Your insurance could soon cover these OTC products

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

HHS, along with several other federal agencies, recently asked health care providers and consumers for feedback on a proposal that would require health insurers to cover certain nonprescription preventive products, such as smoking cessation products. , non-prescription contraceptives, folic acid for pregnant people and breastfeeding supplies.

The Affordable Care Act requires insurers to cover preventive services, including certain 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 Hedging Matters, Especially Now

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

One of the main reasons for this demand is that several months ago, the Food and Drug Administration (FDA) approved the first-ever birth control pill that does not require a prescription. The drug, called Opill, is expected to be available in pharmacies and online early next year, according to Laurie Sobel, associate director of women’s health policy at health research group KFF.

Covering OTC products will not only save consumers money; This will also eliminate the need for a trip to the doctor to obtain a prescription. For people with limited access to health care or limited time to receive it, over-the-counter medications are especially important.

Kierra Jones, senior policy analyst for the Womens Initiative at the Center for American Progress, a think tank in Washington, D.C., called the request for information very encouraging. Jones told Verywell she believes HHS asked for feedback to try to understand the details and get input from communities that this could be transformative.

What’s next for coverage?

If the federal government ultimately requires insurers to cover over-the-counter preventative products, coverage could potentially extend to other products available without a prescription, such as cough and allergy medicines or over-the-counter pain relievers. (A spokesperson for AHIP, a policy and trade advocacy association that represents health insurers, told Verywell that they were not aware of HHS’s request for comment until Verywell contact and that at press time they had not responded to the HHS link sent by Verywell.)

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

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

Although people may sometimes think that over-the-counter products are less important than prescription ones, over-the-counter products of all kinds represent important products for U.S. consumers, said Vin Gupta, MD, Amazon’s chief medical officer. Pharmacy, in Verywell.

Take antibiotics for example. Although they can treat the underlying cause of a bacterial infection, over-the-counter products are important for treating other symptoms of an infection such as fever, pain, and cough.

Many effective allergy, pain reliever, cough, and cold products are sold only as over-the-counter products, without cost sharing or coverage from health insurers.

Americans quickly learned how much of 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 testing at home to detect COVID-19. While the U.S. government recently made four free tests available to all American households, the tests can cost $10 or more each, and people often have to test them multiple times to determine whether they have the virus or not.