While health insurance companies don’t currently cover over-the-counter products, a new proposal from the US Department of Health and Human Services (HHS) is working to change that.
HHS, along with several other federal agencies, recently asked health care providers and consumers to comment 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 women, and breastfeeding supplies.
The Affordable Care Act requires insurers to cover preventive services, including certain types of birth control, but only when prescribed.
“We know that making preventive care available over the counter can improve access – but there can still be cost barriers,” HHS Secretary Xavier Becerra said in a statement.
Why OTC coverage matters, especially now
While health insurers generally pay at least some of the cost of prescription drugs, few other than Medicaid and some comprehensive Medicare plans pay for over-the-counter (OTC) products.
A key reason for the request is that a few months ago, the Food and Drug Administration (FDA) approved the first-ever 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 the health research group KFF.
Coverage for OTC products won’t just save consumers money; it will also eliminate the need to visit a doctor to get a prescription. Over-the-counter medicines are particularly important for people with limited access to or time for health care.
Kierra Jones, 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 that she believes HHS has asked for comments “to try to figure out the nuts and bolts and get input from communities for whom this could be transformative”.
What’s next for coverage?
If the federal government ultimately requires insurers to cover preventive OTC products, coverage could potentially expand to include other products available without a prescription, such as cough and allergy medicines or over-the-counter pain relievers. (A spokesperson for AHIP, a policy 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 had not responded to the HHS link sent by Verywell at press time).
Logan Tucker, a spokesman for the Consumer Healthcare Products Association (CHPA), which represents manufacturers and distributors of OTC drugs, dietary supplements and medical devices, told Verywell that “CHPA is carefully evaluating the request for information with our member companies.”
Tucker said the average US household spends about $645 a year on OTC products.
While people sometimes think of non-prescription products as less important than prescription ones, “OTC products of all kinds are important products for American consumers,” Dr Vin Gupta, chief medical officer of Amazon Pharmacy, told Verywell.
Take antibiotics, for example. While they can treat the underlying cause of a bacterial infection, OTC products are important for treating other symptoms of infection, such as fever, aches and coughs.
Many effective allergy, pain relief, and cough and cold products are sold only as OTC products, without cost sharing or coverage by health insurance.
Americans quickly learned what a dent OTC products can make in their pocketbooks when the COVID-19 public health emergency ended last May and insurers were no longer required to cover home tests to detect COVID-19. While the US government recently made four tests available free of charge to all US households, tests can cost $10 or more each, and people often need to be tested several times to determine whether they have the virus or not.
