Over-the-Counter (OTC) Catalog Get the OTC items you need.

Transcription

1 2015 Over-the-Counter (OTC) Catalog Get the OTC items you need. Medicare Advantage Plans H5087_CA027266_WCM_OTC_ENG CMS Accepted WellCare 2014 CA_07_14_EC EC5OTCCAT60343E

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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 a couple of 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. Call Customer Service to order your OTC items 1 EC5OTCCAT60343E

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 In-home testing and monitoring Hormone replacement 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. You cannot order them from us, and if you buy these items at a store, we can t repay you for them. 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 items you want. We ll send them to your home and deduct the amount from your monthly benefit. ID# OUR CATALOG ITEMS ACNE TREATMENT Benzoyl Peroxide Gel Benzoyl Peroxide Gel 45gm $ % 10% ALLERGY Cold & Allergy PE Cold & Allergy PE 24ct $ Diphenhydramine Benadryl Allergy 100ct $ mg Capsules Softgels Dye Free 24ct $ Nasal Spray 1oz $ Afrin Nasal Spray Original 0.5oz $7.50 Loratadine 10mg Loratadine 10mg ct $4.00 Loratadine 10mg Loratadine 10mg ct $ Saline Nasal Spray 1.5oz $ Ocean Nasal Spray 1.5oz $4.50 Cetirizine 10mg ct $11.50 Zyrtec OTC Adult mg 24-Hour Tab 5ct $9.00 Sinus & Allergy PE Sinus & Allergy PE ct $3.50 Afrin Nasal Spray Afrin Nasal Spray 0.5oz Sinus Sinus 0.5oz $7.50 Allegra OTC 180mg Allegra OTC 180mg 15ct Hour 24-Hour 15ct $19.00 Allegra OTC 60mg 12-Hour 12ct * = Quantities and brands may vary depending upon availability. = Dual-purpose items ** = Covered under either Part B or Part D Allegra OTC 60Mg 12-Hour 12ct $13.50 Call Customer Service to order your OTC items 3

6 ANTACID / ACID REDUCERS Antacid (Antigas) Antacid (Antigas) ct $ mg 80mg Antacid Assorted Tums 150ct $ Regular Assorted Fruit 150ct $ Antacid Chewable Extra Strength 96ct $3.50 Tums Extra Strength Assorted 96ct $ Antacid Liquid DS 12oz $4.50 Antacid Liquid DS Antacid Regular Antacid Regular oz $4.50 Strength Liquid Strength Liquid Effervescent Pain Relief 36ct $ Alka-Seltzer Original 24ct $ Famotidine 10mg Famotidine 10mg 70ct $ Famotidine Pepcid AC 30ct $ mg Original Strength 30ct $13.50 Gas Relief Softgel Extra Strength 30ct Gas-X Extra Strength $ Softgels 10ct $ Milk of Magnesia 12oz $4.00 Milk of Magnesia Pink Bismuth Liquid 8oz $3.50 Pepto-Bismol Liquid Original 8oz $5.50 Pink Bismuth Chewable 30ct $ Pepto-Bismol Caplets Original 40ct $9.50 Ranitidine 75mg ct $ Zantac 75mg 30ct $13.00 Alka-Seltzer Alka-Seltzer 12ct Original Original 12ct $3.50 Gas-X Chew Tab Gas-X Chew Tab 36ct Peppermint Peppermint 36ct $7.50 Gas-X Extra Strength Cherry Crème 18ct Gas-X Extra Strength Cherry Crème 18ct $6.00 Nexium 24-Hour Heartburn Relief 20mg Prevacid OTC 24-Hour Capsules Prilosec OTC 20mg Tab 14ct ct ct Nexium 24-Hour Heartburn Relief 20mg Prevacid OTC 24-Hour Capsules Prilosec OTC 20mg Tab 14ct $ ct $ ct $ Call Customer Service to order your OTC items

