Maximizing Patient Care with OTC Benefits in Medicare Advantage

Most Medicare Advantage (MA) plans, also known as Medicare Part C, in addition to offering Medicare Parts A, B, and sometimes prescription drug coverage, also provide over-the-counter (OTC) benefits. These OTC benefits are usually offered monthly or quarterly and include drugs and health-related items such as antacids, decongestants, antihistamines, antibacterial ointment, thermometers, sleep aids, elastic knee supports, toothbrushes, toothpaste, and gum stimulators. They may also include dual-purpose items such as natural progesterone, appetite suppressants, and fat absorption inhibitors, etc. Plans often provide an OTC catalog that lists covered items. The quantity and types of products covered, as well as policies on whether unused benefits can be carried over to the next month or quarter, differ by plan.

Understanding and using the MA OTC benefits can save patients money and help them stay healthier. As pharmacists, you can inform your patients about these OTC benefits, help them determine whether their MA plan offers them, review the catalog with them to identify products that meet their needs, and explain the policies surrounding the OTC benefit.

To learn more about MA plans and OTC benefits, you can take our free continuing education course at https://aub.ethosce.com/content/navigating-medicare-advantage-plans-maximizing-plan-utilization-better-health-outcomes#group-tabs-node-course-default5