2016 OVER-THE-COUNTER (OTC) CATALOG MEDICARE ADVANTAGE PLANS

Transcription

1 2016 OVER-THE-COUNTER (OTC) CATALOG MEDICARE ADVANTAGE PLANS Get the OTC items you need. H5087_CA030531_WCM_OTC_ENG_FINAL CMS Accepted WellCare 2015 CA_06_15 EC6OTCCAT66586E_0615

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3 The Benefits of Easy Choice Health Plan Add Up. What is Easy Choice s OTC benefit? Simply put, we give you a monthly dollar amount; you spend it on some of the over-the-counter (OTC) items you use every day. It s that easy. The OTC benefit is part of your health plan. Every month you can get brand-name or generic OTC medications and products like bandages, pain relievers, cold medicine, toothpaste, vitamins and much more. You can use this catalog, then order online or by phone, and we ll ship your items right to your door. Each plan offers different OTC benefit amounts. Check your Evidence of Coverage or Summary of Benefits for your specific benefit amount for your plan. Remember that your benefit and items are only for your use. Use your benefit each month. It does not roll over to the next month. How Do I Use My OTC Benefit? There are several ways to get your items. No matter how you order them, we ll ship them right to your door. It s that easy. Allow 7-10 days to receive your order. Find the items you want in this catalog, then: 1. Give us a call at , TTY 711, Monday-Friday, 6:30 a.m. 8:00 p.m. Pacific. 2. Visit us at Log in using your member ID number and date of birth. You can find your member ID number on your Easy Choice member ID card. To Get the Most Out of Your OTC Benefit: 1. Make sure to order your items every month. If you skip a month, the benefits don t carry over to the next month. 2. Use your monthly dollar amount to stock up on a variety of items by ordering different items every month. Call Customer Service to order your OTC items 1 EC6OTCCAT66586E_0615

4 What Can I Order With My OTC Selection? Eligible items On the next few pages, you ll find a list of products. These are the items that you can order from us and have mailed to your home. Eligible items include but are not limited to: fiber supplements, first aid supplies, medicines, ointments, sprays with active medical ingredients that alleviate symptoms, topical sunscreen, supportive items for comfort such as knee braces and adult incontinence products, and mouth care such as dental floss and toothbrushes. Dual-purpose items What are dual-purpose items? They re medicines and products that can be used for either a medical condition or for general health and well-being. You can get dual-purpose items as part of your OTC benefit if you use them to treat a specific medical condition and your doctor recommends the product or medicine. Talk with your doctor before buying dual-purpose items. For your convenience, we ve marked dual-purpose items with a ( ). Dual-purpose items include but are not limited to: Minerals and vitamins Hormone replacement In-home testing and monitoring Weight-loss items Some items, under certain circumstances, may be covered under either Part B or Part D. For example, gauze may be covered under Part B when it is being used, as prescribed, to perform surgical wound dressing changes. For your convenience, we ve marked these items with a (**). What s not eligible? The following categories and items listed are not eligible for the OTC benefit. Non-eligible items include but are not limited to: Alternative medicines such as botanicals, herbals, probiotics and nutraceuticals Baby items such as diapers and formula Contraceptives such as birth control pills and spermicides Convenience and comfort items such as scales, fans and magnifying glasses Cosmetic items such as mouthwash, bad breath remedies, deodorants and teeth whitening Food products or supplements Replacement items such as hearing aid batteries and contact lens containers 2 Call Customer Service to order your OTC items.

5 Items You Can Order From Us Do you prefer lower-cost generics or familiar brand-name products? Your OTC benefit lets you make the choice! Look over the list of eligible items on the next few pages. You can order online or by calling us and telling us the ID numbers of the items you want. We ll send them to your home and deduct the amount from your monthly benefit. OUR CATALOG ITEMS ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT ALLERGY PREVENTION AND TREATMENT 1 Allergy Relief (Cetirizine) 10mg Tablets 30 $ Zyrtec 14 $17 2 Allergy Relief (Loratadine) 10mg Tablets 30 $7 502 Claritin 10 $12 ANALGESICS / ANTIPYRETICS 3 Acetaminophen 325mg 100 $3 503 Tylenol 325mg Regular 100 $10 Tablets Strength Tablets 4 Acetaminophen 500mg 100 $7 504 Tylenol 500mg Extra 100 $16 Tablets Strength Tablets 5 Aspirin 325mg Tablets 100 $3 505 Bayer Aspirin 325mg 100 $8 6 Aspirin 81mg Chewable 36 $3 NA Bayer Aspirin 81mg NA NA Chewable 7 Aspirin Enteric Coated 120 $7 507 Bayer EC Aspirin 81mg 32 $4 81mg Tablets (Adult Regimen) 8 Aspirin Enteric Coated 325mg Tablets 100 $4 508 Ecotrin Tablets 100 $6 * = Quantities and brands may vary depending upon availability. = Dual-purpose items ** = Covered under either Part B or Part D Some items may vary depending on manufacturer: Caplets/tablets/capsules/softgels. Call Customer Service to order your OTC items 3