7 ANTACID / ACID REDUCERS Rolaids Extra Strength Chewable 96ct Rolaids Extra Strength Chewable 96ct $6.00 Fruit Fruit Rolaids Regular Rolaids Regular Strength Chewable 150ct Strength Chewable 150ct $6.00 Mint Mint Tagamet HB OTC 200mg 6ct Tagamet HB OTC mg 6ct $3.50 Tums Extra Strength Tums Extra Strength Smoothies Tab 60ct Smoothies Tab 60ct $6.50 Assorted Fruit Assorted Fruit Zantac 75mg 10ct Zantac 75mg 10ct $6.50 Zegerid OTC 20mg 14ct Zegerid OTC 20mg 14ct $15.00 ANTI-DIARRHEAL Anti-Diarrheal Caplet 24ct $5.50 Anti-Diarrheal Caplet Anti-Diarrheal Caplet 12ct $3.50 Anti-Diarrheal Caplet Imodium A-D Liquid Cool Mint 4oz Imodium A-D Liquid Cool Mint 4oz $7.50 Kaopectate Liquid Regular Flavor 8oz Kaopectate Liquid Regular Flavor 8oz $6.00 ANTI-FUNGAL Athletes Antifungal Lamisil AT Athletes oz $ Foot Cream Foot Cream 12gm $ Clotrimazole 1% Cream 1oz $ Lotrimin AF Cream 24gm $ Miconazole Nitrate Cream 2% 30gm $6.50 Miconazole Nitrate Cream 2% Tolnaftate 1% Cream 1oz $5.50 Tolnaftate 1% Cream Tolnaftate 1% Powder 1.5oz $4.00 Tolnaftate 1% Powder Fungi Nail Tincture 30ml Fungi Nail Tincture 30ml $14.50 Lamisil Defense Lamisil Defense 4.6oz Spray Powder Spray Powder 4.6oz $8.50 Lotrimin AF Liquid Lotrimin AF Liquid 4.6oz Spray Spray 4.6oz $9.00 Call Customer Service to order your OTC items 5

8 Lotrimin AF Powder Spray Mycocide NS Antimicrobial Sol ANTI-FUNGAL 4.6oz oz ANTI-ITCH Lotrimin AF Powder Spray Mycocide NS Antimicrobial Sol 6 Call Customer Service to order your OTC items 4.6oz $9.00 1oz $ Calamine Lotion 6oz $ Caladryl Lotion 6oz $ Diphenhydramine Cream 2% Hydrocortisone 1% Anti-Itch Cream Benadryl Regular Strength Itch Relief 1% Cream Cortizone-10 Intensive Healing Formula Anti-Itch Crème Gold Bond Medicated Maximum Strength Cream 1oz $ oz $ oz oz oz Benadryl Extra Strength Itch Stopping 2% Cream Cortaid Anti-Itch Maximum Strength Cream 1% Benadryl Regular Strength Itch Relief 1% Cream Cortizone-10 Intensive Healing Formula Anti-Itch Crème Gold Bond Medicated Maximum Strength Cream 1oz $6.00 1oz $7.00 1oz $5.50 1oz $6.50 1oz $5.00 Psoriasin Ointment 4oz Psoriasin Ointment 4oz $11.50 ANTISEPTIC OINTMENTS / CREAMS Bacitracin Zinc Bacitracin Zinc 1oz $6.00 Ointment Ointment Triple Antibiotic Neosporin Original oz $ Ointment Antibiotic Ointment 1oz $10.00 Bactine Liquid 4oz Bactine Liquid 4oz $5.50 Neosporin Plus Maximum Strength Ointment Neosporin Plus Maximum Strength Ointment 0.5oz oz Neosporin Plus Maximum Strength Ointment Neosporin Plus Maximum Strength Ointment 0.5oz $7.00 1oz $11.50

9 All Night Cold Original Liquid Effervescent Cold Relief Medicated Chest Rub Mucus Relief DM COLD / COUGH / FLU REMEDIES 8oz $ Vicks NyQuil Liquid 8oz $ ct $ Alka-Seltzer Plus Cold Effervescent Original 20ct $ oz $ Vicks VapoRub 3.53oz $ ct $ Mucus Relief 60ct $ Sudogest PE Tab 10mg Tussin DM Sugar Free Liquid Clear 36ct $6.00 4oz $ Mucinex DM Extended Release Mucinex Extended Release Sudogest PE Tab 10mg Robitussin DM Sugar Free Peak Cold Cough/Congestion 20ct $ ct $ oz $ Tussin Form 8oz $5.00 Tussin Form Robitussin Peak Tussin Form CF 8oz $ Cold Max Multi- 4oz $8.50 Symptom Liquid Robitussin DM Tussin Form DM 8oz $ Peak Cold Cough/ 4oz $7.00 Congestion Alka-Seltzer Plus Alka-Seltzer Plus Cold Formula Cold Formula 36ct Effervescent Effervescent 36ct $10.00 Original Original Chloraseptic Sore Throat Spray Menthol Contac Cold/Flu Day/Night Caplet Coricidin HBP Chest Congestion & Cough Liqui-Gels 6oz ct ct Chloraseptic Sore Throat Spray Menthol Contac Cold/Flu Day/Night Caplet Coricidin HBP Chest Congestion & Cough Liqui-Gels 6oz $ ct $ ct $7.50 Call Customer Service to order your OTC items 7

