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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

Name Description Date
Rebatable OTC Drug List as of 08/15/2020 401.92 KB 2020/10/16
Rebatable OTC Drug List as of 09/15/2020 401.92 KB 2020/10/16
Rebatable OTC Drug List as of 10/15/2020 400.22 KB 2020/10/16
Rebatable OTC Drug List as of 07/15/2020 396.61 KB 2020/08/20
Rebatable OTC Drug List as of 05/15/2020 437.13 KB 2020/06/16
Rebatable OTC Drug List as of 06/15/2020 441.54 KB 2020/06/16
Rebatable OTC Drug List as of 04/15/2020 442.51 KB 2020/04/20
Rebatable OTC Drug List as of 03/15/2020 444.19 KB 2020/04/20
Rebatable OTC Drug List as of 02/15/2020 448.02 KB 2020/02/26
Rebatable OTC Drug List as of 01/15/2020 446.3 KB 2020/01/16
Rebatable OTC Drug List as of 12/15/2019 458.58 KB 2019/12/23
Rebatable OTC Drug List as of 11/15/2019 453.6 KB 2019/11/15
Rebatable OTC Drug List as of 10/15/2019 452.89 KB 2019/10/29
Rebatable OTC Drug List as of 09/15/2019 454.39 KB 2019/10/01
Rebatable OTC Drug List as of 08/15/2019 452.4 KB 2019/08/31
Rebatable OTC Drug List as of 07/15/2019 446.89 KB 2019/07/18
Rebatable OTC Drug List as of 06/15/2019 442.68 KB 2019/06/24
Rebatable OTC Drug List as of 05/15/2019 443.97 KB 2019/05/20
Rebatable OTC Drug List as of 04/15/2019 444.18 KB 2019/04/18
Rebatable OTC Drug List as of 03/15/2019 441.25 KB 2019/03/29
Rebatable OTC Drug List as of 02/15/2019 439.03 KB 2019/02/15
Rebatable OTC Drug List as of 01/15/2019 428.19 KB 2019/01/15
Rebatable OTC Drug List as of 12/15/18 430.82 KB 2018/12/24
Rebatable OTC Drug List as of 11/15/18 425.74 KB 2018/11/29
Rebatable OTC Drug List as of 10/15/18 424.09 KB 2018/11/12
Rebatable OTC Drug List as of 8/30/18 427.87 KB 2018/09/21
Rebatable OTC Drug List as of 6/6/2018 155.69 KB 2018/06/15