Have you ever received prior authorization (PA) requests from the pharmacy for a common over-the-counter (OTC) medication for your Ohio Medicaid patients? This frustrating situation can occur because medication manufacturers must be enrolled in the Medicaid Drug Rebate Program for their products to be covered. Due to the large variety of manufacturers for over-the-counter medications, many may not be covered by Ohio Medicaid plans. To help navigate these situations, the Partners For Kids’ Pharmacy Team has created a list containing covered pediatric over-the-counter medications for patients insured by an Ohio Medicaid plan.  

If you receive a prior authorization for an over-the-counter medication, use this list to search for the prescribed medication, and share which NDC(s) are covered with the pharmacy.  The pharmacy will reprocess the prescription and receive a paid claim. Prior authorizations will be avoided, and your patient will receive the medication sooner!   

For any questions about PFK coverage resources, please contact PFKPharmacy@ChildrensDayton.org.