Over-the-Counter Drug Catalog

Transcription

1 icare Family Care Partnership HMO SNP Over-the-Counter Drug Catalog 2016 As an icare Partnership member, each month you can receive Over-the- Counter (OTC) medications and health-related products shipped to your home at NO COST TO YOU H2237_IC1146 CMS Accepted

2 HOW DOES IT WORK? As an icare Family Care Partnership member, you now have an easy way to get OTC medications and other health-related products at no cost to you! This benefit applies to a selected group of over-the-counter medicines, support items and first-aid supplies. The items in this catalog are only a partial listing of what is available to you. Please visit for a complete listing. Simply place your order over the phone or through the website and your items will be shipped to your home FREE of charge. Order OTC Medications and health-related products each month, delivered to your home free of charge! You may only place one order each month, but you can purchase multiple items in each order. This benefit is only available as a mail-order program. OTC medications under this benefit may only be ordered from Drug Source, Inc. This program is not available at any other pharmacy or mail-order facility. The OTC benefit is not related to your Part D prescription drug benefit if you have Medicare. Because you have Medicaid, you also have access to other OTC benefits with a doctor prescription. If you have an on-going medical need for any of these OTC products, you should discuss this with your Care Team.

3 HOW DO I PLACE AN ORDER? You can order your OTC items by phone or on the website. 1 To order by phone: Call DrugSource, Inc. at (TTY: ) from 8:30 am - 10:00 pm CST Monday through Friday. Let the customer service representative know you are an icare Family Care Partnership Plan member, so they can verify your monthly benefit. Please be ready with your icare Family Care Partnership number and your date of birth. Then, simply order the items you wish to purchase. 2 To order online: 1) Log onto your account at 2) Choose the items you wish to purchase and click Add to Cart. 3) At the top right of the screen, click Checkout. You may adjust your purchases by removing an item or placing a different quantity into the box. 4) Click Check Out Now. Please take a minute to create your customer profile. The profile will allow you to review past purchases and keep your personal information on file for future orders. 5) Click Continue. 6) Review your order and click Finish.

4 WHAT KIND OF ITEMS CAN I ORDER? The following is the Medicare OTC listing of categories available to you in our OTC program: Fiber supplements First-aid supplies Incontinence supplies Medicines, ointments and sprays with active medical ingredients that cure, diminish or remove symptoms Sunscreen lotion Support items Teeth-related or denture-related items Vitamins & minerals Diagnostic equipment Hormone replacement Weight loss items Alternative medicines Baby items Contraceptives Convenience (non-medical) items Cosmetics Food supplements Replacement items, attachments, peripherals ELIGIBLE OTC ITEMS DUAL- PURPOSE* NON- ELIGIBLE ITEMS** * Certain OTC products are considered dual-purpose like vitamins and minerals. You should only order these products after discussing them with your healthcare provider to see if s/he recommends the item for a specific condition. ** Non-eligible items, if purchased, will not be covered by the plan. The items in this catalog are only a partial listing of what is available to you. Please visit for a complete listing OR call

5 ATTENTION As an icare Partnership member you have access to OTC items above and beyond what is listed in this catalog. It is your choice to order items in this catalog without a prescription or to obtain a prescription that is covered by icare Partnership. With Partnership you have coverage for a broad range of items and services needed to meet your individual outcomes. Our catalog offers a range of popular and common items that are easy to obtain, but you can also obtain items not listed, simply call your Care Team or Customer Service at , 24 hours-a-day/7 days-a-week (office hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.). TTY users should call

6 CLARITIN ALLERGY 24 HOUR 10MG 30 count. Temporarily relieves these symptoms: runny nose; itchy, watery eyes; sneezing; itching of the nose or throat. Non-drowsy (when taken as directed). Indoor and outdoor allergies. $31.00 LORATADINE 10MG TABLETS 30 count. Generic for Claritin. Temporarily relieves runny nose; itchy, watery eyes; sneezing; itching of the nose or throat. Non-drowsy. COLD, COUGH, & ALLERGY $4.00 ZYRTEC ALLERGY 10MG TABLETS 30 tablets. Temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: runny nose; sneezing; itchy, watery eyes; itching of the nose or throat. Indoor and outdoor allergies. $27.00 CETIRIZINE 10MG TABLETS 30 tablets. Generic for Zyrtec 10mg tablets. Temporarily relieves these symptoms: runny nose; sneezing; itchy, watery eyes; itching of the nose or throat. Indoor & outdoor allergies. $