6 ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT ANTACIDS AND ACID REDUCERS 9 Acid Reducer (Famotidine) 10mg Tablets 30 $6 509 Pepcid AC Tab 30 $11 10 Acid Reducer (Omeprazole) 20mg 14 $ Prilosec 14 $14 11 Acid Reducer (Ranitidine) 75mg Tablets 30 $7 511 Zantac Tablets 30 $15 12 Antacid Tablets 150 $6 512 Tums Tablets 150 $8 13 Effervescent Tablets 36 $4 513 Alka-Seltzer 24 $7 14 Gas Relief Softgel Extra- Strength 20 $4 514 Gas-X Extra Strength 18 $6 ANTICANDIAL (YEAST) 15 Miconazole Vaginal Cream 3 Day 1 $ Monistat Vaginal Cream 3 Day 1 $24 ANTIDIARRHEAL AND LAXATIVES 16 Adult Glycerin Suppositories 12 $3 516 Fleet Adult Suppositories 50 $5 17 Anti-Diarrheal Caplets 12 $4 NA Imodium A-D Caplets NA NA 18 Anti-Nausea Liquid 4 oz. $6 518 Emetrol 4 oz. $9 19 Bisacodyl 5mg Tablets 25 $4 519 Dulcolax Tablets 25 $7 20 Laxative (Bisacodyl) 10mg Suppositories 12 $5 520 Dulcolax Suppositories 8 $13 21 Stomach Relief Flavored Tablets 30 $3 521 Pepto-Bismol Tablets 30 $5 22 Stool Softener Softgel 100 $4 522 Colace Capsules 30 $13 ANTI-INFLAMMATORY 23 Ibuprofen 200mg Liquid 20 $5 523 Advil Liquid Gel Caps 20 $6 Gel Caps 24 Ibuprofen 200mg Tablets 50 $6 524 Advil Tablets 50 $10 25 Naproxen Sodium 220mg Caplets 50 $8 525 Aleve Caplets 24 $7 ARTHRITIS MEDICINE 26 Arthritis Pain Relief 24 $5 NA Tylenol Arthritis NA NA Caplets 27 Hot/Cold Patches 5 $5 527 Icy Hot Patches 5 $7 4 Call Customer Service to order your OTC items

7 ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT BLADDER CONTROL ITEMS 167 Adult Protective Briefs 20 $18 NA Adult Protective Briefs NA NA Small/Medium Small/Medium 168 Adult Protective Briefs 20 $18 NA Adult Protective Briefs NA NA Large Large 169 Adult Protective Briefs XL 20 $20 NA Adult Protective Briefs XL NA NA 170 Adult Bladder Control 28 $9 NA Adult Bladder Control NA NA Pads Pads 200 Disposable Bed Underpads 5 $6 NA Disposable Bed Underpads NA NA COLD/COUGH/FLU REMEDIES 53 APAP Sinus Congestion 24 $4 553 Tylenol Sinus Congestion 24 $8 54 Cough / Throat Drops 30 $3 554 Halls Cough Drops 25 $3 55 Daytime Cold/Flu Relief 16 $5 555 Dayquil Softgel 16 $8 Softgel 56 Daytime Cold/Flu Relief 4 oz. $5 556 Dayquil Liquid 8 oz. $8 Liquid 174 Daytime/Nite-time Cold/ 16 $5 674 Mucinex Day/Night 30 $16 Flu Caplets Caplets 57 Mucus Relief DM Tablets 30 $8 557 Mucinex-DM 20 $15 58 Mucus Relief Tablets 30 $7 558 Mucinex 20 $15 59 Nasal Decongestion Spray 1 oz. $4 559 Afrin Nasal Spray 0.5 oz. $10 60 Nasal Decongestion PE Tablets 36 $4 NA Sudafed PE NA NA 61 Nite-Time Cold/Flu Relief Softgel 16 $5 561 NyQuil Softgel 16 $8 62 Nite-Time Cold/Flu Relief 4 oz. $5 562 NyQuil Liquid 8 oz. $8 Liquid 63 Saline Nasal Spray 1.5 oz. $3 563 Ocean Nasal Spray 1.5 oz. $6 64 Sore Throat Spray 6 oz. $4 NA Chloraseptic Sore Throat NA NA Spray 65 Tussin DM Syrup SF 4 oz. $6 565 Robitussin DM Syrup 4 oz. $8 66 Tussin Syrup 4 oz. $4 NA Robitussin Syrup NA NA 67 Vapor Rub 3.53 oz. $5 NA Vicks Vaporub NA NA Call Customer Service to order your OTC items 5

