Microsoft word - fx-3969-120307 over-the-counter eligible expense listing.doc
Over-the-Counter (OTC) Drug Listing
Type of OTC Drug
Benadryl, Sudafed, Claritin, Alavert, Chlora Trimaton
Tums, Gas-X, Maalox, Mylanta, Pepcid AC, Prilosec OTC
Monistat 3, 7, Femstat 3, Gyne-Lotrimin, Vagistat-1
Benadryl, Sudafed, Actifed, Contac, Tylenol Cold, Nyquil,
Pepto-Bismol, Immodium AD, Ex-Lax, Correctol
Bactine, Cortaid, Lanacort, Benadryl Cream, Caladryl,
Mucinex, Robitussin, Vicks 44, Chloraseptic
Tylenol Cold and Flu, Advil Cold and Sinus, Tavist-D,
Thera-Flu, Alka Seltzer Cold and Flu, Sudafed, Nyquil,
Band-Aids, Bandage Tape, Gauze, Neosporin, Topical
Antibiotics, Rubbing Alcohol, Thermometers, Medical Gloves
Tylenol, Aleve, Advil, Excedrin, Bayer, Ecotrin, Children’s
Internal Analgesic/antipyretic (pain relief)
Motrin, St. Joseph’s Children’s Aspirin
Glucose Tester, Diabetic Supplies, Pregnancy Testing
Excedrin Migraine, Advil Migraine, Motrin Migraine
Compound W, Dr. Scholl’s Clear Away, Wartner
Dual Purpose OTC Drugs: The following items require a note from a health-care provider listing
the diagnosis and medical purpose for the item.
Anti-baldness/hair loss/hair replacement such as Rogaine, but only if to replace hair loss due to a
medical condition (i.e. cancel treatment) and not for balding due to age.
Fiber supplements such as Metamucil and Benefiber.
Glucosamine/chondtroitan for arthritis or other medical conditions (not reimbursable if taken for overall joint health).
Medicated shampoo to treat a specific medical condition such as psoriasis. Only the amount in excess of the cost of normal shampoo will be reimbursed.
Dental fluoride treatments or mouthwashes for the treatment of gingivitis or other oral medical conditions.
Herbal supplements use to treat a specific disease such as St. John’s Wort for depression.
Nose strips such as Breathe Right strips for proper breathing or other medical conditions.
Retin-Ad and other acne medications (not reimbursable if used for cosmetic purposes such as wrinkle reduction.)
Snoring cessation aids and medications such as Breathe Right Spray, Snorezz.
Sunscreen and sunblock as required for a medical condition.
Weight loss/dietary supplements if for a specific medical condition such as obesity.
Vitamins are generally not an eligible expense under the Plan unless they have been prescribed by a doctor to treat, rather than prevent, a medical condition you already have (i.e. anemia, osteoporosis).
How Do I Determine What Is Eligible?
The above listed name-brand medications are examples of types of medications that are eligible for
reimbursement. If you are unsure of the eligibility of an over-the-counter (OTC) medication ask yourself
the following question, “Is what I’m purchasing being used to treat
a medical condition?” If the answer to
that question is Yes the item is eligible. “Treat” is the key word in that sentence. If the answer to the
question is rather, “No… I’m purchasing this item to prevent a medical condition”, then the item is
Examples of items that are used to prevent a medical condition are: vitamins, herbal supplements, fiber
supplements, skin lotions and creams, shampoo, soap, lip balms, toothpaste, mouthwash, etc.
If you have additional questions concerning the eligibility of an over-the-counter item, please contact us
at [email protected]
2302 International Lane, Madison, WI 53704
1-800-422-4661 y [email protected]
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