Over-the-Counter Benefit

Carolina Complete Health offers two ways for members to access over-the-counter (OTC) medications:

Over-the-Counter Medications via the Outpatient Benefit

Carolina Complete Health covers certain over-the-counter medications at the pharmacy when a valid prescription is written by a Carolina Complete Health provider. Covered over-the-counter drugs must be manufactured by a company that has signed a National Medical Drug Rebate Agreement with the Centers for Medicare and Medicaid Services (CMS). These covered over-the-counter drugs include:

  • Preferred Drug List and Clinical Coverage Policy 9a Defined Agents:
    • Smoking deterrent agents (nicotine)
    • Proton pump inhibitors
    • Second generation antihistamines
    • Second generation antihistamine - decongestant combination products (quantity limits apply)
    • Insulin
    • Syringes
    • Test strips
    • Control solution
    • Lancets
    • Lancing Device
    • Pen Needles
    • Contraceptives, oral (levonorgestrel)
    • Cathartics and laxatives - limited to polyethylene glycol 3350

Over-the-Counter Medications via Value-Added Services

In addition to the over-the-counter medications covered at the pharmacy, Carolina Complete Health members also have access to our OTC Value-Added Service.

Through the program, member can order commonly used over-the-counter products up to a value of $30 per calendar quarter from our OTC catalog. These products include pain relievers, first aid supplies and cold medicine through HomeScripts. Please view our OTC Catalog (PDF) for more information.