7 COLD, COUGH, & ALLERGY VICKS VAPO RUB 1.76 oz. On chest and throat, relieves cough from the common cold. On muscles and joints, relieves minor aches and pains. $6.00 MEDICATED CHEST RUB 3.53 oz. Generic for Vicks Vapo Rub. Available in Menthol $4.00 CHLORASEPTIC SORE THROAT SPRAY 6 oz. For temporary relief of occasional minor irritation, pain, sore mouth or sore throat. Alcohol, aspirin and sugar-free. $6.50 ALKA-SELTZER PLUS COLD FORMULA EFFERVESCENT TABLETS 36 tablets. Temporarily relieves minor aches and pains, headache, runny nose, congestion and fever due to a cold. 5 $10.00

8 ROBITUSSIN DM PEAK COLD COUGH/CONGESTION 4 oz. Temporarily relieves cough due to minor throat and bronchial irritation as may occur with a cold. Helps loosen phlegm (mucus). Non-drowsy. COLD, COUGH, & ALLERGY $7.00 TUSSIN COUGH SYRUP 4 oz. Generic for Robitussin cough syrup. $4.00 TUSSIN DM SUGAR FREE COUGH SYRUP 4 oz. $4.00 AFRIN NASAL SPRAY ORIGINAL 0.5 oz. Temporarily relieves nasal congestion due to: common cold, hay fever, upper respiratory allergies. Temporarily relieves sinus congestion and pressure. $7.50 NASAL SPRAY 1oz. Generic for Afrin nasal spray. Temporary relief of nasal congestion due to the common cold; due to hay fever or other upper respiratory allergies; or nasal congestion associated with sinusitis. Reduces swelling of nasal passages. $6.50 6

9 COLD, COUGH, & ALLERGY VICKS DAYQUIL LIQUID CAPSULES 24 count. Temporarily relieves these common cold/flu symptoms: nasal congestion, cough due to minor throat and bronchial irritation, sore throat, headache, minor aches and pains, fever. Non-drowsy. $12.00 OCEAN NASAL SPRAY 1.5 oz. For dry nasal membranes. $5.00 CORICIDIN HBP CHEST CONGESTION & COUGH 20 count. Temporarily relieves cough due to minor throat and bronchial irritation as may occur with a cold. Decongestantfree cold relief for people with high blood pressure. $7.50 VICKS NYQUIL LIQUID 8 oz. Temporarily relieves common cold/ flu symptoms, cough due to minor throat and bronchial irritation, sore throat, headache, minor aches and pains, fever, runny nose and sneezing. Alcohol 10%. 7 $10.00

10 COLD, COUGH, & ALLERGY VICKS NYQUIL LIQUID CAPSULES 24 count. Temporarily relieves common cold/flu symptoms: cough due to minor throat and bronchial irritation; sore throat; headache; minor aches and pains; fever; runny nose and sneezing. $12.00 MUCINEX DM MAXIMUM STRENGTH 14 count. Helps loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus and make coughs more productive. 12 hour. Extended-release bi-layer tablets. MUCUS RELIEF TABLETS 60 count. Generic for Mucinex. $16.50 NEW ADDITION! PURELL HAND SANITIZER 8 oz. For handwashing to decrease bacteria on the skin. Kills 99.99% of germs. $5.00 $4.50 8

11 COLD, COUGH, & ALLERGY HALLS DEFENSE VITAMIN C DROPS WATERMELON 30 pieces. Delivers 100% of the daily value of Vitamin C. Also available from HALLS Defense are Assorted Citrus and Strawberry. $3.00 HALLS HONEY LEMON COUGH DROPS 30 pieces. Temporarily relieves cough, minor irritation or sore throat. Advanced Vapor Action. Fast relief. Also in Cherry. $3.00 COUGH DROPS HONEY LEMON 30 pieces. Generic for Halls. Also available in Cherry and Sugar Free Black Cherry. $2.00 HALLS DEFENSE ZINC DROPS HARVEST CHERRY 25 pieces. Halls Defense Zinc with Vitamin C and Echinacea. 9 $3.00

12 DIABETIDERM FOOT REJUVENATING CREAM 4.0 oz. DiabetiDerm contains the breakthrough ingredient L-Arginine which increases blood flow to help promote healthy circulation. Podiatrist recommended. $13.00 TRIDERMA MD DIABETIC FOOT HEALING CREAM 4.2 oz. Helps prevent and temporarily protect chafed, chapped, cracked skin. Provides relief for itching. DIABETES CARE $10.00 DIABETIC HEALING SKIN CREAM 4 oz. Helps prevent and protects chafed, chapped, cracked or wind burned skin. Increases circulation and speeds healing. $11.00 DEX4 GLUCOSE TABLETS RASPBERRY 50 tablets. Raises low blood sugar fast and boosts energy. Fat-free. Gluten-free. No sodium. No caffeine. $

