Community Care

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.

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

For additional information, please review Request for Service Requirements.

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.

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

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

For more information, please visit the VHA Rehabilitation and Prosthetic Services website.

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.

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

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.

The following information must be included on a prescription in order for the referring VA medical facility pharmacy to fill the prescription:

No, the use of drug samples or drug coupons are prohibited.