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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 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 Drun 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