13 ANTI-ITCH NEW ADDITION! CALAMINE LOTION 6 oz. Generic for Caladryl. Relieves pain, itching, and discomfort from minor skin irritations such as poison ivy, poison oak, and poison sumac. It also helps to dry the oozing and weeping caused by these plants. $4.00 HYDROCORTISONE CREAM + ALOE 1% MAXIUM STRENGTH 1 oz. Generic for Cortaid. 11 $4.00 BENADRYL EXTRA STRENGTH ITCH STOPPING 2% CREAM 1 oz. Temporarily relieves pain and itching due to insect bites, minor burns, sunburn, minor skin irritations and cuts, scrapes, rashes due to poison ivy, oak, and or sumac. Dries oozing and weeping of poison ivy, oak, or sumac. $6.00 BENADRYL REGULAR STRENGTH ITCH RELIEF 1% CREAM 1 oz. Temporarily relieves pain and itching due to insect bites, minor burns, sunburn, minor skin irritations and cuts, scrapes, rashes due to poison ivy, oak, and or sumac. Dries oozing and weeping of poison ivy, oak, or sumac. $5.50

14 DIPHENHYDRAMINE CREAM 2% 1 oz. Generic for Benadryl Cream. ANTI-ITCH $4.50 CORTAID ANTI-ITCH MAXIMUM STRENGTH CREAM 1% 1 oz. Temporarily relieves itching due to minor skin irritations, inflammation, and rashes due to eczema, insect bites, poison ivy, oak, or sumac; soaps detergents cosmetics jewelry seborrheic dermatitis psoriasis. $7.00 HYDROCORTISONE 1% ANTI-ITCH CREAM 1 oz. Generic for Cortaid Cream. $5.00 GOLD BOND MEDICATED MAXIMUM STRENGTH CREAM 1 oz. Temporarily relieves the pain and itch associated with: minor cuts, sunburn, insect bites, scrapes, minor burns and minor skin irritations. $

15 EYE & EAR CARE ARTIFICIAL TEARS 0.5oz. Sterile eye drops help relieve dryness of the eye. $8.00 VISINE AC EYE DROPS 0.5oz. For temporary relief of discomfort and redness of the eye due to minor eye irritations. Seasonal itching & redness relief. For pollen, dust, ragweed. $6.00 CLEAR EYES REDNESS RELIEF DROPS 0.5oz. Relieves redness of the eye from minor eye irritations. Up to 8 hours of soothing comfort. Moisturizing. Sterile. 13 $5.00 DEBROX DROPS EARWAX REMOVAL AID For occasional use as an aid to soften, loosen and remove excessive earwax. When used as directed, this product easily cleanses ear with microfoam action. $7.00

16 VASELINE PETROLEUM JELLY 13 oz. Temporarily protects minor cuts, scrapes and burns. Protects and helps relieve chapped skin and lips from the drying effects of wind and cold weather. FIRST AID PETROLEUM JELLY 13 oz. Generic for Vaseline. $6.00 $4.50 NEOSPORIN ORIGINAL OINTMENT 1 oz. First aid to help prevent infection in minor cuts, scrapes and burns. Effective, long-lasting infection protection. $10.00 TRIPLE ANTIBIOTIC OINTMENT 1 oz. Generic for Neosporin. $

17 FIRST AID BACITRACIN OINTMENT 1 oz. First aid ointment to help prevent infection in minor cuts, scrapes and burns. $6.00 BACTINE LIQUID 4 oz. First aid to help prevent skin infection, and for temporary relief of pain and itching associated with minor cuts, scrapes and burns. No sting. NEW ADDITION! $5.50 JOHNSON & JOHNSON FIRST AID KIT 125 items. Provides essential items to deal with wound treatment & protection, aches & pains, burns, diarrhea and more. $13.50 ABREVA COLD SORE CREAM 2 grams. Treats cold sores/fever blisters on the face or lips. Shortens healing time and duration of symptoms. 15 $24.50

18 RUBBING ALCOHOL 70% 16 oz. Used to help prevent infection. For external use only. Active ingredient: Isopropyl alcohol 70% by volume. $4.00 FIRST AID ALCOHOL PREP PADS 100 count. HYDROGEN PEROXIDE 3% 16 oz. $3.00 $3.50 NEW SKIN LIQUID BANDAGE 1 oz. Helps prevent bacterial contamination in minor cuts and scrapes. Dries fast to form a tough protective cover that allows skin to breathe. $7.00 FIRST AID KIT 42 pieces. Contains: 10 Sheer adhesive bandages, 21 Spots, 3 Clear Adhesive bandages, 3 Fabric Adhesive bandages, 2 Non-adherent pads, 3 Alcohol pads. NEW ADDITION! $

