Welcome to Optum Rx
Welcome to OptumRx
OptumRx is a focused, collaborative and innovative leader in the pharmacy benefit management (PBM) industry. Every day, we serve millions of people through our national network of community pharmacies.
Reminder: On January 1, 2025, the annual deductible requirement for your CHAMPVA benefits will begin again.
• The deductible is applied to the first medical or pharmacy claims processed in 2025 until the deductible is met.
• The deductible is $50 per beneficiary or a maximum of $100 per family per year.
Please, DO NOT mail checks to CHAMPVA or OptumRx to satisfy your deductible requirement. It will automatically be deducted from your submitted claims. Any amount paid over your deductible due to the timing of claim processing will be refunded to you by CHAMPVA
Pharmacy Benefits - Community Care (va.gov)
Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
CHAMPVA changes coming in January 2025 for weight loss medications
Beginning January 1, 2025, CHAMPVA will only cover the medications, Ozempic and Mounjaro, if you have a Type II diabetes diagnosis. These medications are FDA-approved for the management of Type II Diabetes and are not covered for any other uses such as pre-diabetes, weight loss or managing obesity. In general, CHAMPVA does not cover weight loss medications, including Saxenda, Wegovy, and Zepbound.
If you do not have a diagnosis for Type II diabetes but you’ve been receiving these medications, for example you’ve been receiving these prescriptions for pre-diabetes, your prescriptions will no longer be filled. Your pharmacy may alert you that your prescription isn’t covered under your current diagnosis.
Your prescription drug benefits
OptumRx is the Pharmacy Benefit Manager for three programs offered by the VETERAN AND FAMILY MEMBER PROGRAMS (VFMP). These programs include:
Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) - CHAMPVA is the VA's health benefit program for dependents of permanently and totally disabled Veterans, survivors of Veterans who died from service-connected conditions, or who at the time of death, were rated permanently and totally disabled from a service-connected disability.
Spina Bifida Health Care (SB) - The Spina Bifida Health Care Program is a federal health benefit program administered by the Department of Veterans Affairs for Vietnam Veterans' birth children who have been diagnosed with spina bifida (except spina bifida occulta). The program is a fee-for-service (indemnity plan) program that provides reimbursement for medical services and supplies related to spina bifida and conditions associated with spina bifida.
Children of Women Vietnam Veterans Healthcare (CWVV) - The CWVV Health Care Program is a federal health benefits program administered by the Department of Veterans Affairs for children with certain birth defects born to women Vietnam Veterans. The CWVV Program is a fee-for-service (indemnity plan) program. The CWVV Program provides reimbursement for medical care related to conditions associated with certain birth defects except spina bifida, which is covered under the VA's Spina Bifida Program.
VFMP beneficiaries can also use Meds by Mail to have prescriptions mailed to them.
Meds by Mail (MbM) If you are eligible and do not have any other prescription drug coverage you may want to use the CHAMPVA Meds by Mail program. MbM offers nonurgent, maintenance prescription medications delivered directly to your home. The best part of MbM is that there is NO cost share or copay, and no annual deductible. The medication is provided with no out-of-pocket cost to you! Meds by Mail also offers certain specialty medications that could save you hundreds or even thousands of dollars. If you have been diagnosed with Hepatitis C, cancer, or another costly health condition, please contact Meds by Mail to see if your medication is available.
Contact Information
VFMP Beneficiary Services
800-733-8387
OptumRx Beneficiary Services
888-546-5502
OptumRx Pharmacy Technical Helpdesk
888-546-5503
Meds by Mail
Dublin, GA
866-229-7389
Cheyenne, WY
888-385-0235