Washington, D.C.—Community pharmacies providing influenza vaccines to Department of Veterans Affairs (VA) beneficiaries face some added complications. As a result, the VA recently provided extra guidance on reimbursement for the no-cost flu shots to the more than 70,000 pharmacies and urgent care/walk-in locations in Virginia's community care network.
The VA advises that, to be eligible for this benefit, veterans must both be enrolled in the VA healthcare system and have received care through VA from either a VA or a community provider within the past 24 months.
The agency describes six steps that in-network retail pharmacies should follow:
1. Determine which Community Care Network (CCN) region you are part of:
a. Pharmacies located in the following states and/or territories: AL, AR, CT, DC, DE, FL,GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, PR, RI, SC, SD, TN, VA, VI, VT, WI, and WV are part of CCN Regions 1 through 3, administered by Optum/CVS Caremark and can contact Optum at 800-364-6331 to confirm in-network status.
b. Pharmacies in AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, TX, UT, WA, and WY are part of CCN Regions 4 and 5, administered by TriWest Healthcare Alliance/Express Scripts and can contact TriWest at 800-922-1557 to confirm in-network status.
2. Confirm the veteran’s identity by checking their government-issued ID.
3. Ascertain the veteran’s flu vaccine eligibility, which is paid for by VA.
a. After requesting their 10-digit Veteran ID number, verify their eligibility electronically.
b. If pharmacists cannot check their eligibility electronically, they can call the following numbers:
i. Optum at 888-901-6609 (Regions 1-3)
ii. TriWest at 833-483-8669 (Regions 4 and 5). The system will indicate urgent care eligibility, which includes receiving a flu vaccine.
c. If the veteran does not have or know their 10-digit Veteran ID number, pharmacists should use their Social Security Number (SSN) to confirm eligibility with Optum at 888-901-6609 (Regions 1-3), or TriWest at 833-483-8669 (Regions 4 and 5) to confirm eligibility. The system will indicate urgent care eligibility, which includes receiving a flu vaccine.
4. Enter the electronic billing information below according to the CCN region in which the pharmacy is located:
a. Regions 1 through 3 (Optum/CVS Caremark)
i. Step 1: Enter BIN: 004336.
ii. Step 2: Enter PCN: ADV.
iii. Step 3: Enter Rx Group: Flu Shot or COVID-19 Vaccine: Rx3841.
iv. Step 4: Enter Veteran ID: 10-digit Veteran ID or SSN.
v. Step 5: Enter Veteran’s date of birth (YYMMDD format).
vi. If you need help, call the CVS Caremark Pharmacy Help Desk at
800-364-6331 (24/7).
b. Regions 4 and 5 (TriWest/Express Scripts)
i. Step 1: Enter BIN: 003858.
ii. Step 2: Person Code: 01.
iii. Step 3: Enter PCN: A4.
iv. Step 4: Enter Rx Group: Flu Shot or COVID-19 Vaccine: VAPC3RX.
v. Step 5: Enter Veteran ID: 10-digit Veteran ID or SSN.
vi. Step 6: Enter Veteran’s date of birth (YYYYMMDD format).
vii. If you need help, call the Express Scripts Pharmacy Help Desk at
800-922-1557 (24/7).
5. Administer the flu vaccine.
6. Provide documentation of the flu vaccination:
a. Retail pharmacies should provide a copy of the flu vaccine documentation to the veteran and recommend they provide it to their VA primary care provider’s office.
The VA emphasizes that veterans should not be charged a fee or copayment for receiving the flu vaccine.
Pharmacists should be aware that, in recent years, the VA added coverage for the high-dose flu shot for veterans aged 65 years and older to its previous policy offering the standard-dose immunization for all veterans.
The high-dose vaccine contains four times the amount of inactivated viral protein or antigen included in the standard-dose injection. It is approved specifically for individuals aged 65 years and older because research has shown that immune response wanes as people age.
The higher level of antigen stimulates a stronger immune response and produces a greater protection against future infection. This is particularly important for older patients as they account for 70% to 80% of flu-related deaths and 50% to 70% of hospitalizations related to influenza.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
