Your Insurance May Soon Cover These OTC Products

While health insurance companies don’t currently cover over-the-counter products, a new proposal from the U.S. Department of Health and Human Services (HHS) is working to change that.

HHS, along with several other federal agencies, recently asked healthcare providers and consumers to provide comments on a proposal that would require health insurers to cover some preventive non-prescription items, such as smoking cessation products, non-prescription birth control, folic acid for pregnant people, and breastfeeding supplies.

The Affordable Care Act requires insurers to cover preventive services, including specific types of birth control, but only if they are prescribed.

“We know that making preventive care available over the counter can improve access—but there may still be cost barriers,” HHS Secretary Xavier Becerra said in a statement.

Why OTC Coverage Matters, Especially Now

While health insurers generally pay for at least some of the cost of prescription products, very few other than Medicaid and some Medicare comprehensive care plans pay for over-the-counter (OTC) items.

A key reason for the request is that several months ago, the Food and Drug Administration (FDA) approved the very first birth control pill that doesn’t require a prescription. The drug, called Opill, is expected to be available in pharmacies and online by early next year, according to Laurie Sobel, associate director for Women’s Health Policy at health research group KFF.

Coverage for OTC products won’t only save consumers money; it will also eliminate the need for a doctor’s visit to get a prescription. For people with limited access to or time for health care, non-prescription medication is especially important.

Kierra Jones, a senior policy analyst for the Women’s Initiative at the Center for American Progress, a think tank in Washington, DC, called the request for information “really encouraging.” Jones told Verywell she thinks that HHS has asked for comments “to try to figure out the nuts and bolts and to get input from communities that this could be transformative for.”

What’s Next For Coverage?

If the federal government does ultimately require insurers to cover preventive OTC products, coverage could potentially expand to other products available without prescription, like cough and allergy medications or non-prescription pain relievers. (A spokesperson for AHIP, a political advocacy and trade association that represents health insurers, told Verywell that they were unaware of the HHS request for comment until Verywell reached out and at press time had not replied to the HHS link that Verywell sent.)

Logan Tucker, a spokesperson for the Consumer Healthcare Products Association (CHPA), which represents manufacturers and distributors of OTC drugs, supplements, and medical devices, told Verywell that “CHPA is evaluating the request for information carefully with our member companies.”

Tucker said that on average, U.S. households spend about $645 annually on OTC products.

While people may sometimes think of non-prescription products as less significant than prescription ones, “OTC products of all kinds represent important products for American consumers,” Vin Gupta, MD, chief medical officer of Amazon Pharmacy, told Verywell.

Take antibiotics, for example. While they can treat the underlying cause of a bacterial infection, products that are sold over the counter are important for treating other symptoms of an infection such as fever, aches, and coughs.

Many effective allergy, pain relief, and cough and cold products are sold only as non-prescription products, without cost sharing or coverage from health insurers.

Americans quickly learned what a dent OTC products can make in their pocket when the COVID-19 public health emergency ended last May, and insurers were no longer required to cover at-home tests to detect COVID-19. While the U.S. government recently made four tests available for free for all U.S. households, tests can cost $10 or more each, and people often need to test several times to determine if they have the virus or not.