Medicaid Cough and Cold Quick List

Medicaid Cough and Cold Quick List

Medicaid covers these over-the-counter (OTC) drugs pursuant to a written/verbal/electronic prescription This list is subject to revision

1st Generation Antihistamines and

Combinations

2nd Generation Antihistamine Combinations

Class

Generic

Strength

Common Brand Names

Brompheniramine/Phenylephrine Brompheniramine/Phenylephrine/ DM Brompheniramine/ Pseudoephedrine Brompheniramine/ Pseudoephedrine/ DM Chlorpheniramine Clemastine Fumarate Diphenhydramine Triprolidine/ Pseudoephedrine

Cetirizine

1-2.5mg/ 5mL 1-2.5-5mg/ 5mL 1-15mg/5mL 1-15-5mg/ 5mL 2mg/5mL, 4mg 1.34mg 12.5mg/5mL,25mg, 50mg 1.25-30mg/ 5mL, 2.5-60mg

1mg/mL, 5mg, 10mg

Dimetapp Cold & Allergy Elixir Dimetapp DM Cold & Cough Elixir Q-Tapp Q-Tapp DM Aller-Chlor Syrup, Tabs Tavist Benadryl Aprodine

Zyrtec

Dosage Form

Liquid Liquid Liquid Liquid Syrup, Tablets Tablet Capsule, Elixir, Liquid, Solution Syrup, Tablet Chewable Tab, Tablets, Syrup

Age

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