Over the Counter Drug Coverage
The Office of MaineCare Services
(OMS) has changed which over the counter (OTC) products are covered by the
MaineCare, MaineCare Part-D, and DEL
pharmacy programs. Only OTC drugs listed as rebateable on the quarterly CMS
rebate file will be covered. It’s
important to note that the CMS rebate file does not include many store-brand
OTCs. A complete list of OTC drugs that will be covered after February 28th
is provided below and will be updated on a quarterly basis.
NOTE: OMS will only accept NDCs
for the processing of claims. The only exception to this rule will be for a
specific list of UPCs for DME (durable medical equipment) products, such as
insulin syringes, test strips or nutritional products, which do not have corresponding
NDCs. Claims submitted with UPCs for any other products will be rejected. (NOTE: UPCs are commonly
submitted with claims for OTC drugs.)
Please review the letter, below, for
more specific details and required actions on the part of providers. Links to
the current covered OTC list and SMACs are also provided.
OTC Lists and Information
(click column headers to sort)
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Rebatable OTC Drug List as of 12/18/09
242 kB
OTC Coverage Change - Provider Letter 2.01.2008
30 kB
MaineCare MAC List Effective 01.24.08
475 kB