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US · guidance

CMS Pub. 100-16, ch. 4, § 40.2

Access to OTC Benefits

activein force · 2026-08-25 – presentas-observed

The OTC drugs and/or items offered, regardless of how they are packaged or paid for,

must be available at a wide variety of retail outlets or through a mail order catalog. The

MA plan must ensure that the retail outlets through which enrollees may obtain the

covered OTC items are distributed within the service area to ensure that the benefit is

uniformly offered and that all enrollees have access to the benefit. An MA plan that

contracts with a single mail order company to provide OTC items has fulfilled its

obligation of providing uniform and sufficient access to the OTC benefit.

An MA plan’s catalog for OTC may consist of an actual paper catalog that displays

covered OTC drugs and/or items, a list on a website, or a simple order form. Enrollees

may place their orders either through a secure website, mail, or a toll-free number. The

OTC catalog must contain: a list of all plan-covered OTC items and the price of each

item. The MA plan is responsible for the cost of mailing. To avoid excessive mailing

costs, the MA plan may impose a minimum purchase amount per order.

History

(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
2e055ca3c92f3a926ddfe7b982a6b1063586b1c2db3ab131645d17b28e97234e
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