Beneficiaries of the CHAMPVA, Spina Bifida and Children of Women Vietnam Veterans (CWVV) programs can access pharmacy benefits through a local retail pharmacy or through our Meds by Mail program.
Using Meds by Mail (MbM)
Meds by Mail offers nonurgent, maintenance prescription medications delivered directly to your home. Meds by Mail also offers certain specialty medications that could save you hundreds or even thousands of dollars. If you have been diagnosed with Hepatitis C or are being seen by an oncologist, be sure to contact Meds by Mail to see if your medication is available.
The best part of MbM is that there is NO cost share or co-pay and no annual deductible. The medication is provided with no out-of-pocket cost to you! Additional information on the MbM program can be found at Meds by Mail.
You can view a list of the top 200 medications available from Meds by Mail. While this list is not all inclusive, it does contain the most dispensed medications.
IMPORTANT NOTE: Prescription medication must be approved by the U.S. Food and Drug Administration (FDA) and must not be used in conjunction with any experimental program.
Using a Local Pharmacy
The OptumRx (formerly Catamaran) retail pharmacy network is a pharmacy benefits manager that has contracted with the VHA Office of Community Care (OCC) to electronically process pharmacy claims. There are over 67,000 pharmacies nationwide that participate in the OptumRx network. To find a participating pharmacy near you, visit OptumRx and select the Preferred Pharmacy Finder link from the left-hand navigation menu. If you go to a pharmacy that is not part of the OptumRx network, you will have to pay the full cost of the medication and submit a claim to VHA Office of Community Care yourself.
You can print a temporary pharmacy ID card from the OptumRx website by visiting OptumRx beneficiary FAQ’s and selecting the appropriate program link. You can also give your local pharmacy the following information:
RxBIN: 610593 | RxPCN: VA | RxGrp: HAC
CHAMPVA beneficiaries who do not have other health insurance (OHI) with pharmacy coverage are able to use Meds by Mail for nonurgent, maintenance medications and a local pharmacy in the OptumRx network for other prescription medications. If you have Medicare Part D, even though it is primary to CHAMPVA, you are still able to use a OptumRx pharmacy, but you will not be able to use Meds by Mail. Be sure to tell your local pharmacy that you have both Medicare Part D and CHAMPVA.
Pharmacies that are a part of the OptumRx network will collect your 25% cost share/co-pay along with the annual deductible and send the claim to CHAMPVA for the remaining amount. If you have OHI that is not Medicare Part D, you can submit a paper claim to VHA Office of Community Care for the portion that is paid out of pocket. Information on filing CHAMPVA claims can be found on CHAMPVA Claims–Information for Beneficiaries.
For more information on CHAMPVA Pharmacy Benefits, view Fact Sheet 01-05: CHAMPVA Pharmacy Benefits.
Spina Bifida and CWVV Beneficiaries
Spina Bifida and CWVV beneficiaries are able to use a local pharmacy in the OptumRx network and the Meds by Mail program to obtain their medications without a cost share/co-pay. Pharmacies that are a part of the OptumRx network will send the claim electronically to VHA Office of Community Care for payment.
Pharmacy Contact Information
|OptumRx beneficiary help desk||888-546-5502
If a beneficiary, or authorized representative, needs assistance from OptumRx, please call this number. This is the number to contact to order a pharmacy card.
|OptumRx pharmacy help desk||888-546-5503
Pharmacists who have questions or need assistance from OptumRx should use this number.
|Meds by Mail-EAST
8:00 a.m. to 5:30 p.m. (EST), Monday–Friday
|Meds by Mail-WEST
8:00 a.m. to 5:30 p.m. (MST), Monday–Friday
|MbM Automated Prescription Refill Line||888-370-1699|
|CHAMPVA call center||800-733-8387
Please contact CHAMPVA directly for any questions regarding eligibility, or to update insurance information (including pharmacy coverage) on file with CHAMPVA.
|Spina Bifida call center||888-820-1756
Please contact the Spina Bifida Health Benefits Program directly for any questions regarding eligibility.
The products listed below are no longer covered by CHAMPVA. Please contact your health care provider to determine other treatment options. PLEASE NOTE: These lists should not be considered all-inclusive and may change at any time.
Effective September 1, 2015: Compound prescriptions containing any of the following ingredients are no longer a covered benefit.
Excluded Compound Ingredients
- Baclofen Powder
- Bupivacaine HCL Powder
- Cyclobenzaprine HCL Powder
- Diclofenac Sodium Powder
- Ethoxy Diglycol Liquid
- Flurbiprofen Powder
- Fluticasone Propionate Powder
- Gabapentin Powder
- Ketamine HCL Powder
- Ketoprofen Micronized Powder
- Levocetrizine Dihydrocloride Powder
- Lipoderm Base
- Lipo-Max Cream
- Lipopen Plus Cream
- Lipopen Ultra Cream Base
- Meloxicam Powder
- Mometasone Furoate Powder
- Nabumetone Micronized Powder
- Pracasil TM-Plus Gel
- Prilocaine HCL Powder
- Resveratrol Powder
- Spira-Wash Gel
- Tramadol HCL Powder
- Versapro Cream Base
- Versatile Cream Base
Effective October 1, 2015: The following medications are no longer a covered benefit.
- Cytra-2 (Citric Acid/Sodium Citrate)
- Ascorbic Acid
- Calcium Ascorbate
- Citric Acid
- ICAR-C Plus SR
- Multigen Plus
- Potassium Bicarbonate
- Virt-Vite Forte
- Vitamin C
Right to Reconsideration
You and/or your provider have the right to request reconsideration. A written statement explaining your disagreement must be received within one year from the date of this notification. Please attach any pertinent documentation to support your claim, include a copy of this notification with your request, and send to:
VHA Office of Community Care
PO Box 460948
Denver, CO 80246
If you have any immediate questions or concerns, please contact our Customer Service Center, toll-free, at 800-733-8387, Monday through Friday from 8:05 a.m. to 7:30 p.m., EST.