Medicaid Benefits: Over-the-Counter Products

2018

Location	Benefit Covered	Copayment Required?	Limits on Services
United States	Yes - 42 No - 4 NR - 5	Yes - 27	Yes - 30
Alabama	Yes	$0-3.90 dependent on drug cost	Only selected OTCs covered as outlined in State Plan. Many edits: pdl/rx limit/max unit/clinical criteria/TD/ER/etc
Alaska	Yes	No	No
Arizona	Yes	$2.30 per prescription for beneficiaries with Transitional Medical Assistance	Only available in place of prescription drugs that are clinically appropriate and equally safe and less costly
Arkansas	Yes	$0.50 to $3.00 based on cost	up to 31 day supply per Rx and we have quantity limits
California	Yes	No	No
Colorado	Yes	$3 per prescription or refill	Each drug may be subject to utilization controls per the Preferred Drug List or Appendix P criteria.
Connecticut	Yes	No	Only approved OTC products found in Chap. 8.9 on the CMAP website (www.ctdssmap.com) will be eligible for reimbursement.
Delaware	Yes	$10 or less pay $.50; $10.01-$25 pay $1.00; $25.01-$50.00 pay $2.00; $50.01 or more pay $3.00 Never to pay > $15.00 in a month	when prescribed by physician
District of Columbia	Yes	$1.00/Rx	No
Florida	Yes	No	Day and Amount Limits may apply (Limited amount of products covered)
Georgia	No
Hawaii	Yes	No	Listed in the Hawaii Medicaid Drug Formulary.
Idaho	Yes	No	No
Illinois	NR	NR	NR
Indiana	Yes	$3 per prescription	Only OTC items on the OTC Drug Formulary. Age, Quantity and Step Therapy limits also apply.
Iowa	NR	NR	NR
Kansas	Yes	$3.00 per prescription	No
Kentucky	No
Louisiana	Yes	$0.50 -$3.00 based on ingredient cost with federally recognized exemptions. Additional copayment exemptions on USPSTF recommendations	30 or 90 day supply based on the agent prescribed and dispensed
Maine	Yes	No	Limited to specified products
Maryland	Yes	$1 for generic and preferred brand name drugs; $3 for other brand name drugs	Limited to prescribed federally-rebatable OTC products; prescriptions not required for condoms and certain contraceptives
Massachusetts	Yes	$1/selected OTC, $3.65/other specified OTC, up to a maximum of $250/year.	No
Michigan	Yes	$1 preferred drug/$3 non-preferred drug	Coverages defined in policy and Michigan Pharmaceutical Product List (MPPL).
Minnesota	Yes	$3 copay for non-preferred drugs, $1 copay for preferred drugs. Copays are limited to $12 per month. No copays are assessed for certain mental health drugs.	No
Mississippi	Yes	$3 per Rx	2 Brand/5 prescription limit per month
Missouri	Yes	$0.50-$2 based on ingredient cost	Limited list of covered over-the counter products.
Montana	Yes	$4 per prescription for preferred brand drugs; $8 per prescription for non-preferred brand drug	34 day limit
Nebraska	Yes	No	No
Nevada	NR	NR	NR
New Hampshire	Yes	$0, $1, and $2 dependent upon multiple factors: FPL, drug, if waiver recipient and preferred drug status	Limited OTC covered list
New Jersey	Yes	No	quantity limits
New Mexico	Yes	No	No
New York	NR	NR	NR
North Carolina	Yes	copay can vary based on Medicaid or Health Choice but usually copay is $3	OTC's covered include certain non-sedating antihistamines, certain GI meds (ex. Prilosec OTC), and certain smoking cessation products.
North Dakota	Yes	$3 per prescription fill for brand names only	Limited OTC coverage as outlined in pharmacy manual.
Ohio	Yes	Select Brands $2 copay; Drugs requiring prior authorization $3 copay	No
Oklahoma	Yes	No	Limited to Insulin, certain smoking cessation products, family planning products, prescription and non prescription products which do not meet the definition of outpatient covered drug, but are determined to be medically necessary.
Oregon	Yes	No	Requires a prescription from a physicians.
Pennsylvania	No
Rhode Island	Yes	No	Approved list. All not covered.
South Carolina	NR	NR	NR
South Dakota	Yes	$1/generic Rx, $3.30/brand Rx	Coverage restricted to non-sedating antihistamines and lice treatments
Tennessee	No
Texas	Yes	No	Non-preferred OTC drugs on the formulary require PA; drug utilization management policies applicable to some drugs
Utah	Yes	$4 per prescription	Limited to products listed in state plan
Vermont	Yes	$1-3 depending on cost	Generic OTC drugs covered with prescription when medically necessary without option of prior authorization for brand products; drug must be covered by federal rebate agreement; some OTC medications on state’s preferred drug list have additional restrictions; topical antiseptics and rubbing alcohol not covered
Virginia	Yes	$1 for brand, $3 for brand in FFS	No
Washington	Yes	No	Preferred drug list for some OTC, generics first; Some have quantity limits - Washington only covers some over the counter medications that are less costly alternatives to prescription medications.
West Virginia	Yes	Co pays based on the cost of the drug for adults:$0-$5.00=$0.00 $5.01-$10.00=$0.50 $10.01-$20.00=$1.00 $20.01-$50.00=$2.00 $50.01 and greater=$3.00 Out of Pocket Maximums Apply and are combined with medical copayment amounts Tier 1 (up to 50% FPL)-$8.00 Tier 2-(50.01-100%FPL)-$71.00 Tier 3-(100.01% and above)-$143.	NR
Wisconsin	Yes	OTC drugs and diabetic supplies are $0.50 for each prescription	Some items may require prior approval; restrict quantities/days supply; or monitor prescription refill limits
Wyoming	Yes	Yes, copay is $0.65 per prescription for generic drugs and $3.65 for brand name drugs; Client must have a prescription	Over the counter product coverage is limited to select OTCs; list of covered products can be found in the Over the Counter/Cough and Cold Drug Coverage list at www.wymedicaid.org

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Medicaid Benefits: Over-the-Counter Products

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Medicaid Benefits: Over-the-Counter Products

2018

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