10 Coricidin HBP Maximum Strength Flu Mucinex DM Maximum Strength Vicks DayQuil Liquid Capsules Vicks NyQuil Liquid Capsules COLD / COUGH / FLU REMEDIES Coricidin HBP 20ct Maximum Strength Flu Mucinex DM 14ct Maximum Strength 24ct Vicks DayQuil Liquid Capsules 24ct Vicks NyQuil Liquid Capsules 20ct $ ct $ ct $ ct $11.50 Vicks VapoRub 1.76oz Vicks VapoRub 1.76oz $6.00 Vicks VapoRub 6oz Vicks VapoRub 6oz $15.50 EAR CARE Debrox Drops Debrox Drops 0.5oz Earwax Removal Aid Earwax Removal Aid 0.5oz $7.00 EYE CARE Artificial Tears 0.5oz $8.00 Artificial Tears Eye Drops 0.5oz $ Visine Original Eye Drops 0.5oz $6.00 Bausch & Lomb Soothe Hydration Lubricant Eye Drops Clear Eyes Itchy Eye Relief Drops 15ml oz Bausch & Lomb Soothe Hydration Lubricant Eye Drops Clear Eyes Itchy Eye Relief Drops 15ml $ oz $5.00 Refresh Liquigel 0.5oz Refresh Liquigel 0.5oz $12.50 Thera Tears Sterilid Thera Tears Sterilid 1.62oz Lid Scrub Lid Scrub 1.62oz $19.00 Visine A Drops 0.5oz Visine A Drops 0.5oz $7.50 FIBER SUPPLEMENTS Fiber Laxative Fiber Laxative ct $10.50 Caplets Caplets Fiberlax 90ct $ FiberCon 90ct $ Natural Fiber Powder 13oz $9.50 Natural Fiber Powder Metamucil Capsules 100ct Metamucil Capsules 100ct $19.50 Metamucil Fiber Metamucil Fiber 24ct Wafers Cinnamon Wafers Cinnamon 24ct $ Call Customer Service to order your OTC items

11 FIRST AID SUPPLIES Adhesive Fabric BAND-AID Flexible 30ct $ Strips Assorted Fabric Assorted Sizes 30ct $ Adhesive Pads Non- Adhesive Pads Non- 10ct $3.50 Stick Large 3in X 4in** Stick Large 3in X 4in** Adhesive Sheer BAND-AID Comfort- 60ct $ Strips Assorted Flex Sheer Assorted 60ct $3.50 Adhesive Tape Adhesive Tape ea $2.50 1/2in X 5yd** 1/2in X 5yd** Johnson & Johnson Adhesive Waterproof ea $ Tape Waterproof Tape 1/2in X 10yd** 1/2in X 10yd** 1ea $ Alcohol Prep Pads** 100ct $ BD Alcohol Swabs** 100ct $ Cotton Balls 300ct $4.00 Cotton Balls Cotton Swabs 300ct $4.50 Cotton Swabs Hydrogen Peroxide Hydrogen Peroxide 16oz $3.50 3% 3% Sterile Pads Johnson & Johnson ct $ in X 3in** Gauze 4in X 4in Pad** 25ct $ Thermometer Digital Thermometer Digital 1ea $8.00 Flexible Tip Flexible Tip ACE Bandage Velcro ACE Bandage Velcro 1ea in 2in 1ea $5.00 ACE Bandage Velcro ACE Bandage Velcro 1ea in 3in 1ea $8.00 ACE Cold Compress ACE Cold Compress 1ea Reusable Reusable 1ea $7.00 ACE Elastic Bandage ACE Elastic Bandage 1ea in 3in 1ea $8.00 BD Basic BD Basic 1ea Thermometer Digitial Thermometer Digitial 1ea $5.00 Ice Bag 9in 1ea Ice Bag 9in 1ea $9.50 Lanacane Antibacterial First Aid Spray Maximum Strength 3.5oz Lanacane Antibacterial First Aid Spray Maximum Strength 3.5oz $7.50 Call Customer Service to order your OTC items 9

