Virginia Medicaid OTC Benefits 2027: Allowances by Plan and How to Order

Reviewed November 1, 2026. Virginia Medicaid OTC benefits come from two places. Virginia Medicaid’s pharmacy benefit covers certain over-the-counter (OTC) drugs when a provider prescribes them, and some Cardinal Care health plans add an OTC allowance as an extra benefit. The largest general allowance we found is Humana Healthy Horizons in Virginia, at up to $65 a quarter per household in its 2026 value-added benefits.

Quick answer: Virginia Medicaid itself doesn’t issue an OTC card. Check your Cardinal Care health plan’s extra benefits: Humana lists a quarterly OTC allowance, Aetna Better Health lists monthly CVS OTC benefits for new moms and for menstrual care, Sentara lists quarterly allowances for feminine hygiene and incontinence products, and Anthem and UnitedHealthcare offer narrower product benefits. If you have Medicare and Medicaid, a 2027 dual plan (D-SNP) may include a much larger monthly OTC credit.

Does Virginia Medicaid cover over-the-counter items?

Yes, for some drugs. The Department of Medical Assistance Services (DMAS) Pharmacy Manual says “Virginia Medicaid covers certain FDA approved over-the-counter (OTC) drugs when used as therapeutic alternatives to more costly legend drugs.” Covered categories include pain relievers, antacids, antihistamines such as loratadine, laxatives and stool softeners, topical antifungals, iron, vitamins and minerals, contraceptives and naloxone. DMAS adds that “MCOs are required to carry the same categories.”

You need a prescription for these, and DMAS does not cover “Non-FDA approved OTC medications” or “Products used for cosmetic purposes.” Personal care items such as pads, diapers or first aid supplies are usually only available through a health plan’s extra benefits, which are described below.

Virginia Medicaid OTC benefits by health plan

Virginia’s Medicaid managed care program is called Cardinal Care Managed Care. DMAS lists five health plans: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons in Virginia, Sentara Health Plans (Sentara Community Plan) and UnitedHealthcare. These are the OTC-type extras each plan lists on its own site:

Extra benefits can change each year, and most plans don’t publish a plan year on these pages. Confirm the current amount with the plan before you switch for an OTC benefit.

Humana Healthy Horizons in Virginia OTC allowance

Humana’s $65 a quarter is the only general-purpose OTC allowance among Virginia’s Medicaid plans. It is per household, not per person, and it resets each quarter. Humana’s page doesn’t explain how to order, so call Member Services at 844-881-4484 (TTY 711), the number DMAS lists for Humana. For how Humana handles Medicaid OTC benefits in other states, see Humana Medicaid OTC benefits.

Sentara Community Plan OTC benefits

Sentara’s Medicaid plan doesn’t list a general OTC allowance or catalog. Its two product allowances work much like one, and unused dollars carry over within the year. Our Sentara Medicaid OTC benefits guide explains how to request them and Sentara’s other added benefits.

How to use an OTC benefit with Virginia Medicaid

1. Find your health plan. It’s on your Cardinal Care member ID card. If you aren’t sure you’re covered, see how to check your Medicaid status.
2. Read the plan’s extra-benefits page or member handbook. It tells you who qualifies, the amount and whether unused dollars roll over.
3. Order the way the plan says. Aetna’s benefits are used through CVS Health in store or for delivery. Humana and Sentara ask you to contact the plan.
4. Use it before it expires. Humana’s quarterly allowance doesn’t roll over, and Sentara’s balances expire at the end of the year.

For typical catalog items, see our list of what you can buy with an OTC card. Because Aetna uses CVS, our guide to CVS OTC benefits explains how ordering works there. For the general steps, see how to apply for an OTC card with Medicaid.

Can I change my Virginia Medicaid plan to get a better OTC benefit?

