Medicaid covers over the counter drugs (1page) that are medically necessary. Only generic versions of certain over the counter drugs are covered. An exception process is available to request non-covered over the counter drugs, and all cough and cold preparations.
EXCEPTION FORM
Over the Counter and Cough & Cold Preparations Exception Form
(1 page)
Medicaid does not pay for:
- OTC items to maintain comfort or treat discomfort
- Any items, both prescription and OTC, to treat coughs and colds
- Over the counter vitamins (Medicaid will cover prescription prenatal vitamins)
Non-Covered Medication Exceptions
Prescribers who have patients with unique clinical needs complete the exception form above, and submit it with the OTC or cough and cold prescription. This form will allow the pharmacist to fill the prescription and receive Medicaid reimbursement.
QUESTIONS & ANSWERS
1. Why isn't there a specific list of non-covered or excluded medications?
There are over 98,000 over the counter drug packages. The number of drugs is too large to list individually, thus Medicaid has provided a listing by therapeutic class of covered OTC drugs.
2. How can I tell which medications require an exception form?
Any OTC medication that is not on the Covered OTC Drug list will require an exception form. All cough and cold medications will require an exception form.
3. Who can I contact for more information?
- Prescribers who have questions about this information or have patients with unique clinical needs may call FHSC at:
(603) 224-2083.
- Recipients who have questions about this information may call Medicaid Client Services at: (800) 852-3345, ext. 4344.
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