Member Services

Comprehensive List of Approved OTC items
List of Most commonly used OTC items 
OTC paper claim form (English, Spanish or Chinese)

At Healthfirst, we understand that not all medications and health-related items our members need are behind the pharmacy counter.  A daily health care regimen might include drugs and supplies available over-the-counter.  We also understand that accessing these over-the-counter (OTC) items may be difficult for lower-income Medicare beneficiaries. Because of this, Healthfirst is offering members of our Special Needs Plans (SNPs) a monthly benefit to use for certain eligible OTC items. Using your Healthfirst Easy OTC Card, you can get the everyday items that are not included with your Medicare Part B or Part D prescription drug coverage.

If you are a member of Healthfirst's Life Improvement (HMO) or Maximum Plan (HMO), you will receive a Healthfirst Easy OTC Card with a pre-funded monthly benefit allowance upon enrollment. With this allowance, you may purchase the everyday OTC and health-related items you need at any Express Scripts Inc. (ESI) network pharmacy. This includes items such as aspirin, cold & flu relief medications, and adhesive bandages.

To get your OTC items, you can either take your Healthfirst Easy OTC Card and the OTC item(s) you've selected to the pharmacy counter at any pharmacy in ESI's network or you can swipe the card at any cash register at certain locations.* The amount you spend will be automatically deducted from your monthly benefit allowance. Click hereor the links at the top of the page to view the lists of eligible OTC items you can purchase with your Healthfirst Easy OTC card. Please note that not all OTC items are eligible.

Dual-purpose items such as vitamins, minerals, supplements, diagnostic tools, (e.g., blood pressure monitors), hormone replacements, weight loss items, and items used to assist in weight loss can be purchased only after you discuss your need for them with your provider.  These dual-purpose items are available only for a specific diagnosable condition. Please refer to the grid below for some examples of dual purpose items, eligible items and non-eligible items. For a complete listing of eligible items please refer to the Healthfirst Easy OTC listings above.

If you forget to bring your Healthfirst Easy OTC Card with you to the pharmacy, you may also request reimbursement using a paper claim form. After paying for the OTC items, simply mail your completed paper claim form to us along with a copy of the receipt(s) for the eligible items you purchased. If you purchased any dual-purpose items, a prescription or note from your doctor should also be included with your paper claim form. We will then reimburse you for the eligible OTC items and deduct that amount from your Easy OTC account balance.

Please Remember:

• That OTC purchase(s) must be for your use only and cannot be used for family members or friends. Only you can use your Healthfirst Easy OTC card to buy items that are on the approved OTC listings.
• The Healthfirst OTC card is not a debit or credit card and cannot be converted to cash.
• Unused balances automatically roll over each month. However, any unused balances expire on December 31 of each year or if you leave the Life Improvement Plan (HMO) or the Maximum Plan (HMO) - even if you enroll into another Healthfirst Medicare Plan.
• The Healthfirst Easy OTC Card cannot be used to purchase Part B or Part D covered items.
• Dual purpose items require a discussion with your provider prior to purchase.

Eligibility table of OTC items

Footnotes:

1. Each item in the alphabetized OTC lists is either a medicine, ointment or spray, or a condition which is addressed by a medicine, ointment or spray: acid, acne, allergy, analgesics (which reduce pain, inflammation), anti-arthritics, antibiotics, antiradicals, anti-diarrheas, anti-fungals, anti-gas, anti-histamines, anti-inflammatory, anti-insect, anti-itch, anti-parasitic, antiseptics, antipyretics (fever reducing), arthritis, asthma, blood clotting, bruises, burns, calluses, corns, colds, cold sores, cough, diabetes, flu, decongestants, dermatitis, eczema, digestive aids, ear drops, expectorants (mucus), eye drops, gastro-intestinal, hay fever, headaches, hemorrhoidal, incontinence, influenza, laxatives, (medicated) lactose intolerance products, lice, (medicated) lip products, menopausal, menstrual, sinus, motion sickness, nasal, osteoporosis, pain, psoriasis, pediculicide, rash, respiratory scars, sleep, smoking, snoring, sore throat, stomach, travel sickness, steroids, sunscreen, thrush, warts, worms, wounds, etc.

2. The following are not eligible: Baby medicines, contraceptives, dehydration drinks, dry skin lotions (e.g. Eucerin, Aquaphor), hair-loss products, Lactaid milk (because it is a food not a medicine), and shampoos to fight dandruff. Certain smoking cessation may be Part B. Certain diabetic supplies may be Part B or Part D. For the status of food supplements, see Table above.

3. Antiperspirants, chap stick, deodorants, facial cleansers, feminine products, grooming devices, hair conditioners, hair removal, hair bleaches, moisturizers, perfumes, shampoos, shaving and men’s grooming, and soaps.

If you have questions about the use and limitations of your Healthfirst Easy OTC Card, please call Member Services at 1-888-260-1010 or TDD/TTY: 1-800-662-1220 (for the hearing or speech impaired) Monday through Sunday from 8 am to 8 pm. If you wish to confirm whether your local pharmacy participates, please call Express Scripts (ESI) at 1-800-214-3559 or TDD/TTY 1-800-899-2114, 24 hours per day, 7 days a week.

*The swipe card solution is currently available at Rite Aid stores. It may be available at other pharmacy locations in the future.  Please check back often for updates and remember that you can still use the Healthfirst Easy OTC card at the pharmacy counter of any ESI network pharmacy. 

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