VA Medical Facilities Took Steps to Safeguard Refrigerated Pharmaceuticals but Could Further Reduce the Risk of Loss

Refrigerated pharmaceuticals must be stored within manufacturer-recommended temperature ranges to maintain their potency. Exposure to excessive heat, cold, or light can cause these pharmaceuticals to lose potency, risking significant waste of medical and financial resources. In January 2019, VA reported a loss of about $1.1 million because medical facilities failed to maintain appropriate storage temperatures for refrigerated pharmaceuticals. These losses prompted Veterans Health Administration’s (VHA) Pharmacy Benefits Management Services (PBM) to issue three notices between January 2020 and August 2021 to clarify responsibilities, processes, and procedures for safeguarding refrigerated pharmaceuticals. The VA Office of Inspector General (OIG) conducted this audit to determine if VA medical facilities met requirements to safeguard the potency and value of refrigerated pharmaceuticals and found that VA medical facilities generally did so. For example, most medical facilities reported using electronic monitoring systems with software alerts for temperature excursions, and most medical facilities reported using, or being in the process of acquiring, pharmaceutical-grade purpose-built refrigerators and freezers. Some refrigerated pharmaceutical loss is expected, and VA medical facilities reported about $1.7 million in such losses for fiscal year 2021 out of about $1.4 billion spent on these kinds of drugs, a figure the OIG acknowledges is comparatively minimal. PBM officials agreed that medical facility officials need to strengthen and reinforce safeguards to further reduce their risk of refrigerated pharmaceutical loss and risk to veterans who could receive compromised medications or vaccines. The OIG recommended the under secretary for health reinforce requirements for storing refrigerated pharmaceuticals and establish a procedure to ensure medical facilities comply with VHA Notice 2021-16. Guidance should also be updated to clarify that medical facilities must report all refrigerated pharmaceutical loss.