Medical Assistance Coverage of Over-the-Counter (OTC) Medications - A Factsheet for Consumers

Although the PA Code sets out the categories of OTC medications that can be covered, there is, unfortunately, no complete list of the names of OTC medications covered by Pennsylvania’s Medicaid program. [...] Are there requirements to be met before Medicaid will cover an OTC medication? Yes The following requirements have to be met for Medicaid to cover an OTC medication: 1. [...] The manufacturer of the OTC medication must participate in the Medicaid Drug Rebate Program, and 3. [...] Will Medicaid cover OTC medications for dual eligibles (people with both Medicare and Medicaid)? Yes Medicaid is always the payer of last resort, but it can and should cover OTC medications for dual eligibles. [...] What can people on Medicaid do to get their OTC medications? • People can show their Medicaid coverage ID cards at the pharmacy and ask the pharmacy to bill an OTC medication to their Medicaid coverage.