19 FIRST AID BANDAID FLEX FABRIC 3/4 30 count. Wicks away blood to keep wounds clean. Extra flexibility - unique Memory Weave fabric that moves with you. Non-stick pad that won t stick to the wound for gentle removal. 3/4 in x 3 in (1.9 cm x 7.6 cm) $4.00 BANDAID COMFORT-FLEX PLASTIC ALL ONE SIZE 60 count. New Quiltvent technology: Creates air channels for superior breathability, wicks away blood to keep wounds clean. Non-stick pad that won t stick to the wound. 3/4 in x 3 in (1.9 cm x 7.6 cm). $2.50 BANDAID SHEER ASSORTED 60 bandages. Variety of sizes. Non-stick pad won t stick to wound for gentle removal. Includes: 10-1 in x 3 in (2.5 cm x 7.6 cm), 20-3/4 in x 3 in (1.9 cm x 7.6 cm), 30-5/8 in x 2-1/4 in (1.5 cm x 5.7 cm). $3.50 ADHESIVE SHEER STRIPS ASSORTED 60 bandages. Generic for Bandaid Sheer Assorted. 17 $2.50

20 COTTON SWABS 300 count. A variety of uses, including first-aid, baby care and household cleaning. FIRST AID $4.50 JUMBO COTTON BALLS 100 count. Ideal for first-aid, baby care and the application and removal of make-up. EPSOM SALT 16 oz. $2.00 $4.50 ACE ELASTIC BANDAGE 3 IN. 1 bandage. Ideal for elbow, ankle or knee. Antimicrobial treatment inhibits growth of bacteria on the bandage. Latex free. $

21 FIRST AID CARA INSTANT ICE PACKS 2 packs. Reduces swelling and relieves pain. Disposable and portable. $4.00 ICY HOT BACK PATCHES LARGE 5 patches. Temporarily relieves minor pain from arthritis, backaches, tendonitis, muscle strains and more. Extra strength. LICE TREATMENTS 19 $8.50 BED BUDDY HOT/COLD PACK 1 pack. Easy to use and provides instant soothing heat for sore muscles, aches, and pains. Can also be used as a cold pack. Provides natural moist heat. Reusable. Ready in minutes. One size fits all. $11.00 NIX LICE TREATMENT CONTROL SPRAY 5oz. $9.00 NIX CREME RINSE 2 oz. Single Treatment. $14.00

22 AUTOMATIC BP MONITOR + 1 unit. Includes 2 arm cuffs to fit most arm sizes. Extra Large size digits. Risk Category Indicator alerts user when readings fall into prehypertensive or hypertensive risk categories. Batteries and storage case included. $50.00 BASIC THERMOMETER DIGITIAL + 1 unit. For oral, underarm or rectal temperature reading. A safe, accurate alternative to glass thermometers. Signals when done. HOME MEDICAL $5.00 OMRON BLOOD PRESSURE MONITOR MANUAL + 1 unit. Includes 1 contoured arm cuff (fits arms 9 inches to 13 inches in circumference)*, 1 air inflation bulb, 1 illustrated English Spanish instruction manual The monitor makes it simple to measure your blood pressure and pulse rate at home. $37.50 *Large cuff sold separately. Batteries not included. + Some of these items may be covered by Medicare Part A or Part B if the item is determined medically necessary. Please check with your physician before ordering. 20

23 HOME MEDICAL NEW ADDITIONS! CARA HEATING PAD ECONO DRY 11.5 X 14 $20.50 CARA HEATING PAD MOIST/DRY W/SELECT TEMPERATURE $33.00 BATH MAT 1 mat. Soft, cushioned bath mat with textured surface to prevent slipping. $15.00 MEDICHEST 7 DAY PLANNER Raised lettering & highlighted Braille. 28 color-coded compartments. $9.50 PILL ORGANIZER 7 DAY XXL Optional divider for 7 or 14 compartments. 21 $5.50

24 LEG & FOOT CARE (ANTI-FUNGAL) LOTRIMIN AF CREAM 24 grams. Cures most athlete s foot, jock itch, and ringworm. Relieves itching, burning, cracking, scaling and discomfort which accompany these conditions. $14.50 CLOTRIMAZOLE CREAM 1% 1 oz. Generic for Lotrimin. Cures most athlete s foot, jock itch and ringworm. Non-staining. $7.00 TINACTIN ATHLETE S FOOT SPRAY 5.3 oz. For treatment of most athlete s foot and ringworm. For effective relief of itching, burning and cracking. Cools the burn. $8.00 TOLNAFTATE 1% CREAM 1 oz. Generic for Tinactin. Proven clinically effective in the treatment of athlete s foot, jock itch, and ringworm. For effective relief of the itching, scaling, burning, and discomfort that can accompany these conditions. $

