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Over-the-Counter Drug Coverage

Take a copy to the pharmacy!

View entire Formulary (medication)

In addition to prescription benefits, all over-the-counter medications on this list are covered by MedStar Family Choice with a written or telephoned prescription. Refills are permitted. Prescriptions may be written for the State limited 12-month maximum. OTC products covered are restricted to generics when available. Brand names are provided as reference only.

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Generic Name Example of Brand Name
Antacids

aluminum hydroxide/magnesium hydroxide

Alamag

Antibacterial, Topical
benzoyl peroxide bar, crgm, gel, lotion 5% Panoxyl, Neutrogena Acne Mask
benzoyl peroxide bar, gel 10% Panoxyl

neomycin/bacitracin/polymixin B

Neosporin

Antifungals, Topical
clotrimazole Lotrimin AF

tolnaftate

Tinactin

Antifungals, Vaginal
clotrimazole

Gyne-Lotrimin

miconazole Monistat

Monistat

Antihistamines
diphenhydramine Benadryl

loratadine

Claritin

loratadine/pseudoephedrine ext-rel

Claritin-D

Anti-Inflammatories,Topical

hydrocortisone 0.5%, 1% crm, oint

Cortizone

Antilipemic Agents, Miscellaneous  
niacin caps 250 mg  
Contraceptives, Barrier
condoms Trojan

spermicide gel

Gynol II

 Contraceptives, Emergency

 

 levonorgestrel*

Plan B One-Step

 levonorgestrel - Next Choice* 

 

Cough/Cold/Allergy (OTC not covered for <4 yrs)
clemastine Tavist-1
guaifenesin syrup Robitussin
guaifenesin/dextromethorphan syrup Robitussin DM
pseudoephedrine drops PediaCare

pseudoephedrine tabs, syrup

Sudafed

sodium chloride solution

Ocean

Gastrointestinal

famotidine chewable tabs, tabs

Pepcid AC

meclizine chewable tabs 25 mg

 

omeprazole magnesium delayed-red

Prilosec OTC

ranitidine tabs 75 mg

Zantac 75

Laxatives 
bisacodyl Dulcolax

docusate sodium                                                        

Colace

glycerin rectal suppository

Glycerin Suppository-Adult

glycerin rectal suppository

Glycerin Suppository-Pediatric

magnesium citrate

Magnesium Citrate

polyethylene glycol 3350

MiraLAX

sennosides 8.6 mg tablets

Senokot

sennosides 15 mg tablets

Ex-Lax
sennosides/docusate sodium Peri-Colace

sodium phosphate/sodium biphosphate enema soln

Fleet Enema-Adult

sodium phosphate/sodium biphosphate enema soln

Fleet Enema-Pediatric
Nutritional/Supplements 
calcium Tums

electrolyte rehydrating soln

Pedialyte
ferrous gluconate Fergon

ferrous sulfate

Feosol

multivitamins + iron

multivitamins + iron

omega-3 fatty acids/+vitamin E

Fish Oil
polysaccharide iron complex

vitamin B complex with C

Nephro-Vite
Pain & Fever

acetaminophen

Tylenol

aspirin 81 mg (not chewable)

Bayer

enteric coated aspirin

Ecotrin

ibuprofen

Motrin IB, Advil
naproxen sodium Aleve
Pediculocides

permethrin liquid

NIX Crème Rinse
Miscellaneous, Topical
ammonium lactate 12%
AmLactin

calamine lotion

Calamine

docosanol

Abreva

eucalyptus/menthol/compound rub

Vicks Vaporub
ketotifen   Zaditor
nicotine transdermal

salicylic acid gel 17%

 
salicylic acid pad 40%  

salicylic acid 17%/collodion

Duofilm

salicylic acid plaster 40%

 
tetracaine oint 0.5% Pontocaine

zinc oxide

Desitin

 

This page was last updated on 02/07/13

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