Over-the-Counter (OTC) Coverage
This medication coverage applies only to Gateway Health Plan® members for coverage, drugs must be written as a prescription.
Drugs are listed alphabetically by category. Specific OTC drugs are listed as examples and are not inclusive of all covered products.
Analgesic
Acetaminophen
Acetaminophen combination
Aspirin
Aspirin combination
Nonsteroidal anti-inflammatory agent
Salicylate
Dermatologicals/Topical Therapy
Acne (benzoyl peroxide)
Anesthetics (benzocaine, dibucaine, lidocaine,
cyclomethycaine, pramoxine, tetracaine)
Antibacterials (bacitracin, neomycin, triple
antibiotic preparation, povidone-iodine,
tetracycline)
Anti-inflammatory agents (hydrocortisone 1%)
Dermatological baths (colloidal oatmeal)
Fungicides (clotrimazole, miconazole, tolnaftate,
terbinafine, undecylenic acid, clioquinol,
salicyclic acid, triacetin)
Tar preparations (not including soaps and
cleansing agents)
Wet dressings (aluminum acetate)
Scabicides/pediculicide (permethrin, RID)
Endocrine/Diabetes
Insulin
Insulin needles and syringe
Diagnostic device
Diabetic supplies (lancets, alcohol swabs)
Gastroenterology
Antacid
Antidiarrheals (kaolin-pectin combinations,
loperamide)
Antiflatulents (simethicone)
Antinauseants (cyclizine, meclizine,
dimenhydrinate)
Laxatives and stool softener
Histamine-2 receptor antagonist
Prilosec OTC
Obstetrics & Gynecology
Contraceptives (condoms, contraceptive jellies)
Contraceptive device
Pregnancy Test Kits
Vaginal fungicide
Ophthalmic Preparation
Ocular lubricants (polyvinyl alcohol or cellulose
derivatives)
Decongestants (Naphcon, Visine)
Phenylephrine 0.12%
Sodium chloride
Respiratory, Allergy, Cough & Cold
Antihistamines (diphenhydramine, loratadine)
Bronchodilator
Cough and cold product
Nasal preparations (naphazoline, xylometazoline,
oxymetazoline, phenylephrine, saline)
Saline for inhalation
Smoking Cessation Product
Nicotine replacement
Vitamins, Hematinics & Electrolyte
Vitamin
Prenatal vitamin
Calcium salt
Iron products (not including long-acting products)
Nicotinic acid
Oral electrolyte mixture
Medical Supplies
Please check with Gateway Health Plan® for coverage
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