Cough and cold combination products for children less than 2 years of age are not covered. This excludes single entity antihistamines. Other uses of cough and cold products for children less than 6 years of age are subject to clinical prior authorization. Products containing acetaminophen, ibuprofen, or narcotics for children less than 6 years of age are not covered.
Products require prior authorization if the product is not indicated for the person’s age. Products containing a narcotic will require prior authorization if a child is between 6 and 12 years of age.