How to Fill Out the VA Meds by Mail Order Form (10-0426)

VA Form 10-0426 is the order form CHAMPVA and Spina Bifida Health Care Program beneficiaries use to request maintenance medications through the Meds by Mail program. Fill out the one-page form with your personal and provider information, attach the original written prescription from your doctor, and mail both to the Meds by Mail processing center in Cheyenne, Wyoming. There is no copay and no shipping charge.¹

Who the Form Is For

Two groups can use Form 10-0426: beneficiaries of the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and individuals covered under the Spina Bifida Health Care Program.²

One eligibility rule catches people by surprise: you cannot have any other health insurance that covers prescriptions, and that includes Medicare Part D.³ If you pick up prescription coverage through a new job, a spouse’s plan, or Medicare, notify CHAMPVA right away. The VA can recover costs for shipments filled after you gained other coverage.

What You Can and Can’t Order

Meds by Mail is for maintenance medications — the drugs you take on an ongoing basis for chronic conditions. Ask your provider to write each prescription for a 90-day supply with refills.¹

Do not send Form 10-0426 for:

Immediate-use or one-time-use prescriptions
Schedule II controlled substances²
Blood glucose meters
GLP-1 medications prescribed for weight loss⁴

Fill those at a local pharmacy instead. Not every strength or formulation is stocked either, so call the Meds by Mail line before ordering if you’re unsure your specific medication is available.

Filling Out the Form

Download Form 10-0426 at va.gov/forms/10-0426/ or request a paper copy from a CHAMPVA service line.⁵ Each patient submits a separate form. If two family members use the program, each one sends their own.²

Print clearly. If the VA can’t identify you from what you’ve written, they won’t fill the prescription. The fields you need to complete:

Patient name — last, first, middle initial, matching your CHAMPVA card
Social Security number and date of birth — both are required, and a missing one will stop the order
Mailing address, with checkboxes to mark whether this is a change and whether it’s permanent or temporary
Daytime phone numbers, home and cell
Known medication allergies and relevant health conditions, so the pharmacy can screen for interactions
Prescribing provider’s name and phone number

Sign and date at the bottom. There’s a separate signature line if you want easy-open (non-child-resistant) lids on your bottles.²

A fresh Form 10-0426 goes with every mailed prescription, even when the VA already has your information on file from an earlier order.²

Getting the Prescription Ready

The prescription you attach must be an original written by a licensed healthcare provider. Photocopies are not accepted.² Before you mail anything, check that the prescription itself shows:

Your full legal name
The last four digits of your Social Security number
Your date of birth
Your mailing address
The provider’s full name, phone number, and mailing address¹

If any of that is missing, ask the provider to add it before the prescription leaves the office. Incomplete prescriptions get rejected or delayed.

Where to Send It

Attach the original prescription to your completed Form 10-0426 and mail both to:

Meds by Mail
PO Box 20330
Cheyenne, WY 82003-7008²

Use a secure envelope. The form carries your Social Security number, and original prescriptions can’t be replaced the way copies can. Certified mail or a tracked service is worth considering.

Skipping the Paper Form

Your provider can send the prescription electronically instead. Ask them to search for “Meds by Mail CHAMPVA” in their e-prescribing system, pharmacy ID 5204437.¹ An e-prescription cuts out the mail transit and the paper form entirely, provided your Meds by Mail account is already set up with current information.

How Long It Takes

New prescriptions can take up to 21 days from the day you mail your order to arrive at your door.¹ That window covers mail time to Cheyenne, filling the order, and the return shipment. Refills move faster because your information is already in the system. Don’t wait until the bottle is empty to submit.

Refills Don’t Need a New Form

Once a prescription is in the system, you don’t mail a new Form 10-0426 for refills unless the original prescription’s refills have run out. Three ways to request one:

Online through My HealtheVet at myhealth.va.gov. Register and identify yourself as a CHAMPVA beneficiary; the Pharmacy feature then lets you refill and track prescriptions.⁶
Automated phone line at 888-370-1699, 24/7, with your full Social Security number and prescription number ready.⁷
Live representative on the Meds by Mail East line at 866-229-7389 or West line at 888-385-0235, Monday through Friday.⁷

When the last refill on a prescription runs out, you’re back to either mailing a fresh Form 10-0426 with a new original prescription or having your provider e-prescribe another one.

1
Veterans Affairs. Meds by Mail for CHAMPVA and Other Family Member Programs
2
Department of Veterans Affairs. VA Form 10-0426 Meds by Mail Order Form
3
eCFR. 38 CFR 17.270 – General Provisions and Definitions
4
Veterans Affairs. Prescription Medications Covered Through Meds by Mail
5
Veterans Affairs. VA Form 10-0426 – Meds by Mail Order Form
6
Connected Care. My HealtheVet Now Offers Meds by Mail Online Refills and Tracking
7
Veterans Affairs. Take Advantage of Your CHAMPVA Pharmacy Benefits