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Pharmacy Benefits

icon pill bottleBeneficiaries of CHAMPVA, the Spina Bifida and the Children of Women Vietnam Veterans (CWVV) health care benefits programs are provided pharmacy benefits through a local retail pharmacy or through our Meds by Mail (MbM) program.

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.

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Information for CHAMPVA Beneficiaries

Eligible CHAMPVA beneficiaries who do not have other health insurance (OHI) with pharmacy coverage are able to use MbM for nonurgent, maintenance medications. Prescribed, maintenance medication will be mailed to your home.*
*Refrigerated medications cannot be delivered to a post office box or outside of the continental United States.

You can use your local pharmacy in the OptumRx network for other prescription medications. Pharmacies that are a part of the OptumRx network will collect your 25% cost share/copay along with the annual deductible and send the claim to CHAMPVA for the remaining amount.

If you have other health insurance with pharmacy coverage, including Medicare Part D, even though it is primary to CHAMPVA, you are still able to use an OptumRx pharmacy. Be sure to tell your pharmacy that you have both primary prescription coverage and CHAMPVA. In this case, you may not have a cost share if the medication is covered by your primary insurance as well as by CHAMPVA.

The CHAMPVA Pharmacy Benefits fact sheet has more information about pharmacy benefits. You can find more information about filing CHAMPVA claims for beneficiaries on the CHAMPVA Claims page.

Information for Spina Bifida and CWVV Beneficiaries

Spina Bifida and CWVV beneficiaries can use a local pharmacy in the OptumRx network and the Meds by Mail program to obtain their medications without a cost share/copay. Pharmacies that are a part of the OptumRx network will send the claim electronically to VHA Office of Integrated Veteran Care (VHA IVC) for payment.

CWVV beneficiaries can only use OputmRx to obtain prescriptions for their rated disability or conditions related to their disability. The first time a prescription is received, the beneficiary must pay 100% out-of-pocket. The beneficiary must then submit a claim with medical documentation to show it is related to their disability. If related, the beneficiary will be reimbursed and then will be able to use OptumRX for future refills of that medication. Each prescription must first be paid by the beneficiary and then reviewed in order to be considered for CWVV pharmacy benefits.

Using Meds by Mail (MbM)

Meds by Mail offers nonurgent, maintenance prescription medications delivered directly to your home. The best part of MbM is that there is NO cost share or copay, and no annual deductible. The medication is provided with no out-of-pocket cost to you! 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, cancer, or another costly health condition, please contact Meds by Mail to see if your medication is available.

You can view a list of the most common medications available from Meds by Mail at the link below. Additional information can be found on the Meds by Mail page.

List of the most common medications available from Meds by Mail
(This list is only a small sample of the thousands of medications available.)

Using a Local Pharmacy

OptumRx is a pharmacy benefits manager that has contracted with the VHA Office of Integrated Veteran Care to provide a retail pharmacy network that will electronically process pharmacy claims. There are over 66,000 pharmacies nationwide that participate in the OptumRx network. 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 Integrated Veteran Care yourself.

To find a participating pharmacy near you, visit the OptumRx website and select the Preferred Pharmacy Finder link from the left-hand navigation menu. You can also print a temporary pharmacy ID card from the OptumRx beneficiary FAQ’s page, or by giving your local pharmacy the following information: RxBIN: 610593 | RxPCN: VA | RxGrp: HAC

Pharmacy Contacts

OptumRx Beneficiary Help Desk

If a beneficiary, or authorized representative, needs assistance from OptumRx, call this number. This is also the contact number to order a pharmacy card.

OptumRx Pharmacy Help Desk

Pharmacists who have questions or need assistance from OptumRx should use this number.

Meds by Mail-EAST
Dublin, GA

8:00 a.m. to 5:30 p.m., Monday–Friday, Eastern Time

Meds by Mail-WEST
Cheyenne, WY

8:00 a.m. to 5:30 p.m., Monday–Friday, Mountain Time

MbM Automated Prescription Refill Line

CHAMPVA Call Center

Contact CHAMPVA directly for any questions regarding eligibility, or to update insurance information (including pharmacy coverage) on file with CHAMPVA.

Spina Bifida Call Center

Contact the Spina Bifida Health Care Benefits Program directly for any questions regarding eligibility.

Excluded Benefits

The products listed below are no longer covered by CHAMPVA. Please contact your health care provider to determine other treatment options. 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.

Excluded Medications

  • Cytra-2 (Citric Acid/Sodium Citrate)
  • Ascorbic Acid
  • Calcium Ascorbate
  • Citric Acid
  • Folbic
  • Folgard
  • Hemocyte-F
  • ICAR-C Plus SR
  • Iron
  • Midrin
  • Multigen Plus
  • Potassium Bicarbonate
  • Pyridoxine
  • Virt-Vite Forte
  • Vitamin C
  • Zinc

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 notification. Please attach any pertinent documentation to support your claim and include a copy of the notification with your request.

VHA Office of Integrated Veteran Care
ATTN: Appeals
PO Box 460948, Denver CO 80246

If you have any immediate questions or concerns, please contact our Customer Service Center:
800-733-8387, Monday–Friday
8:05 a.m.–7:30 p.m., Eastern Time