Federal Reports

The VA Office of Inspector General (OIG) assessed allegations at the New Mexico VA Health Care System (facility) regarding the policy and practices related to the provision of buprenorphine treatment for patients with opioid use disorder.The OIG substantiated that pharmacists declined early refills of buprenorphine despite prescribing providers’ documented clinical rationales, which increased patients’ risk for adverse clinical outcomes associated with interruption of buprenorphine treatment. The OIG substantiated that justification for declining early refills was incorrectly based on a facility policy that was not applicable to the use of buprenorphine for treatment of opioid use disorder.The OIG substantiated that the Opioid Safety Committee pharmacist placed standing orders for urine drug screening without coordinating with patients’ prescribing providers. However, the pharmacist acted within the scope of practice.The OIG did not substantiate that the facility’s Opioid Safety Committee Chairperson interfered with prescribing providers’ practices regarding buprenorphine orders for patients with opioid use disorder, the facility’s standing operating procedure (SOP) on buprenorphine treatment for patients with opioid use disorder was inconsistent with VHA guidance or that facility practices varied from VHA guidance on increasing access to buprenorphine.The OIG did not substantiate that facility leaders failed to respond to a provider’s report of patient safety concerns. However, actions taken by leaders did not fully address the reported concerns.The OIG identified a related concern regarding staffing challenges that affected the Substance Use Disorder program and plans for expanding buprenorphine treatment.The OIG made five recommendations to the Facility Director to align facility practices with policy applicable to early refills for buprenorphine; ensure communication between providers, pharmacists, and patients for early medication refills; clarify and educate staff on the Opioid Safety Committee’s role in buprenorphine treatment; revise the facility’s buprenorphine SOP; and review Substance Use Disorder provider staffing.

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.

We audited the expenditures made by the Mississippi Department of Wildlife, Fisheries, and Parks under grants awarded by the FWS.

Our objective was to evaluate DIA's efforts to assess, standardize, and coordinate open source intelligence tools and data sets across the Department of Defense Components. We issued our results in a classified report on June 30, 2022.