MassHealth Over-the-Counter Drug List
This page lists the only over-the-counter (OTC) drugs that are covered by MassHealth without prior authorization (PA). All other OTC drugs except insulins require PA. Please refer to 130 CMR 406.411(A) and 406.412(A)(2) for further information on OTC drugs.
Insulins that are available without PA are listed in the MassHealth Drug List. All insulins are covered for members at home, in nursing facilities, or in rest homes.
The items are listed alphabetically by therapeutic class, then by the generic name of the drug or drug ingredients. In general, MassHealth pays only for generic versions of these OTC drugs, singly or in combination, regardless of strength or dosage form. Combination products that contain active ingredients that are not included in this list require PA.
Notwithstanding the above, MassHealth may pay for a brand-name OTC product if that product meets the definition of medical necessity at 130 CMR 406.204. Any such product for which payment is permitted appears on this list by brand name.
Allergy Agents, Ophthalmic:
- Alaway (ketotifen)
- Naphcon-A (naphazoline/pheniramine)
- Opcon-A (naphazoline/pheniramine)
- Vasocon-A (naphazoline/atazoline)
- Visine-A (naphazoline/pheniramine)
Analgesics:
- acetaminophen
- aspirin
- aspirin with buffers
- capsaicin
- ibuprofen
- ketoprofen
- naproxen
Antihistamines/Decongestants:
- brompheniramine
- cetirizine syrup, tablet
- cetirizine tablet
- chlorpheniramine
- diphenhydramine
- loratadine
- pseudoephedrine < 240 mg/day
Antimicrobials, Topical:
- bacitracin
- chlorhexidine gluconate
- clotrimazole
- hydrogen peroxide
- iodine
- isopropyl alcohol
- miconazole
- neomycin
- polymixin B
- povidone
- tolnaftate
Contraceptives, Topical:
- nonoxynol-9
Gastrointestinal Products:
- aluminum carbonate
- aluminum hydroxide
- bisacodyl
- bismuth subsalicylate
- calcium carbonate
- casanthranol
- cimetidine
- cod liver oil
- Culturelle (lactobacillus rhamnosus GG) < 18 years
- docusate sodium
- famotidine
- glycerin
- kaolin/pectin
- loperamide
- magaldrate
- magnesium citrate
- magnesium hydroxide
- magnesium trisalicylate
- meclizine
- mineral oil
- psyllium
- ranitidine
- senna
- simethicone
- sodium bicarbonate
Vitamins and Nutrients:
- ascorbic acid
- calcium carbonate
- calcium citrate
- calcium glubionate
- calcium gluconate
- calcium phosphate
- cyanocobalamin
- electrolyte solution (pediatric)
- ferrous fumarate
- ferrous gluconate
- ferrous sulfate
- folic acid
- magnesium gluconate
- multivitamins, N.F.
- multivitamins with minerals
- niacin
- niacinamide
- nicotinic acid
- pediatric vitamins
- prenatal vitamins
- pyridoxine (vitamin B6)
- retinol (vitamin A)
- riboflavin
- thiamine
- vitamin B complex
- vitamin D
- vitamin E, oral
Miscellaneous Products:
- A&D ointment
- ammonium lactate 12%
- artificial tears
- benzoyl peroxide (under 21 years old)
- calamine lotion
- carbamide peroxide
- cherry syrup
- coenzyme Q10 < 18 years
- colloidal oatmeal
- Commit (nicotine) < 90 days/treatment regimen and < two treatment regimens/year
- hydrocortisone
- hydrophilic ointment
- lanolin
- nicotine – < 90 days/treatment regimen and < two treatment regimens/year
- Ora-Plus suspending vehicle
- Ora-Sweet-SF syrup
- Ora-Sweet oral syrup
- permethrin
- petrolatum
- piperonyl butoxide
- Plan B (levonorgestrel)
- Plan B One Step (levonorgestrel)
- potassium phosphate
- pyrethrum
- saliva substitute
- selenium sulfide
- simple syrup
- sodium chloride solution for inhalation
- sodium phosphate
- water for inhalation
- witch hazel
- zinc oxide
Nonlegend Drug List (PDF) download
Last updated 11/09/09
This information is provided by MassHealth.