25 LEG & FOOT CARE MEN S DRESS KNEE HIGH SOCK 8-15MMHG 1 pair. S, M, L, XL sizes. Provides relief from tired, aching legs and mild swelling. Helps improve circulation. $17.00 JOBST WOMEN S MOD COMPRESSION KNEE HIGH 15-20MMHG 1 pair. M, L, XL sizes. Continuous relief from aching legs and varicose veins. $41.50 (L/XL) $42.50 (M) JOBST WOMEN S SHEER KNEE HIGH 8-15MMHG 1 pair. For tired, aching legs, improved circulation and reduction of mild swelling. S, M sizes. Silky beige. $13.00 WOMEN S ULTRASHEER THIGH HIGHS 8-15MMHG 1 pair. M, L sizes. 23 $21.00

26 GOLD BOND MEDICATED FOOT POWDER MAX STRENGTH 4 oz. Temporarily relieves pain and itch from minor skin irritations on the foot. Absorbs excess moisture. LEG & FOOT CARE $4.50 DR SCHOLLS CALLUS REMOVER ONE STEP For removal of calluses. Relieves pain while removing calluses. Medicated disk removes callus while cushion relieves pain. $5.50 DR SCHOLLS CORN CUSHION REGULAR 9 count. $3.50 DR SCHOLLS CORN REMOVER ULTRA THIN PADS $3.50 COMPOUND W GEL 0.25oz. For the removal of common and plantar warts. Maximum strength. Painless removal. No drip formula. Safe, effective and easy to use. NEW ADDITION! $

27 MOTION SICKNESS/VERTIGO DRAMAMINE CHEW TABLETS 8 count. For prevention and treatment of these symptoms associated with motion sickness: nausea, vomiting, dizziness. $5.00 DRAMAMINE TABLETS 12 count. For prevention and treatment of nausea, vomiting and dizziness. For children and adults. Easy open travel package. $5.50 MOTION SICKNESS TABLETS 12 count. Generic for Dramamine. 25 NEW ADDITION! $2.50 BONINE TABLETS 8 count. Prevents and treats nausea, vomiting or dizziness associated with motion sickness. Works up to 4 times longer and causes less drowsiness than original Dramamine. $4.50

28 COLGATE TOOTHBRUSH PLUS SOFT ADULT 1 brush. Effectively cleans at the back and in between teeth. COLGATE TOOTHPASTE 8.2 oz $3.00 $5.00 SENSODYNE ORIGINAL 4 oz. Builds protection against painful sensitivity of the teeth due to cold, heat, acids, sweets or contact. Includes fluoride for cavity protection. ORAL CARE $7.50 ACT ANTICAVITY FLUORIDE RINSE 18 oz. Aids in the prevention of dental cavities. Strengthens teeth and freshens breath. #1 dentist recommended brand. Available in Mint or Cinnamon $5.00 LISTERINE MOUTHWASH ORIGINAL 33.8 oz. To help prevent and reduce plaque and gingivitis and for bad breath. $

29 ORAL CARE NEW ADDITION! EFFERDENT DENTURE CLEANSER TABLETS 90 tablets. Works on dentures, partials and retainers. Kills 99.9% of the bacteria that cause denture odor. Dissolve tough stains in hard-to-reach places. Keep dentures fresh and clean. $7.00 SUPER POLIGRIP DENTURE ADHESIVE CREAM ZINC FREE 2.4 oz. Strong, all-day hold. Ooze-control tip. Zinc free. $7.50 ORAL-B DENTURE BRUSH 1 brush. For freshness and effective stain removal for dentures. 27 $3.50 DENTAL FLOSS MINT WAXED 140 yds. $2.50 ORAL CARE COMBO KIT Crest Toothpaste 3.6oz, Dental Floss 100yds, Toothbrush Full Head, Soft. $7.50

30 TOOTHBRUSH FULL HEAD SOFT 1 brush. Curved handle conforms to your hand for comfort and control. Tapered head for easy access to back teeth. ORAL CARE $1.50 FIXODENT CONTROL DENTURE ADHESIVE CREAM PLUS SCOPE FLAVOR 2 oz. Use once a day for all day hold with Scope flavor for fresher breath. $7.00 ORAJEL MAXIMUM STRENGTH GEL 0.42 oz. For the temporary relief of pain due to toothaches. $8.00 SEA-BOND DENTURE ADHESIVE UPPERS ORIGINAL 15 each. Thin, soft adhesive wafer. Strong hold with no pasty ooze. Easy, no-mess clean-up. Available in Lower $

31 MEDICATED LIP CARE BLISTEX LIP MEDEX 0.25 oz. For the temporary relief of pain and itching associated with minor lip irritations. Temporarily protects and helps relieve chapped, or cracked lips. $2.50 CARMEX STICK SPF 15 STRAWBERRY 0.15 oz. Helps to provide relief of the symptoms of dry chapped lips. $2.00 CARMEX EASY-ON APPLICATOR 0.35 oz. Helps to provide relief of the symptoms of cold sores and dry chapped lips. $2.00 BLISTEX MED LIP BALM SPF oz. Temporarily protects and helps relieve chapped or cracked lips. Easyglide formula. Provides SPF 15 protection 29 $2.00

