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Title: Section 85.21 - Establishment of list of reimbursable, nonprescription drugs

Effective Date


85.21 Establishment of list of reimbursable, nonprescription drugs. Pursuant to section 365-a of the Social Services Law nonprescription drugs included in the therapeutic categories listed in this section may be reimbursed in the New York State Medical Assistance Program.

(a) Analgesic and Antipyretic

(1) Acetaminophen
(2) Acetylsalicylic Acid

(3) Ibuprofen

(b) Antacid

(c) Antivertigo (1) Dimenhydrinate

(d) Cough and Cold

(1) Phenylephrine Hydrochloride

(2) Guaifenesin and/or Decongestant and/or Antitussive

(3) Non-Narcotic Antitussants and/or Antihistamine
(4) Antihistamine and Decongestant

(5) Nonnarcotic Antitussants and/or Upper Respiratory Combinations of Antihistamines and Decongestants

(6) Decongestant

(7) Sodium Chloride nasal drops/spray

(e) Dermatological

(1) Bacitracin

(2) Neomycin
(3) Tolnaftate

(4) Aluminum Acetate
(5) Hydrocortisone

(f) Family Planning

(1) Contraceptive

(g) Fecal Softener and Laxatives

(1) Milk of Magnesia

(2) Heavy Mineral Oil

(3) Docusate, Calcium, Potassium or Sodium

(4) Bisacodyl

(5) Bulk Laxatives

(6) Barium Enema PrepKit

(7) Senna

(h) Hematinic

(1) Ferrous Sulfate

(2) Ferrous Gluconate

(i) Insulin

(j) Vitamin/Mineral

(1) ACD with or without iron
(2) Multi-vitamin with or without iron (3) Therapeutic Vitamins with or without Minerals

(4) Prenatal Vitamins, (5) Ascorbic Acid

(6) Calcium
(7) Pyridoxine Hydrochloride

(8) Vitamin D

(9) Thiamine Hydrochloride

(10) Magnesium (11) Nicotinic Acid

(k) Basic Aluminum Carbonate Products (only for persons with diagnosis of chronic renal disease)

(l) Ocular/Oral Lubricants

(1) Lubricant Ophthalmic

(2) Sodium Chloride Ophthalmic

(3) Artificial Tears

(4) Saliva Substitute

(m) Anti-Diarrheal Product

(1) Kaolin-Pectin Combination
(2) Attapulgite Suspension

(3) Loperamide HCl

(4) Polycarbophil

(n) Antihistamines

(o) Enzyme

(1) Pancreatic Tablets

(p) Pediculicide

(q) Emetic

(1) Ipecac Syrup (r) Smoking cessation.


VOLUME A-1a (Title 10)