DME/Pharmacy Requirements–Information for Providers
Durable Medical Equipment (DME) Requirements
The information below provides information specific to Veterans for prosthetics, orthotics, DME and sensory aid fulfillment services.
How do I obtain routine DME for a Veteran?
All routine DME requests (not needed urgent or emergently during the visit) should be requested within twenty-four (24) hours or the next business day after completion of healthcare services from which the prescription was generated. To request routine DME, prosthetics or orthotics for a Veteran, complete VA Form 10-10172, Community Care Provider—Request for Service, and return it to your local VA facility’s community care office. Page 2 of the form is dedicated to these specific requests.
For additional information, please review Request for Service Requirements.
Is DME required as part of the visit covered?
Yes, if a provider determines that DME is needed emergently or urgently to stabilize or decrease the risk of further injury it is covered under the authorization for the visit and can be provided by the community provider.
DME rentals are only covered for the first 30 days. The Community Care Network (CCN) will not pay for DME rentals beyond the initial 30 days. The provider must submit a Request for Service form to VA in advance if the DME rental is required beyond 30 days to ensure proper care coordination and no disruption to rental services.
All routine DME requests (not needed urgent or emergently during the visit) should be requested via the Community Care Provider–Request For Service, VA Form 10-10172, within twenty-four (24) hours or the next business day after completion of healthcare services from which the prescription was generated.
Are implanted devices covered?
Yes, implantable devices are covered under the authorization for the primary problem or procedure.
How do I get more information about VHA Prosthetics and Sensory Aids Services?
For more information, please visit the VHA Rehabilitation and Prosthetic Services website.
The information below identifies the requirements for prescribing medications to Veterans for prescription fulfillment services. The following information pertains to medications prescribed under the Community Care Network (CCN). For a list of participating, contracted retail pharmacies, please use the VA Facility Locator.
ATTENTION: VA pharmacies now accept electronic prescriptions from community providers for eligible Veterans for all medications, including controlled substances. VA still accepts and fills controlled substance prescriptions received by paper (or fax where applicable). VA pharmacies will be located in the provider pharmacy database.
Where can I find the VA Formulary for Community Care?
The VA Formulary for Community Care can be found on the Pharmacy Benefits Management Services website. This site includes downloadable files for both the VA National Formulary and the VA Urgent/Emergent Formulary, as well as a VA Formulary Search Tool.
- The VA National Formulary indicates if a drug has a Criteria for Use (i.e. Prior Authorization), Restrictions,
or is listed on the Urgent/Emergent Formulary.
- The VA Formulary Search Tool is an aid for VA and non-VA users to easily search for formulary items.
What is the VA process to request non-formulary drugs?
All providers must follow Veterans Health Administration (VHA) Directive 1108.08, VHA Formulary Management Process, which includes provisions for requesting non-formulary drugs. If you need to submit a non-formulary request for a medication, please contact the Community Care representative at the referring VA medical facility to obtain their non-formulary request form.
If a prescription is needed, what pharmacy do I send the prescription to for fulfillment?
Immediate need prescriptions may be sent to the referring VA medical facility's pharmacy, or to a retail pharmacy participating in the network. Immediate need prescriptions are contained on the VA Urgent/Emergent Formulary.
- Up to a 14-day supply with no refills of the immediate need medication may be authorized.
- A seven-day supply for opioids, or up to the opioid prescribing limit allowed by State—whichever is less—may be authorized. CCN may authorize a refill for a seven-day supply of opioids within a 30-day timeframe for a maximum total supply of 14 days.
- If the medication is needed past 14 days, the provider must send another prescription to the referring VA medical facility’s pharmacy for prescription fulfillment services.
For a list of participating contracted retail pharmacies, please use the VA Facility Locator.
Routine/maintenance prescriptions must be sent to the referring VA medical facility’s pharmacy. If you do not have the ability to electronically submit prescriptions to pharmacies, please contact the Community Care representative at the referring VA medical facility for their pharmacy FAX number.
NOTE: If a drug has a Criteria For Use (e.g. prior authorization), then you must fax a completed Criteria For Use document to the pharmacy of the referring VA medical facility. You can use the VA Formulary Search Tool to easily search for formulary items including Criteria For Use documents.
What information must I include on a prescription in order for the referring VA medical facility pharmacy to fill the prescription?
The following information must be included on a prescription in order for the referring VA medical facility pharmacy to fill the prescription:
- Date of Birth
- Phone number
- FAX number
- Social Security Number
- Personal DEA number (NOT facility-specific DEA number)
- National Provider Identifier (NPI) number
Does VA allow me to provide drug samples or coupons to Veterans?
No, the use of drug samples or drug coupons are prohibited.