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Pharmacy benefits

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  |  Using a local pharmacy  |  Contact information  |  Excluded 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 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 on our Meds by Mail Web page.

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 (VHA CC) to electronically process pharmacy claims. There are over 82,000 pharmacies nationwide that participate in the OptumRx network. To find a participating pharmacy near you, visit the OptumRx website 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 the OptumRx beneficiary FAQ’s page and selecting the appropriate program link. You can also give your local pharmacy the following information:

RxBIN: 610593 | RxPCN: VA | RxGrp: HAC

CHAMPVA beneficiaries

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-VHA CC.

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-VHA CC 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 our CHAMPVA Claims–Information for Beneficiaries page.

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: 1-888-546-5502
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: 1-888-546-5503
Pharmacists who have questions or need assistance from OptumRx should use this number.
Meds by Mail-EAST:
Dublin, GA
1-866-229-7389
8:00 a.m. to 5:30 p.m. (EST), Monday–Friday
Meds by Mail-WEST:
Cheyenne, WY
1-888-385-0235
8:00 a.m. to 5:30 p.m. (MST), Monday–Friday
MbM Automated Prescription Refill Line: 1-888-370-1699
CHAMPVA call center: 1-800-733-8387
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: 1-888-820-1756
Please contact the Spina Bifida Health 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. 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 Lipopen Plus Cream
Bupivacaine HCL Powder Lipopen Ultra Cream Base
Cyclobenzaprine HCL Powder Meloxicam Powder
Diclofenac Sodium Powder Mometasone Furoate Powder
Ethoxy Diglycol Liquid Nabumetone Micronized Powder
Flurbiprofen Powder Pracasil TM-Plus Gel
Fluticasone Propionate Powder Prilocaine HCL Powder
Gabapentin Powder Resveratrol Powder
Ketamine HCL Powder Spira-Wash Gel
Ketoprofen Micronized Powder Tramadol HCL Powder
Levocetrizine Dihydrocloride Powder Versapro Cream Base
Lipoderm Base Versatile Cream Base
Lipo-Max Cream  

Effective October 1, 2015: The following medications are no longer a covered benefit.

Excluded medications
Cytra-2 (Citric Acid/Sodium Citrate) Iron
Ascorbic Acid Midrin
Calcium Ascorbate Multigen Plus
Citric Acid Potassium Bicarbonate
Folbic Pyridoxine
Folgard Virt-Vite Forte
Hemocyte-F Vitamin C
ICAR-C Plus SR 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 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
ATTN: Appeals
PO Box 460948, Denver CO 80246

If you have any immediate questions or concerns, please contact our Customer Service Center, toll-free, at
1-800-733-8387, Monday through Friday from 8:05 a.m. to 7:30 p.m., Eastern Standard Time.