DME Requirements/Pharmacy Requirements - Community Care
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DME Requirements/Pharmacy Requirements

Durable Medical Equipment (DME) Requirements

The information below provides information that is specific to Veterans for prosthetics, orthotics, DME, and sensory aid fulfillment services.

How do I obtain routine DME for a Veteran?

To request routine DME, prosthetics, or orthotics for a Veteran, complete VA Form 10-10172, Request for Service, and return it to your local VA facility’s community care office. Note the specific section on Page 2 of the form that is dedicated to these requests.

For additional information, please review the Request for Service process.

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. All routine DME requests (not needed urgent or emergently during the visit) should be requested via the VA Form 10-10172, Community Care Provider–Request For Service.

VA Form 10-10172, Community Care Provider–Request For Service

Are devices implanted devices covered?

Yes, implantable devices are covered under the authorization for the primary problem or procedure.

Pharmacy Requirements

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) or a Patient-Centered Community Care (PC3) Urgent Care contract.

For a list of participating contracted retail pharmacies, please use the VA Facility Locator.

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.
VA National FormularyVA Formulary Search Tool
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.

VHA Directive 1108.08, VHA Formulary Management Process

If a prescription is needed, what pharmacy do I send the prescription to for prescription fulfillment services?

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.
  • Only a seven-day supply for opioids, or up to the opioid prescribing limit allowed by State—whichever is less—may be authorized.
  • If the medication is needed past 14 days, the provider will need to 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 Ccommunity 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.

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:

  • Name
  • Date of Birth
  • Gender
  • Address
  • Phone number
  • FAX number
  • Social Security Number
  • Personal DEA number (NOT facility-specific DEA number)
  • National Provider Indentifier (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.