Part D Plan Covers Over-the-Counter (OTC) Medications under the Utilization Management Program

SAS Name

This variable indicates whether or not the Part D plan pays for Over-the-Counter medications (OTCs) under its Utilization Management (UM) Program.


Plans that elect to cover OTC drugs as part of general drug utilization management or part of a step therapy protocol have identified the applicable drugs and they appear in the OTC Drug file (which is delivered as part of the Formulary File). When OTC_UM_PROGRAM='Y' then the over-the-counter drugs that appear in the OTC Drug File are allowed by the plan.

Source: CMS (HPMS Files)

Code Code value
Y Yes
N No