32 ADVIL 200MG TABLETS 100 count. Temporarily relieves minor aches and pains due to: headache, toothache, backache, menstrual cramps, the common cold, muscular aches, minor pain of arthritis. Temporarily reduces fever. $14.50 IBUPROFEN 200MG CAPLETS 100 coated caplets. Generic for Advil 200mg caplets. Temporarily relieves minor aches and pains. Temporarily reduces fever. PAIN MANAGEMENT $6.00 ALEVE 220MG CAPLET 100 count. Temporarily relieves minor aches and pains due to: minor pain of arthritis, muscular aches, backache, menstrual cramps, headache, toothache, the common cold; temporarily reduces fever. Strength to last 12 hours. $15.00 NAPROXEN SODIUM 220 MG CAPLETS 100 count. Generic for Aleve 220mg caplets. Temporarily relieves minor aches and pains. Temporarily reduces fever. $

33 PAIN MANAGEMENT ACETAMINOPHEN 500MG TABLETS 100 count. Generic version of Tylenol. $5.00 PAMPRIN MULTI-SYMPTOM CAPLETS 20 caplets. For temporary relief of cramps, headache, bloating and muscular aches from menstrual periods. $5.00 BAYER 325 TABLETS 100 count. Temporarily relieves: Headache, Muscle pain, Toothache, Menstrual pain, Pain and fever of colds, Minor pain of arthritis. Recommended by doctors for aspirin regimen use. 31 $10.00 ASPIRIN 325MG TABLETS 100 tablets. Generic version of Bayer. Temporarily relieves headache, muscle pain, toothache, menstrual pain, pain and fever of colds, minor pain of arthritis. $3.50

34 BAYER ADULT 81MG ENTERIC COATED LOW DOSE ASPIRIN 120 count. For the temporary relief of minor aches and pains or as recommended by your doctor. Because of its delayed action, this product will not provide fast relief. $10.00 ASPIRIN ADULT ENTERIC COATED 81MG TABLETS 120 coated caplets. Generic for Bayer 81mg Aspirin. Temporarily relieves headache; muscular aches; backache; toothache; menstrual periods; minor pains of arthritis; and reduces fever. $3.50 BAYER CHILD CHEW ASPIRIN LOW DOSE 36 count. For the temporary relief of minor aches and pains or as recommended by your doctor. Caffeine and sodium free. $3.50 ASPIRIN CHILD CHEW 81MG 100 count. Generic for Bayer Chewable Aspirin. PAIN MANAGEMENT $

35 PAIN MANAGEMENT CAPZASIN NO MESS APPLICATOR 1 oz. Temporarily relieves minor pain from arthritis, muscle strains and sprains, bruises and cramps. Odor-free. NEW ADDITION! $10.00 SALONPAS ARTHRITIS PAIN RELIEF PATCH 5 count. Temporarily relieves mild to moderate aches & pains of muscles & joints associated with: Arthritis, Sprains, Strains, Bruises, Simple backache. Apply for 8 to 12 hours. 2-3/4 x 3-15/16 inches. $8.50 BENGAY PAIN RELIEVING CREAM ULTRA STRENGTH 4 oz. Temporarily relieves the minor aches and pains of muscles and joints associated with: simple backache, arthritis, strains, bruises, sprains. Deep penetrating pain relief. Non-greasy. $10.00 ARTHRITIS HOT DEEP PENETRATING PAIN RELIEF CREAM 3.0 oz. Generic for Bengay. 33 $4.50

36 TUCKS PADS 40 pads. Temporarily relieves local itching and discomfort associated with hemorrhoids. Also available in 100 count pads ($10.00). HEMORRHOID ANTISEPTIC CLEANSING PADS 100 count. Generic for Tucks. $6.00 NEW ADDITION! $6.00 PREPARATION H OINTMENT 2 oz. Helps relieve itching and discomfort associated with hemorrhoids. Temporarily shrinks hemorrhoidal tissue and relieves burning. HEMORRHOIDAL CREAM 1.8 oz. Generic for Preparation H. $15.50 NEW ADDITION! $

37 INCONTINENCE DEPENDS POISE PADS ULTRA THIN LITE 30 count. Blue Absorb-Loc Core provides protection in a thin, comfortable pad. Locks away wetness and neutralizes odor. Thin, flexible fit moves with you. $10.00 PROTECTIVE DISPOSABLE UNDERWEAR Quantity: 20 - Medium size (fits ) Quantity: 18 - Large size (fits ) Quantity: 14 - XLarge size (fits ) $15.00 CALMOSEPYINE OINTMENT (MOISTURE BARRIER) 4 oz. Prevents and helps heal skin irritations. NEW ADDITION! $8.50 A & D OINTMENT 4 oz. First aid in: minor burns, scalds, sunburn, windburn, diaper rash, chafing, chapped skin, nipple care, abrasions, cuts, ulcers. 35 $6.00

