name drugs after concerns continue therapy successfully - so your feedback matters.
Do CHAMPVA beneficiaries get the same formulary as veterans?
Yes, CHAMPVA uses the same VA National Formulary. Spouses and dependents of veterans get the same drug coverage, copays, and access to Meds by Mail. The only difference is eligibility - CHAMPVA is for dependents, not veterans themselves. But the drugs, tiers, and rules are identical.
Next Steps
If you’re new to VA benefits, give yourself two to three visits to learn the system. Most veterans say it clicks after talking to a VA pharmacist or using Meds by Mail for the first time.
Don’t wait until you run out of meds to check coverage. Use the Formulary Advisor today. Save the phone number. Ask questions. The VA system works best when you know how to use it - and you’re entitled to every benefit it offers.
Brittany Wallace
January 1, 2026 AT 19:25VA’s generic-first policy is basically the healthcare equivalent of buying store-brand cereal - same nutrition, half the price. It’s not radical, it’s just smart. Why pay $15 for sertraline when $0 works just as well? The system’s not perfect, but it’s one of the few places where bureaucracy actually serves people instead of squeezing them.
And honestly? If private insurers copied even 20% of this, we wouldn’t need 17 different insurance plans just to afford insulin.