(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) Non-narcotic 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 Prep Kit
- (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 HCI
(4) Polycarbophil
(n) Antihistamine(s)
(o) Enzyme
(1) Pancreatic Tablets
(p) Pediculicide
(q) Emetic
(1) Ipecac Syrup
(r) Smoking Cessation
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.
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