8 ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT DENTAL AND DENTURE CARE 69 Denture Adhesive Cream 2.4 oz. $5 569 Fixodent 2.4 oz. $7 70 Denture Cleaner 40 $4 570 Efferdent 16 $5 71 Fluoride Toothpaste 6 oz. $4 571 Colgate 4 oz. $5 72 Premium Adult 1 $2 572 Colgate Toothbrush 1 $4 Toothbrush 73 Premium Dental Floss 1 $2 573 Reach Dental Floss 1 $3 75 Sensitive Teeth Toothpaste 4 oz. $5 NA Sensodyne NA NA 76 Toothache Relief Liquid/ Gel 0.33 oz. $4 576 Anbesol Liquid/Gel 0.41 oz. EAR CARE 77 Ear Syringe 1 $3 NA Ear Syringe NA NA 78 Ear Wax Drops 0.5 oz. $6 578 Debrox Ear Wax Drops 0.5 oz. $8 EYE CARE 79 Artificial Tears 0.5 oz. $4 579 Visine Tears 0.5 oz. $7 93 Red Eye Relief Drops 0.5 oz. $3 593 Visine Drops 0.5 oz. $6 FIBER SUPPLEMENTS 94 N/A - Brand Only NA NA 594 Vitafusion Fiber Well 90 $18 Gummies 95 Fibertab Caplets 90 $9 595 FiberCon Caplets 90 $16 FIRST AID AND MEDICAL SUPPLIES 96 Adhesive First-Aid Tape* 1 $2 NA Adhesive First-Aid Tape* NA NA 189 Aid Ankle Support 1 $7 NA Aid Ankle Support NA NA 191 Aid Elbow Support 1 $7 NA Aid Elbow Support NA NA 192 Aid Hand/Wrist Support 1 $7 NA Aid Hand/Wrist Support NA NA 166 Aid Knee Support 1 $7 NA Aid Knee Support NA NA 190 Aid Wrist Support 1 $7 NA Aid Wrist Support NA NA 97 Alcohol Pads* 100 $3 NA Alcohol Pads* NA NA 162 Anti-Embolism Stockings Extra Large 1 $13 NA Anti-Embolism Stockings Extra Large NA NA 163 Anti-Embolism Stockings Large 1 $13 NA Anti-Embolism Stockings Large NA $9 NA 6 Call Customer Service to order your OTC items

9 ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT FIRST AID AND MEDICAL SUPPLIES 164 Anti-Embolism Stockings 1 $13 NA Anti-Embolism Stockings NA NA Medium Medium 165 Anti-Embolism Stockings 1 $13 NA Anti-Embolism Stockings NA NA Small Small 98 Athletic Bandage* 1 $2 NA Athletic Bandage* NA NA 99 Bandages Assorted 100 $6 599 Band-Aids 100 $ Butterfly Closures* 10 $2 NA Butterfly Closures* NA NA 101 Corn and Callus Remover 0.5 oz. $4 NA Dr. Scholl s Corn and Callus Remover NA NA 102 Cotton Balls 100 $4 NA Cotton Balls NA NA 103 Cotton Swabs 150 $4 603 Q-Tips Cotton Swabs 170 $5 104 First Aid Kit 1 $8 NA First Aid Kit NA NA 105 Flexible Tip Thermometer 1 $10 NA Flexible Tip Thermometer NA NA 106 Ice Bag 1 $4 NA Ice Bag NA NA 107 Liquid Wart Remover 0.5 oz. $6 607 Compound W Wart 1 $8 Remover 108 Oral Digital Thermometer 1 $5 NA Oral Digital Thermometer NA NA 60 Second 60 Second 109 Stretch Gauze Bandage* 1 $2 NA Stretch Gauze Bandage* NA NA HEADACHE RELIEF 110 Headache Relief Tablets 24 $4 610 Excedrin Migraine 24 $6 HEMORRHOIDAL PREPARATIONS 111 Hemorrhoid Ointment 2 oz. $7 611 Preparation-H Ointment 2 oz. $ Hemorrhoid Pads 100 $7 612 Tucks Medicated Pads 100 $ Hemorrhoid Relief Suppositories 12 $7 613 Preparation-H Suppositories 12 $10 LACTOSE INTOLERANCE 114 Lactase Enzyme 60 $ Schiff Digestive Advantage Lactose Capsules 32 $10 MOTION SICKNESS MEDICATION 115 Motion Sickness Tablets 12 $3 615 Dramamine Motion Sickness 12 $6 Call Customer Service to order your OTC items 7

