VA Form 10-0426: Meds by Mail Order Form – Download PDF – VA Form 10-0426 is the official Meds by Mail Order Form used by qualified beneficiaries to request maintenance prescription medications through the Department of Veterans Affairs mail-order pharmacy service. This free service delivers non-urgent medications directly to your home with no copays, no deductibles, and no enrollment required for eligible users.
If you are a CHAMPVA beneficiary, enrolled in the Spina Bifida Health Care Benefits Program, or qualify under related family member programs, this form (or electronic options) helps you access convenient prescription fulfillment.
Who Can Use VA Meds by Mail and VA Form 10-0426?
Eligibility is limited to specific VA programs:
- Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
- Spina Bifida Health Care Benefits Program (SBHCBP)
- Children of Women Vietnam Veterans (CWVV)
Important restriction: You generally cannot use Meds by Mail if you have other health insurance that includes prescription drug coverage (including Medicare Part D).
Benefits of Using Meds by Mail for Prescription Medications
Meds by Mail provides significant advantages for eligible veterans’ family members:
- No out-of-pocket costs — zero copays or deductibles for covered maintenance medications
- 90-day supplies with refills for ongoing treatments
- Home delivery anywhere in the United States and territories
- Access to certain specialty medications (e.g., for Hepatitis C or cancer) that may offer substantial savings
- Convenient refill options via phone, mail, or My HealtheVet for eligible users
Delivery typically takes up to 21 days, so plan ahead by requesting a 30-day supply from a local pharmacy as a bridge.
How to Use VA Form 10-0426 (Step-by-Step Instructions)?
- Download the official form — Get the latest fillable PDF directly from the VA:
Download VA Form 10-0426 (Meds by Mail Order Form) - Complete all sections — Print or type clearly. Include:
- Full patient name, SSN, and date of birth (required for identification)
- Complete mailing address and phone numbers
- Medication allergies and health conditions
- Optional non-safety cap request (with signature)
- Today’s date
- Attach the original prescription — Photocopies are not accepted. The form must accompany every mailed paper prescription.
- Mail to the correct address based on your location (West or East regions as specified on the form).
Pro Tip: Use a separate form for each patient or family member.
Preferred Method: Electronic Prescribing (E-Prescribing)
Many providers now send prescriptions electronically, which is faster and more convenient than paper forms:
- Ask your provider to e-prescribe to “Meds by Mail CHAMPVA” (Pharmacy ID often listed as 5204437).
- No VA Form 10-0426 needed for electronic orders.
Refilling Prescriptions Through Meds by Mail
- Use the automated phone system: 1-888-370-1699
- Return the refill slip included with each shipment
- Track refills online via My HealtheVet (for eligible CHAMPVA users)
- Mail refill requests early to avoid gaps in medication supply
Common Covered Medications and What to Expect
Meds by Mail focuses on maintenance medications for chronic conditions (e.g., high blood pressure, diabetes, cholesterol, asthma, etc.). It does not cover immediate-use, one-time, or Schedule II controlled substances — obtain those locally.
Check the VA’s official lists of covered medications for examples.
Contact Information and Support
- West Region: 1-888-385-0235
- East Region: 1-866-229-7389
- CHAMPVA Help Line: 1-800-733-8387
- Hours: Monday–Friday, typically 8:00 a.m. to 7:30 p.m. ET
For the most current details, always refer to official VA resources.
Download VA Form 10-0426 Now
Ready to order?
Download VA Form 10-0426 – Meds by Mail Order Form (Official Fillable PDF)
This form and service are provided by the U.S. Department of Veterans Affairs to support eligible beneficiaries. Always verify your eligibility and the latest instructions on VA.gov.
This article is for informational purposes only and is based on official VA resources as of 2026.