12 FIRST AID SUPPLIES Johnson & Johnson Johnson & Johnson 1ea First Aid Kit 140 Items First Aid Kit 140 Items 1ea $13.50 New-Skin Liquid New-Skin Liquid 1oz Bandage Bandage 1oz $6.00 Nexcare Comfort Nexcare Comfort 35ct Strip 3/4in Strip 3/4in 35ct $3.00 Purell Hand Sanitizer 8oz Purell Hand Sanitizer 8oz $4.00 Vaseline Petroleum Vaseline Petroleum 13oz Jelly Jelly 13oz $6.00 Vicks Comfortflex Vicks Comfortflex 1ea Thermometer Thermometer 1ea $15.50 FOOT CARE Dr. Scholl s Callous Dr. Scholl s Callous 1ea Remover One Step Remover One Step 1ea $5.50 Dr. Scholl s Corn Remover Extra Thick Pads Dr. Scholl s Corn Cushion Regular 1ea ct Dr. Scholl s Corn Remover Extra Thick Pads Dr. Scholl s Corn Cushion Regular 1ea $3.50 9ct $3.50 ID# PACK CONTAINS AMT HOME CARE KITS Cough Peak Max Multi- Symptom Cold And Pack Contains: Robitussin Peak CF Max Multi- Symptom Cold 4oz, BD Basic Oral Thermometer, $18.00 Fever Combo Acetaminophen 325mg 100ct Pack Contains: Eye Drops 0.5oz, Mack s Wax Away Ear Eye And Nose Combo $12.00 Removal System, Saline Nasal Spray 1.5oz Pack Contains: Hydrogen Peroxide 16oz, Triple First Aid Essentials Antibiotic Ointment 1oz, BAND-AID Flexible $15.00 Fabric Strips 30ct Hemorrhoid Care Combo Pack Contains: Tucks Pads 40ct, Hemorrhoidal Cream 1.8oz $ Oral Care Combo Pack Contains: Crest Toothpaste 3.6oz, Dental Floss 100yds, Toothbrush Full Head, Soft $ Pain Relief Combo Pack Contains: Arthritis Pain Reliever Caplets 50ct, Icy Hot Pain Relieving Cream 1.25oz $ Call Customer Service to order your OTC items

13 HEMORRHOIDAL CARE Antiseptic Cleansing Pads 100ct $ Tucks Medicated Pads 100ct $ Hemorrhoidal Cream 1.8oz $ Preparation H Cream Maximum Strength 0.9oz $ Hemorrhoidal Preparation H 12ct $ Suppositories Suppositories 24ct $17.50 Preparation H Preparation H 2oz Ointment Ointment 2oz $15.50 Tucks Medicated Pads 40ct Tucks Medicated Pads 40ct $6.50 INCONTINENCE A&D Ointment 4oz A&D Ointment 4oz $6.00 Balmex Clear Balmex Clear 3.5oz Protection Ointment Protection Ointment 3.5oz $6.00 Balmex Diaper Rash Cream With Zinc 4oz Balmex Diaper Rash Cream With Zinc 4oz $5.50 Oxide Oxide Desitin Ointment 2oz Desitin Ointment 2oz $5.50 Fitted Briefs Extra Fitted Briefs Extra 15ct Large (Diapers) Large (Diapers) 15ct $15.00 Fitted Briefs Large Fitted Briefs Large 18ct (Diapers) (Diapers) 18ct $15.00 Fitted Briefs Fitted Briefs 16ct Medium (Diapers) Medium (Diapers) 16ct $15.00 Perfit Protective Underwear Extra Large Perfit Protective Underwear Large Perfit Protective Underwear Medium Prevail Bladder Control Pads, Moderate Prevail Underpad (Bed Liners) 30in X 36in 14ct ct ct ct ct Perfit Protective Underwear Extra Large Perfit Protective Underwear Large Perfit Protective Underwear Medium Prevail Bladder Control Pads, Moderate Prevail Underpad (Bed Liners) 30in X 36in 14ct $ ct $ ct $ ct $ ct $25.00 Call Customer Service to order your OTC items 11

