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 first aid supplies and cold medicine through CVS. Please view our OTC Catalog (PDF) for more information.

Coverage Resources:

Please use the following resources for coverage details:

• Preferred Drug List (PDL)
• Clinical Coverage Policy 9A
• Pharmacy Clinical Coverage Criteria
• Drug Look-up Tool