38 STOMACH REMEDIES & DIGESTIVE HEALTH TUMS ASSORTED TABLETS 150 tablets. As an antacid, relieves heartburn, sour stomach, acid indigestion and upset stomach. Also can be used as a source of extra calcium. $6.50 ANTACID ASSORTED TABLET 150 tablets. Generic for Tums Assorted Tablets. $4.00 TUMS EXTRA STRENGTH TABLETS ASSORTED 96 tablets. As an antacid, relieves heartburn, sour stomach, acid indigestion and upset stomach. Also can be used as a source of extra calcium. ANTACID CHEWABLE EXTRA STRENGTH 96 tablets. Generic for Tums Extra Strength. $6.50 $

39 STOMACH REMEDIES & DIGESTIVE HEALTH PRILOSEC OTC TABLETS 42 tablets. Treats frequent heartburn (occurs 2 or more days a week). Not intended for immediate relief of heartburn; this drug may take 1 to 4 days for full effect. Three 14-day courses of treatment. $32.00 OMEPRAZOLE 20MG TABLETS 42 tablets. Generic for Prilosec OTC tablets. $27.50 SENNA TABLETS 100 count. Generic for Senokot. Laxative. $6.50 FAMOTIDINE 10MG TABLETS 30 tablets. Generic for Pepcid AC. Relieves heartburn associated with acid indigestion and sour stomach. 37 $6.00

40 PEPTO-BISMOL LIQUID ORIGINAL 8 oz. Relieves travelers diarrhea, diarrhea, upset stomach due to overindulgence in food and drink, including: heartburn, indigestion, nausea, gas, belching. STOMACH REMEDIES & DIGESTIVE HEALTH Available in Cherry $5.50 PEPTO-BISMOL CAPLETS ORIGINAL 40 tablets. Relieves: travelers diarrhea, diarrhea, upset stomach due to overindulgence in food and drink, including: heartburn, indigestion, nausea, gas, belching, fullness. PINK BISMUTH TABLETS CHEWABLE 30 tablets. Generic for Pepto Bismol tablets. PINK BISMUTH LIQUID 8 oz. Generic for Pepto Bismol liquid. BISACODYL TABLET 25 count. Generic for Dulcolax. $9.50 $3.50 $3.50 $

41 STOMACH REMEDIES & DIGESTIVE HEALTH IMODIUM A-D LIQUID COOL MINT 4 oz. Controls symptoms of diarrhea, including travelers diarrhea. Available in Cinnamon $7.50 METAMUCIL FIBER WAFERS APPLE 24 count. These delightfully crunchy wafers contain psyllium fiber husk, a 100% natural source of soluble and insoluble fiber that works with your body to help your natural cleansing process. $9.00 KAOPECTATE LIQUID REGULAR FLAVOR 8 oz. Relieves diarrhea. Relieves nausea and upset stomach associated with this symptom. Goes to the source. This product also contains two electrolytes to help you recover fast. $6.00 STOOL SOFTENER SOFTGELS 100 count. Generic for Docusate Sodium. 39 $4.50

42 THERAPEUTIC SKIN CARE AVEENO SOOTHING OATMEAL BATH TREATMENT 8 pack. Temporarily protects and helps relieve minor skin irritation and itching due to poison ivy, insect bites and more. $8.00 PURE ALOE GEL FRUIT OF THE EARTH 6 oz. Cooling gel made from fresh Aloe Vera leaves. Provides relief from sunburn, minor burns, skin irritations and dry skin. $5.50 BANANA BOAT SPORT SUNBLOCK LOTION SPF 30 8 oz. Helps prevent sunburn. Provides water resistant protection for any sport activity. $10.50 ALOE VESTA SKIN CONDITIONER 8 oz. Ideal for routine moisturizing, skin protection and sensitive skin in mind. Helps prevent and temporarily protect chafed, chapped and cracked skin. $

43 VITAMINS & SUPPLEMENTS VITAMIN B6 100 MG* 100 tablets. $7.50 VITAMIN B12 500MCG* 60 tablets. $9.00 SUPER B COMPLEX VITAMIN C + IRON* 100 tablets. Vitamin B Complex formula combined with150 mg of vitamin C and 20 mg of iron per tablet. $8.50 VITAMIN E 400IU SOFTGELS* 100 tablets. 41 $11.50 *Certain OTC products are considered dual-purpose like vitam discussing them with your healthcare provider to see