Sometimes. DMAS says “You can change your health plan in the first 90 days after you become a Cardinal Care Managed Care member.” After that, “you can only change your plan during open enrollment,” which happens once a year based on your region. Changes outside those windows need DMAS approval.

To compare or change plans, call the Cardinal Care Managed Care Helpline at 1-800-643-2273 (TTY 1-800-817-6608), Monday to Friday, 8:30 a.m. to 6 p.m., or visit VirginiaManagedCare.com. Our step-by-step guide on how to change your Medicaid plan in Virginia covers the details. An OTC allowance is only one factor, so make sure your doctors and pharmacy are in the new plan’s network.

If you have Medicare and Virginia Medicaid: 2027 dual plans

People with both Medicare and Medicaid can choose a Dual Eligible Special Needs Plan (D-SNP). These Medicare Advantage plans run on the calendar year and often include a monthly OTC credit that is much larger than a Medicaid allowance. Examples from the carriers’ own 2027 Summaries of Benefits:

You can compare 2027 plans during Medicare Open Enrollment, October 15 to December 7, 2026, and people with Medicaid may be able to change plans at other times under Medicare’s special enrollment rules. See Aetna OTC benefits, Humana OTC catalog and UnitedHealthcare OTC benefits for how each carrier’s card works.

Virginia Medicaid OTC phone numbers

Frequently asked questions

Does Virginia Medicaid give you an OTC card?

No. DMAS doesn’t issue an OTC card. Some Cardinal Care health plans add OTC benefits, such as Humana’s allowance of up to $65 a quarter per household. Others offer product-specific allowances.

Which Virginia Medicaid plan has the best OTC benefit?

For a general allowance, Humana Healthy Horizons in Virginia lists the most, up to $65 a quarter per household. Aetna’s CVS benefits and Sentara’s allowances are limited to specific products or members. Network and other benefits matter more for most people.

Does Virginia Medicaid cover Tylenol or allergy medicine?

Virginia Medicaid covers certain OTC pain relievers and antihistamines when a provider prescribes them as an alternative to a more costly prescription drug. Ask your pharmacist whether your product is covered.

Does FAMIS have OTC benefits?

FAMIS members get the pharmacy benefit through their health plan, but plans don’t always say which extra benefits apply to FAMIS. Ask your plan before you rely on an OTC allowance.

Can I get OTC benefits if I have Medicare and Medicaid in Virginia?

Yes, often through a D-SNP. For 2027, UnitedHealthcare Dual Complete VA-YL lists a $419 monthly OTC credit and Humana Dual Fully Integrated lists $350 a month.

For allowances in other states, see our Medicaid OTC benefits guide, Texas Medicaid OTC benefits and Florida Medicaid OTC benefits. Anthem members can also read Anthem OTC benefits.

This article is general information. Medicare365 is not affiliated with or endorsed by any Virginia Medicaid health plan, DMAS, Medicare or any U.S. government agency. Benefits vary by plan and program and can change; check your member handbook or call the number on your member ID card.

Sources

• DMAS: Cardinal Care members
• DMAS: Cardinal Care Managed Care (changing plans)
• DMAS bulletin: July 1, 2025 Cardinal Care Managed Care contract
• DMAS Pharmacy Manual, Chapter 4 (updated 3/4/2026)
• Cover Virginia: Health plans
• Humana Healthy Horizons in Virginia: Value-added benefits
• Aetna Better Health of Virginia: Extra benefits
• Sentara Health Plans: Medicaid added benefits
• Anthem HealthKeepers Plus: Extras
• UnitedHealthcare Community Plan: Virginia Cardinal Care extra benefits
• UnitedHealthcare Dual Complete VA-YL 2027 Summary of Benefits
• UnitedHealthcare Dual Complete VA-Y4 2027 Summary of Benefits
• Humana Dual Fully Integrated H2875-001 2027 Summary of Benefits
• Aetna Medicare FIDE H1610-001 2027 Summary of Benefits
• Sentara Community Complete 2027 Summary of Benefits