OTC Preventive Services Coverage Rule: Withdrawn in 2025
Updated November 1, 2026. The federal proposal to make health plans cover over-the-counter (OTC) preventive items without a prescription was withdrawn. The Treasury, Labor and Health and Human Services departments (including CMS) proposed the rule, “Enhancing Coverage of Preventive Services Under the Affordable Care Act,” on October 28, 2024, and withdrew it effective January 15, 2025. The rule never took effect.
Quick answer: The withdrawn rule would have required private health plans to cover certain recommended OTC contraceptives “without requiring a prescription” and without cost sharing. It never took effect. Medicare Part D doesn’t cover OTC drugs at all, but many Medicare Advantage and Medicaid plans offer separate OTC allowances you can use for health products.
What the OTC preventive services proposal would have done
The agencies first asked for public comments on covering OTC preventive items in 2023, then published proposed rules in the Federal Register on October 28, 2024 (89 FR 85750). The proposal would have required group health plans and health insurance issuers to cover certain recommended over-the-counter contraceptive items “without requiring a prescription” and without cost sharing such as copays or deductibles.
The rule was aimed at employer and individual health plans under the Affordable Care Act. It wouldn’t have changed Medicare.
Why the proposal was withdrawn
In a Federal Register notice published January 15, 2025, the agencies said they decided to “withdraw the proposed rules at this time, focusing instead on other matters,” and noted that they may propose new rules in the future. The withdrawal took effect that day.
Does Medicare cover over-the-counter products?
Not through Part D. CMS states that “OTC drugs are excluded from Medicare Part D coverage per section 1860D-2(e)(2)(A) of the Social Security Act.” A Part D plan may still give certain OTC drugs at no cost as part of a utilization management program, such as step therapy, but those aren’t a regular benefit you can shop with.
Where people with Medicare do get OTC help is through Medicare Advantage extra benefits. Many plans include an OTC allowance or card for items like pain relievers, cold medicine, first aid supplies and vitamins. See:
- What are OTC benefits? The OTC card explained for 2027
- Medicare Advantage plans with OTC benefits for 2027
- What you can buy with an OTC card
Does Medicaid cover OTC items?
State Medicaid programs often cover certain OTC drugs when a provider prescribes them, and many Medicaid health plans add an OTC allowance. For example, Virginia Medicaid covers certain FDA-approved OTC drugs “when used as therapeutic alternatives to more costly legend drugs.” Read our Medicaid OTC benefits guide for plan allowances by state, including Virginia and Texas, and plan guides such as Sentara Medicaid OTC benefits.
Frequently asked questions
Do health plans have to cover OTC birth control without a prescription?
Not under federal rules. The 2024 proposal to require that was withdrawn on January 15, 2025. Some plans or states may cover more, so check your plan documents.
Did the OTC preventive services rule apply to Medicare?
No. It was written for private group and individual health plans under the Affordable Care Act.
Can I use a Medicare Advantage OTC card for preventive items?
Often, yes, for items in your plan’s OTC catalog, such as first aid supplies or vitamins. Benefits vary by plan, so check your plan’s 2027 Evidence of Coverage or catalog.
Will the rule come back?
The agencies said they may propose new rules later. Any new proposal would be published in the Federal Register and open for public comment first.
This article is general information. Medicare365 is not affiliated with or endorsed by CMS, Medicare or any U.S. government agency.