44 CALTRATE 600MG PLUS D TABLETS* 60 tablets. Contains calcium and advanced levels of vitamin D. VITAMINS & SUPPLEMENTS $10.50 CALCIUM CARBONATE 600MG PLUS D TABLET* 60 tablets. Generic for Caltrate. $6.00 FLAXSEED OIL 1000MG SOFTGEL* 60 tablets. Good source of Omega-3 fatty acids. Sodium free $9.50 VITAMIN D3* 100 tablets IU per tablet. Sodium free. VITAMIN D3* 100 tablets IU softgels. Sodium free. $7.50 $6.50 ins and minerals. You should only order these products after if s/he recommends the item for a specific condition. 42

45 VITAMINS & SUPPLEMENTS MAG OX 400 MG* 120 tablets. Concentrated magnesium supplement. $19.00 GLUCOSAMINE CHONDROITIN 500/400* 120 capsules. $23.50 POTASSIUM GLUCONATE 99 MG* 100 tablets. $5.50 FOLIC ACID 400 MCG TABS* 180 tablets. 43 $6.50 *Certain OTC products are considered dual-purpose like vitam discussing them with your healthcare provider to see

46 VITAMINS & SUPPLEMENTS ONE A DAY WOMENS TABLETS* 100 tablets. A complete multivitamin with more of what matters to women. Bone strength and breast health are not just issues for older women. $11.50 CENTRUM SILVER 50+* 100 tablets. Specially formulated with key nutrients to help meet the nutritional needs of women and men 50+. $15.50 CEROVITE SENIOR TABLETS* 100 tablets. Generic for Centrum Silver tablets IU per tablet. Sodium free. $6.00 $7.50 $8.00 $5.50 FERROUS SULFATE TAB 325 MG* Generic for Feosol. FISH OIL 1000MG SOFT GELS* May help reduce coronary heart disease risk; important for heart health. NATURE S BOUNTY ACIDOPHILUS CAPSULE* Helps support gastrointestinal health. ins and minerals. You should only order these products after if s/he recommends the item for a specific condition. 44

47 WOMEN S HEALTH MICONAZOLE 7 VAGINAL SUPPOSITORIES 7CT 7 count. Generic for Monistat Suppositories. $6.00 MONISTAT 3 CREAM PREFILLED APPLICATORS 3 count. 3 day treatment for vaginal yeast infections. $18.50 MONISTAT 7 CREAM DISPOSABLE APPLICATORS 1.59 oz. Treats vaginal yeast infections. Ultra slim disposable applicators. 7 day treatment. $13.50 MICONAZOLE 7 VAGINAL CREAM 45gm. Generic for Monistat $10.50

48 icare Family Care Partnership is a Coordinated Care plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in icare Partnership depends on contract renewal. This benefit is only for icare Partnership members. Items that qualify for purchase are from the Medicare Over-the-Counter (OTC) list. Only categories of items on the Medicare OTC list are covered by the plan, subject to the following conditions: Enrollees may purchase any eligible item on the Medicare OTC list. Enrollees may only purchase a dual-purpose item if the enrollee first discusses the purchase of the dual-purpose item with their health care provider, and their health care provider orally recommends the item for a specific diagnosable condition. Enrollees may not purchase noneligible items. If enrollees purchase non-eligible items, they will not be covered by the plan. Purchased items on the Medicare OTC list may only be used by the enrollee. It is prohibited to purchase OTC items for family members and friends. Independent Care will not cover additional types or classes of products not belonging to the categories on the CMS OTC list. Unused funds expire at the end of the year and revert back to icare. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits may change on January 1 of each year. OTC prices, quantities and brands are subject to periodic changes. Please contact icare for details. This document can be made available in different languages or formats. Call your Care Team or Customer Service at , 24 hours-aday/7 days-a-week (office hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.) for more information or if you need help in understanding this document. TTY users should call It s a good idea before buying an OTC product to check with your doctor or pharmacist first if you have any existing medical conditions. Some OTC medications could cause serious side effects or interact with your prescription medication. You should also speak to your pharmacist or doctor if you are unclear on how to use a product. For full information on icare Partnership benefits, call your Care Team or Customer Service at , 24 hours-a-day/7 days-a-week (office hours: Monday- Friday, 8:30 a.m. to 5:00 p.m.). TTY users should call

49 For more information about long-term care options available to you in your county contact the Aging & Disability Resource Centers (ADRC). The Resource Center can also assist you with information about eligibility and enrollment. ADRC of Dane County: , TTY: Wisconsin Relay ADRC of Kenosha County , TTY: Aging Resource Center of Milwaukee County (60 years of age or older) , TTY/TDD: Disability Resource Center of Milwaukee County (Under 60 years of age) , TTY/TDD: ADRC of Racine County , TTY: Wisconsin Relay 711

50 You can call your Care Team to help you access your monthly benefit for OTC medications and health-related products. Call toll-free to place your order today: or TTY: Monday-Friday 8:30am-10:00pm CST or order online at Administered by 2015 Independent Care Health Plan