US · guidance
CMS Pub. 100-16, ch. 4, § 40.2
Access to OTC Benefits
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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