The short answer
Psychiatry and medication management count as mental health care, so they use VA's 20-day and 30-minute standards. They need their own Community Care authorization. A therapy authorization doesn't automatically cover them. Routine prescriptions from a community psychiatrist go to a VA pharmacy and follow VA's formulary. Urgent prescriptions of up to 14 days can be filled at an in-network pharmacy.
How do Community Care psychiatry referrals work?
The same way as other mental health referrals. Psychiatry and medication management are mental health care, so under 38 CFR 17.4040(a)(1), you qualify for Community Care if VA can't schedule you within 20 days of your request and within a 30-minute average drive. You can also qualify under best medical interest.
Your VA team prepares a referral, and VA issues an authorization for psychiatry with a provider, a type of care, and a time period. See How to Get a Referral.
Does my therapy authorization cover a psychiatrist?
No. An authorization covers a specific package of services, called a Standardized Episode of Care (SEOC). Therapy and psychiatry are usually separate. If your community therapist thinks you need medication, they can't just send you to a psychiatrist on VA's dime. They ask VA first.
The same goes for psychological testing, an intensive outpatient program, or another new mental health service. Each needs approval through a Request for Service (RFS), VA Form 10-10172, sent by your community provider. See How Community Providers Request More Care.
You can also ask your VA team for a psychiatry referral directly.
How do prescriptions from a community psychiatrist work?
They follow VA's pharmacy rules, under 38 CFR 17.4025(b) and VA's provider guidance:
- Routine and maintenance medications go to the VA pharmacy at your referring VA facility. The psychiatrist can send them electronically, including controlled substances. VA fills them, usually by mail.
- Supply limits: VA fills up to a 90-day supply, with a 12-month limit including refills. Controlled substances and some other medications are limited to 30 days or less.
- Urgent needs: For a medication you need right away, VA pays for up to a 14-day supply with no refills at an in-network retail pharmacy, if the drug is on VA's urgent/emergent formulary.
- Formulary: VA uses its National Formulary. Some medications have Criteria for Use, extra documentation VA reviews first. For a drug not on the formulary, the psychiatrist uses VA's non-formulary request process through the referring facility.
- Samples and coupons: VA's provider guidance prohibits them for VA prescriptions.
Details: How Prescriptions From Community Care Providers Work.
What should I watch for when starting with a community psychiatrist?
- Timing. A new prescription mailed from a VA pharmacy can take days. Ask the psychiatrist whether you need a short urgent supply to bridge the gap.
- Medication changes. Tell your VA team and VA pharmacy if a dose changes, so VA's list stays current.
- Two prescribers. If a VA provider and a community psychiatrist both prescribe for you, make sure each knows what the other prescribed.
- Controlled medications. These have shorter fill limits and stricter rules. Plan refills ahead.
Do I pay at the pharmacy?
For prescriptions filled through VA, any copay is billed by VA later, based on your priority group and the medication's tier. In 2026, VA medication copays range from $5 to $11 for a 30-day supply, capped at $700 a year. Priority Group 1 pays nothing. See VA copay rates.
Can I keep a psychiatrist I already see?
Often yes, if they're in VA's network. Continuity of care is a best medical interest factor. See Keeping Your Current Therapist or Psychiatrist.