The short answer
CHAMPVA covers prescriptions three ways. At an OptumRx network pharmacy, you pay your deductible, then 25%. Through Meds by Mail, maintenance drugs are free, but only if you have no other prescription coverage, including Medicare Part D. At other pharmacies, you usually pay upfront and file for reimbursement. Other drug plans pay first.
The three ways to fill a prescription
| Route | Best for | What you pay (CHAMPVA only) |
|---|---|---|
| OptumRx network pharmacy | Urgent and regular prescriptions | Deductible, then 25% |
| Meds by Mail | Regular maintenance drugs, if you have no other drug coverage | Nothing |
| Non-network pharmacy | When there's no other option | Pay upfront, then file for reimbursement |
VA's CHAMPVA care page covers both urgent prescriptions and ones you take regularly.
Using an OptumRx pharmacy
CHAMPVA has no network for doctors, but it does use a pharmacy network: OptumRx. VA says it includes most local pharmacies.
- Show your OptumRx prescription card. If you lost it, VA says you can print a temporary one online.
- Tell the pharmacy about any other drug coverage.
- For help finding a network pharmacy, call OptumRx Beneficiary Services at 888-546-5502.
When CHAMPVA is your only drug coverage, you pay your yearly deductible ($50 per person, $100 per family), then 25% of the allowable amount, under 38 CFR 17.274. Your family's yearly total stops at $3,000.
For pharmacy staff
VA lists these OptumRx routing values:
- BIN: 610593
- PCN: VA
- Group: HAC
- Cardholder ID (302-C2): the beneficiary's Social Security number
The OptumRx Pharmacy Help Desk is 888-546-5503. Don't use TRICARE or VA Community Care pharmacy billing information for a CHAMPVA patient.
Using Meds by Mail
Meds by Mail sends regular maintenance medications to your home with no deductible and no cost share.
The catch: you can't have any other health insurance with drug coverage, including Medicare Part D. New prescriptions can take up to 21 days, so it's not for urgent needs. Some drugs, including many opioid pain medications, aren't available. More here: How to start Meds by Mail.
If Part D is your only other drug coverage, think carefully before dropping it to use Meds by Mail. More here: CHAMPVA and Medicare Part D.
What if you have other drug coverage?
It pays first, and CHAMPVA pays second, under 38 CFR 17.276. Give the pharmacy both plans. VA says when both cover the drug, you generally won't owe a CHAMPVA cost share. The CHAMPVA Guidebook says the pharmacy sends both claims electronically.
If you paid out of pocket, file with the other plan first, then send CHAMPVA its EOB. More here: CHAMPVA prescription reimbursement.
Is every drug covered?
No. The Guidebook says drugs generally must be FDA-approved for the condition, prescribed by an authorized provider, and dispensed under state law. 38 CFR 17.272 excludes most over-the-counter products, with exceptions like insulin and diabetic testing supplies.
Some drugs have their own rules. For example, GLP-1 drugs aren't covered for weight loss. More here: CHAMPVA and GLP-1 medications.
Do prescriptions need prior authorization?
Not as a rule. But specific drugs can, like Wegovy and Zepbound for their covered uses.
Before filling a prescription
- Do you have other drug coverage?
- Is the drug covered for your diagnosis?
- Does it need prior authorization?
- Is it urgent, or a maintenance drug that could go through Meds by Mail?
- If you pay out of pocket, did you get a detailed receipt?