Wisconsin Medicaid covers the following list of over-the-counter (OTC) drugs under HealthCheck "Other Services." These drugs are covered when the recipient is under 21 years of age and a comprehensive HealthCheck screening has occurred within the last 365 days. These OTCs do not require prior authorization.

Note: This table includes Wisconsin Medicaid’s most current information and may be updated periodically.

Wisconsin Medicaid HealthCheck "Other Services" Covered Over-the-Counter Drugs

Antidiarrheals

Iron supplements

Lactase products

Laxatives

Multivitamins

Topical protectants

Attachment 1: Brand Medically Necessary Drugs That Require Prior Authorization
Attachment 2: Brand Medically Necessary Prior Authorization Documentation
Attachment 3: MedWatch Reporting Form (FDA Web site) (PDF, 53 KB)
Attachment 4: Specialized Transmission Approval Technology-Prior Authorization (STAT-PA) Drugs
Attachment 5: Drug Products Requiring Paper Prior Authorization
Attachment 6: Diagnosis-Restricted Drugs (Organized by Generic Drug Name)
Attachment 7: Diagnosis-Restricted Drugs (Organized by Diagnosis Code Description)
Attachment 8: Covered Over-the-Counter Drugs
Attachment 9: Noncovered Drugs
Attachment 10: Age- and Gender-Restricted Drugs
Attachment 12: Comparison of Wisconsin Medicaid and Wisconsin SeniorCare Policies
Attachment 13: Obsolete 1/1/05: STAT-PA Drug Worksheet for Brand Name Clozaril^® — Use Prior Authorization / Brand Medically Necessary Attachment (PA/BMNA) (fillable PDF, 225 KB)  | Instructions (PDF, 71 KB)

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