This bill aims to codify and significantly improve the administration of the Department of Veterans Affairs (VA) national formulary. It mandates a uniform national formulary across all VA medical facilities, restricting local formularies unless a drug is approved through a specific non-formulary request process or a national waiver. The legislation also requires regular public communication and detailed reporting on formulary decisions and changes to ensure transparency. A key provision is the establishment of a Pharmacy and Therapeutics Committee within the Veterans Health Administration, composed of physicians, clinical pharmacists, and pharmacoeconomists with expertise in geriatric and mental health care. This committee is tasked with making timely, evidence-based formulary decisions, reviewing new drugs within 120 days of FDA approval, and operating under strict conflict-of-interest rules. All significant formulary changes must be publicly justified with clinical rationale. The bill creates a standardized electronic non-formulary drug request system , ensuring initial decisions are communicated within 96 hours and providing a tiered appeals process for denials. It mandates uniform criteria for evaluating these requests across all VA facilities and ensures that approved non-formulary drugs remain portable for veterans transferring care within the VA system. To enhance cost-effectiveness, the legislation authorizes the VA to negotiate supplemental discounts with pharmaceutical manufacturers, potentially linking formulary placement to lower prices. It also encourages the use of flexible purchasing arrangements and value-based purchasing agreements , where payments are tied to a drug's effectiveness for veterans. Furthermore, the bill establishes a tiered copayment schedule , making generic and formulary drugs less expensive for veterans to encourage their use. Finally, the bill establishes a temporary Veterans Formulary Advisory Committee to gather veteran and clinician input on formulary decisions. This committee, composed of front-line providers and stakeholders, will provide advisory feedback to the Secretary and the P&T Committee for two years.