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What documentation do I need to submit for reimbursement of eligible OTC drugs and medicines?


All OTC medicines/drugs (excluding insulin) require a physician's prescription in order to be considered for reimbursement. The prescription must be legible and include the following information:

The date
The name of the patient for whom the OTC medicine is prescribed
The name of the OTC medicine
The dosage requirement (the potency of the item must match the prescribed amount)
The number of refills
The provider's address

A Letter of Medical Necessity (LMN) will not be accepted in place of a physician's prescription.

Along with the prescription, include your completed and signed claim form. Your signature on the claim form certifies that you, your spouse, your dependent or adult child through age 26 will use the item purchased.

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