"Dual Purpose" Items Requiring Doctor's Diagnosis and Recommendation
“Dual Purpose” OTC drugs are ones that are deemed to have both a medical purpose and a personal/cosmetic or general health purpose. OTC drugs on this list that will be reimbursed only with a doctor’s note stating that person has a specific medical condition and that the OTC drug/medicine is recommended to treat it and that the treatment is not for cosmetic purposes. In addition, the participant must still supply the proper substantiation.
- Acne Treatment (most skin care and acne treatment is NOT reimbursable
because it constitutes a cosmetic procedure. There is an exception
if the procedure is necessary to ameliorate a deformity arising
from, or directly related to, a congenital abnormality, a personal
injury resulting from an accident or trauma, or disfiguring disease”)
- Dietary Supplements or herbal medicines to treat a specific
medical condition in narrow circumstances
Example: Doctor tells you to take 1000 MG of vitamin B-12 daily to treat a specific vitamin deficiency or to take Vitamin B for Scurvy.
Dietary Supplements to improve and maintain general health are NOT reimbursable.
Prenatal vitamins
- Feminine hygiene products – Dr. prescribed
- Fiber Supplements under narrow circumstances
Not reimbursable if taken daily as a supplement to normal diets, but reimbursable if taken to treat a specific medical condition for a limited time.
- Glucosamine/chondroitin for arthritis or other medical condition.
St. John’s Wort for depression.
- Medicated Shampoos under narrow circumstances
Only if a doctor diagnoses the person as having a specific scalp infection (not just dry scalp or dandruff) and prescribes a special treatment to be applied for a limited period of time.
- Orthopedic Shoes and inserts (only the extra cost over buying
non-orthopedic shoes/boots can be reimbursed). The average cost
of non-orthopedic shoes will be considered to be $25 and non-orthopedic
boots will be $50.00.
- OTC hormone therapy and treatment for menopause to treat symptoms
such as hot flashes, night sweats, etc.
- Pills for persons who are lactose intolerant
- Sunscreen (must have present existence of a disease such as
skin cancer)
- Weight Loss Drugs to treat a specific disease