10 ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT PEDICULICIDES (HEAD LICE TREATMENTS) 136 Lice Comb 1 $2 NA Lice Comb NA NA 137 Lice Treatment Shampoo 4 oz. $ LiceMD Lice Shampoo 4 oz. $12 SLEEPING AIDS 138 Night Time Sleep Tablets 24 $4 638 Sominex Tablets 16 $7 (Diphenhydramine) 139 Sleep Aid Tablets (Doxylamine) 16 $5 639 Unisom Tablets 16 $7 SMOKING CESSATION PRODUCTS 196 Nicotine Gum 2mg 20 $10 NA Nicotine Gum 2mg NA NA 197 Nicotine Gum 4mg 20 $10 NA Nicotine Gum 4mg NA NA TOPICAL OINTMENTS AND CREAMS 140 Anti-Itch Cream 1 oz. $3 640 Benadryl Cream 1 oz. $6 141 Clotrimazole 1% Cream 0.5 oz. $5 641 Lotrimin AF 0.42 oz. $ Cold Sore Treatment 1 $7 NA Herpecin NA NA 143 Hydrocortisone 1% 1 oz. $3 NA Cortaid NA NA Cream 144 Muscle Rub Cream 1.25 oz. $4 644 Bengay 2 oz. $6 145 Petroleum Jelly 4 oz. $3 645 Vaseline Jelly 3.75 $5 oz. 171 SPF 50 Sunblock 4 oz. $6 NA Coppertone SPF 50 Sunblock NA NA 146 Tolnaftate 1% Cream 1.25 oz. $5 646 Tinactin Cream 0.5 oz. $ Triple Antibiotic Ointment 1 oz. $6 647 Neosporin Ointment 0.5 oz. $7 VITAMINS AND MINERALS 148 Adult Multi-Vitamins 100 $8 NA Adult Multi-Vitamins NA NA 149 Calcium Vitamin D 60 $7 649 Caltrate D Tablets 60 $ Calcium Tablets 60 $5 NA Calcium Tablets NA NA 151 Ferrous Sulfate (Iron) 325mg Tablets 100 $6 NA Ferrous Sulfate (Iron) 325mg Tablets NA NA 152 Folic Acid 400mcg Tablets 100 $4 NA Folic Acid 400mcg Tablets NA NA 153 Magnesium 500mg Tablets 100 $4 NA Magnesium 500mg Tablets NA NA 8 Call Customer Service to order your OTC items

11 ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT VITAMINS AND MINERALS Continued 155 Vitamin A 10,000 IU 100 $4 NA Vitamin A 10,000 IU NA NA Softgel Softgel 156 Vitamin B $8 NA B-12 Vitamins NA NA 157 Vitamin B-Complex 100 $5 NA Vitamin B-Complex NA NA 158 Vitamin B-Complex 70 $8 NA Vitamin B-Complex NA NA Gummy Gummy 159 Vitamin C 500mg Tablets 100 $4 NA Vitamin C 500mg Tablets NA NA 193 Vitamin C Gummy 60 $8 NA Vitamin C Gummy NA NA 160 Vitamin E 400 IU Softgel 100 $7 NA Vitamin E 400 IU Softgel NA NA 161 Zinc 50mg Tablets 100 $5 NA Zinc 50mg Tablets NA NA Call Customer Service to order your OTC items 9

12 We re always just a phone call away! If you re ready to enroll or have enrollment questions, call , 8 a.m. to 8 p.m., 7 days a week. If you re already a member, call the number for your state/plan listed below. California: Easy Choice Freedom Plan (HMO SNP) Easy Choice Value Plan (HMO) Easy Choice Best Plan (HMO) Easy Choice Plus Plan (HMO) Hours of operation are Monday Friday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are available Monday Sunday, 8 a.m. to 8 p.m., or visit us anytime at Nurse Advice Line (24 hours, 7 days a week) TTY for all of the above

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16 Easy Choice Health Plan (HMO SNP), a WellCare company, is a Medicare Advantage organization with a Medicare contract and a contract with the California Medicaid program. Enrollment in Easy Choice (HMO SNP) depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments and restrictions may apply. Benefits, premiums and/or co-payments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. If you meet certain eligibility requirements for both Medicare and Medicaid, your Part B premiums may be covered in full. Some plans are available to those who have medical assistance from both the state and Medicare. Please contact Easy Choice for details. P.O. Box Tampa, FL