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Medical Assistance (Medicaid) Over-the-Counter (OTC) Medication Coverage

This medication coverage applies only to Gateway HealthSM members for coverage, drugs must be written as a prescription.

Drugs are listed alphabetically by category. Specific OTC drugs are listed as examples and are not inclusive of all covered products.

 

Analgesic

Acetaminophen
Acetaminophen combination
Aspirin
Aspirin combination
Nonsteroidal anti-inflammatory agent
Salicylate

 

Dermatologicals/Topical Therapy

Acne (benzoyl peroxide)
Anesthetics (benzocaine, dibucaine, lidocaine, cyclomethycaine, pramoxine, tetracaine)
Antibacterials (bacitracin, neomycin, triple antibiotic preparation, povidone-iodine, tetracycline)
Anti-inflammatory agents (hydrocortisone 1%)
Dermatological baths (colloidal oatmeal)
Fungicides (clotrimazole, miconazole, tolnaftate, terbinafine, undecylenic acid, clioquinol, salicyclic acid, triacetin)
Tar preparations (not including soaps and cleansing agents)
Wet dressings (aluminum acetate)
Scabicides/pediculicide (permethrin, RID)

 

Endocrine/Diabetes

Insulin
Insulin needles and syringe
Diagnostic device
Diabetic supplies (FreeStyle and Precision Xtra® products), lancets, strips, alcohol swabs

 

Gastroenterology

Antacid
Antidiarrheals (kaolin-pectin combinations, loperamide)
Antiflatulents (simethicone)
Antinauseants (cyclizine, meclizine, dimenhydrinate)
Laxatives and stool softeners (Miralax, Milk of Magnesia, bisocodyl, docusate)
Histamine-2 receptor antagonist
Prilosec OTC

 

Obstetrics & Gynecology

Contraceptives (condoms, contraceptive jellies)
Contraceptive device
Pregnancy Test Kits
Vaginal fungicide

 

Ophthalmic Preparation

Antihistamine (Alaway, Zaditor)
Ocular lubricants (polyvinyl alcohol or cellulose derivatives)
Decongestants (Naphcon, Visine)
Phenylephrine 0.12%
Sodium chloride

 

Respiratory, Allergy, Cough & Cold

Antihistamines (diphenhydramine, loratadine)
Bronchodilator
Cough and cold products (for MA recipients under 21 years of age; prior authorization required for children less than 4 years of age)
Nasal preparations (naphazoline, xylometazoline,
oxymetazoline, phenylephrine, saline)
Saline for inhalation

 

Smoking Cessation Product

Nicotine replacement

 

Vitamins, Hematinics & Electrolyte

Vitamin
Prenatal vitamin
Calcium salt
Iron products (not including long-acting products)
Nicotinic acid
Oral electrolyte mixture

 

Medical Supplies

Please check with Gateway HealthSM for coverage.