The following over-the-counter (OTC) drugs require a legal prescription for Medicaid reimbursement. Coverage is limited to generic drugs for most covered OTC drugs, excluding insulin, ophthalmic lubricants, and contraceptives. Insulin is covered by Wisconsin SeniorCare; however, SeniorCare does not cover any additional OTC drugs.

Note: This table includes Wisconsin Medicaid’s most current information and may be updated periodically. Certain drugs listed in this table are registered or trademarked by the manufacturer.

Wisconsin Medicaid-Covered Over-the-Counter Drugs

Oral or Rectal Analgesics1

Antacids

Topical or Vaginal Antifungals

Antibiotic Ointments

Bismuth Subsalicylate

Capsaicin

Contraceptives

Cough Syrups2

Diphenhydramine

Ferrous Gluconate for pregnant women3

Ferrous Sulfate for pregnant women3

Topical Hydrocortisone Products

Insulin4

Lice Control Products

Loratadine

Loratadine with Pseudoephedrine

Meclizine

Ophthalmic Lubricants

Pinworm Treatment Products

Prilosec OTC™

Pseudoephedrine

Pyridoxine Tablets

Therapeutic Oral Electrolyte Replacement Solutions

1Limited to single entity aspirin, acetaminophen, and ibuprofen products only. These analgesics are included in the daily rate for nursing facility recipients.

2Covered cough syrups are limited to products for treatment of coughs only. Covered products include those containing a single component (e.g., terpin hydrate or guaifenesin), a single cough suppressant (e.g., codeine or dextromethorphan), or a combination of an expectorant and cough suppressant. Multiple ingredient cough/cold products are not covered.

3Ferrous Gluconate and Ferrous Sulfate are covered by Wisconsin Medicaid for a 60-day period beyond the end of pregnancy.

4Insulin is the only covered OTC product for Wisconsin SeniorCare participants.

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 9: Noncovered Drugs
Attachment 10: Age- and Gender-Restricted Drugs
Attachment 11: Covered Over-the-Counter Drugs for HealthCheck "Other Services"
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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