Covered Over-the-Counter Products
In accordance with Federal Law, a prescription is required for coverage of these non-prescription products. To see a complete list of products in each group, click on the heading.
Antihistamines (Covered for members 0-20)
CETIRIZINE HCL ORAL 1 MG/ML SOLUTION
CETIRIZINE HCL ORAL 10 MG TABLET
CETIRIZINE HCL ORAL 5 MG TABLET
CETIRIZINE HCL ORAL 5 MG/5 ML SOLUTION
LORATADINE ORAL 10 MG TAB RAPDIS
LORATADINE ORAL 10 MG TABLET
LORATADINE ORAL 5 MG/5 ML SOLUTION
Calcium / Vitamin D
CALCIUM CARBONATE/VITAMIN D3 ORAL
Family Planning
CONDOMS, FEMALE
CONDOMS, LATEX, LUBRICATED
CONDOMS, LATEX, NON-LUBRICATED
CONDOMS, NON-LATEX, LUBRICATED
CONDOMS, NON-LATEX, NON-LUBRI
LEVONORGESTREL ORAL 1.5 MG TABLET (PLAN B)
NONOXYNOL 9 VAGINAL 1000 MG CON.SPONGE
NONOXYNOL 9 VAGINAL 12.5% FOAM/APPL
NONOXYNOL 9 VAGINAL 2.2 % JELLY
NONOXYNOL 9 VAGINAL 28 % FILM
NONOXYNOL 9 VAGINAL 3.5 % GEL/PF APP
Laxatives (Covered for members 0-20)
POLYETHLYENE GLYCOL (PEG-3350)
Lice Treatment (Covered for members 0-20)
PERMETHRIN TOPICAL 1 % LIQUID
PIPERONYL BUTOXIDE/PYRETHRINS (VANALICE)
Ophthalmic allergy (Covered for members 0-20)
KETOTIFEN FUMARATE OPHTHALMIC 0.025 % DROPS
Smoking Cessation
NICOTINE POLACRILEX BUCCAL 2 MG GUM
NICOTINE POLACRILEX BUCCAL 2 MG LOZENGE
NICOTINE POLACRILEX BUCCAL 4 MG GUM
NICOTINE POLACRILEX BUCCAL 4 MG LOZENGE
NICOTINE TRANSDERM 14MG/24HR PATCH TD24
NICOTINE TRANSDERM 21 MG/24HR PATCH TD24
NICOTINE TRANSDERM 21-14-7MG PATCH DYSQ
NICOTINE TRANSDERM 7MG/24HR PATCH TD24
Topical Anti-Fungal (Covered for members 0-20)
CLOTRIMAZOLE TOPICAL 1 % CREAM (G)
TERBINAFINE HCL TOPICAL 1 % CREAM (G)
TOLNAFTATE TOPICAL 1 % CREAM (G)
