7 OTC Product Categories Completely Covered by Insurance

DECEMBER 07, 2015
Katie Eder, Senior Editor
Did you know that health plans completely cover certain OTC products when patients present a prescription?
Under Affordable Care Act requirements, insurers must cover certain OTC preventive medications at 100% with no co-pays, co-insurance, or deductibles, but only when the patient obtains a prescription.
In addition, health care reform rules effective January 1, 2011, allow distributions from health flexible spending arrangements (FSAs) and health reimbursement arrangements (HRAs) to reimburse the cost of OTC medicines or drugs when they are purchased with a prescription. Eligible prescribed OTC expenses that Aetna FSAs may pay, for example, are OTC acid controllers, anti-diarrheals, cold sore remedies, sleep aids, painkillers, and respiratory treatments, among others.
To get these OTC expenses reimbursed from their employer’s health FSA or HRA, patients need to provide documentation such as a customer receipt issued by a pharmacy that reflects the date of sale and the amount of the charge, along with a copy of the prescription, according to the Internal Revenue Service.
To provide pharmacists with opportunities to add value to patient counseling by informing their patients of these potential medication cost savings, Plantsvszombies.info reached out to America’s largest health insurers to find out which OTC product categories they cover when the medicines are age-, gender-, and condition-appropriate and prescribed by a licensed health care professional for preventive care purposes.
The 7 OTC product categories where complete coverage overlaps across UnitedHealthcare, Anthem, Aetna, Cigna, and Humana are as follows: