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
- Naloxone OTC
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 - English (PDF) / Spanish (PDF) for more information.
Coverage Resources:
Please use the following resources for coverage details: