The short answer
If you paid a pharmacy yourself, you can file a CHAMPVA claim. Get a pharmacy printout with the drug, strength, quantity, cost, 11-digit NDC, fill date, and prescriber, plus any other drug plan's EOB. File online or by mail. You get back CHAMPVA's share, not necessarily what you paid.
Do you need to file yourself?
OptumRx network pharmacies bill CHAMPVA for you, per VA's CHAMPVA care page. You usually file only when:
- you used a pharmacy outside the network, or
- the pharmacy wouldn't bill CHAMPVA.
If you have other drug coverage, give the pharmacy both cards so it bills both. For regular maintenance drugs, Meds by Mail avoids claims entirely if you have no other drug coverage.
What do you need from the pharmacy?
A register receipt usually isn't enough. Ask for a prescription printout or history showing:
- pharmacy name, address, and phone,
- drug name, dosage, strength, and quantity,
- cost, including any copay,
- the 11-digit NDC (National Drug Code),
- fill date, and
- prescriber's name.
The CHAMPVA Guidebook adds that it should show the patient and what was paid.
The NDC isn't the Rx number. The Rx number is the pharmacy's label number. The NDC identifies the drug itself. A missing NDC is one of the most common reasons these claims stall.
What if you have other drug coverage?
It pays first, under 38 CFR 17.276. Include its EOB or statement showing what it paid or your copay. If it denied the drug, include the denial.
How much will CHAMPVA pay back?
VA's care page says CHAMPVA may reimburse 75% of its allowable amount after any deductible. For out-of-network pharmacies, 38 CFR 17.275 sets a specific pricing formula, so CHAMPVA's price may be lower than what you paid. Don't expect 75% of the cash price. More here: CHAMPVA allowable amount.
How to file
- Get the full pharmacy printout.
- Get the other plan's EOB, if any.
- Set up direct deposit. VA only pays you that way. More here: CHAMPVA direct deposit.
- File online on VA's claim page, or by mail with VA Form 10-7959a to VHA Office of Integrated Veteran Care, CHAMPVA Claims, PO Box 500, Spring City, PA 19475. Copy the backs of two-sided papers.
- Keep copies of everything.
More here: File a claim online or by mail.
Deadline and timing
File within 1 year of the fill date. Processing takes about 90 days. If VA asks for more, you have 1 year from that letter to respond. More here: CHAMPVA claim filing deadlines.
Checklist
- Proof of what you paid
- Pharmacy printout with every field, including the 11-digit NDC
- Other plan's EOB, if any
- Direct deposit set up
- Online submission or current Form 10-7959a
- Copies kept