Overview of OTC Benefit

40.1 – Overview of OTC Benefit (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) MA plans may offer as a supplemental benefit health-related items and medications that are: available without a prescription, and are not covered by Medicare Part A, Part B or Part D. MA plans may never offer as a Part C supplemental benefit an OTC drug or item that also is covered under Part B or that is paid for under Part D for the plan’s enrollees. OTC drugs and items that are eligible to be included in a Part C supplemental benefit must meet our criteria for qualification as a supplemental benefit in section 30 of this chapter. Detailed information about OTC drugs paid for under Part D may be found in Chapters 5 and 7 of the Medicare Prescription Benefit Manual, Pub 100-18. Under Part C, MA plans may cover health-related OTC items such as adhesive or elastic bandages, and OTC drugs such as antihistamines and analgesics, that meet the criteria as eligible supplemental benefits under Part C, presented in section 30.1 above. Medical supplies associated with the administration of insulin, (e.g., alcohol wipes and syringes) must be paid for under Part D and are not eligible to be covered as a supplemental benefit. Since items and drugs that may be covered by the MA plan as supplemental benefits are for the enrollee, OTC items may be purchased for the enrollee only.