14 Surecare Protective Underwear Extra Large Surecare Protective Underwear Large Surecare Protective Underwear Medium INCONTINENCE Surecare Protective 14ct Underwear Extra Large 18ct Surecare Protective Underwear Large Surecare Protective 18ct Underwear Medium LACTOSE INTOLERANT 14ct $ ct $ ct $20.00 Lactaid Caplets 120ct Lactaid Caplets 120ct $18.50 Lactaid Fast Act Lactaid Fast Act 32ct Caplets Caplets 32ct $11.00 LAXATIVES Bisacodyl 5mg 100ct $7.00 Bisacodyl 5mg Bisacodyl 5mg 25ct $ Dulcolax 5mg 25ct $ Clearlax Powder 4.1oz $ MiraLAX Pwd 7 doses 4.1oz $ Clearlax Powder 8.3oz $ MiraLAX Powder 8.3oz $ Magnesium Citrate Magnesium Citrate 10oz $3.00 Cherry Cherry Magnesium Citrate Magnesium Citrate 10oz $3.00 Lemon Lemon Natural Laxative Plus Stool Softener 60ct $5.00 Natural Laxative Plus Stool Softener Senna 100ct $ Senokot -S 30ct $ Stool Softener Stool Softener 100ct $4.50 Softgels Softgels Ex-Lax Pieces Ex-Lax Pieces 24ct Regular Strength Regular Strength 24ct $6.00 Ex-Lax Ex-Lax 30ct Regular Strength Regular Strength 30ct $7.50 Fleet Enema Adult 4.5oz Fleet Enema Adult 4.5oz $4.00 Fleet Glycerin Fleet Glycerin 24ct Suppository Suppository 24ct $ Call Customer Service to order your OTC items

15 LICE TREATMENT Nix Control Spray Nix Control Spray 5oz Pump Pump 5oz $8.00 Nix Lice Treatment Nix Lice Treatment 2oz Creme Rinse Single Creme Rinse Single 2oz $14.00 Nix Lice Treatment 2oz x Nix Lice Treatment 2oz x $23.00 Creme Rinse 2oz Creme Rinse 2oz LOZENGES Cough Drops Black Cough Drops Black ct $2.00 Cherry Sugar Free Cherry Sugar Free Cough Drops Cherry 30ct Halls Mentho-Lyptus $ Drops Cherry 30ct $ Cough Drops Honey Halls Cough Drop 30ct $ Lemon Honey Lemon 30ct $3.00 Cepacol Maximum Strength Lozenge 16ct Cepacol Maximum Strength Lozenge 16ct $4.00 Honey Lemon Honey Lemon Halls Defense Halls Defense Vitamin C Drops Vitamin C Drops 25ct Sugar Free Assorted Sugar Free Assorted 25ct $3.00 Citrus Citrus Halls Defense Zinc Drops Harvest 25ct Halls Defense Zinc Drops Harvest 25ct $3.00 Cherry Cherry MISCELLANEOUS CARE** Lumiscope Self- Lumiscope Self- Taking Blood Taking Blood 1ea Pressure Kit With Pressure Kit With 1ea $17.50 Stethoscope Stethoscope MOTION SICKNESS Motion Sickness Tab 12ct $ Dramamine 50mg 12ct $5.50 Bonine 8ct Bonine 8ct $4.50 ORAL CARE Dental Floss 100yd 1ea $2.50 Dental Floss 100yd Dental Floss Mint Dental Floss Mint ea $2.50 Waxed 100yd Waxed 100yd Toothbrush Full Head Soft 1ea $1.50 Toothbrush Full Head Soft Call Customer Service to order your OTC items 13

16 ORAL CARE Anbesol Gel Regular Anbesol Gel Regular 0.33oz Strength Cool Mint Strength Cool Mint 0.33oz $7.00 Anbesol Liquid Regular Strength 0.41oz Anbesol Liquid Regular Strength 0.41oz $7.00 Cool Mint Cool Mint Colgate Toothpaste Colgate Toothpaste 8.2oz Regular Super Regular Super 8.2oz $5.00 Efferdent Denture Efferdent Denture 40ct Cleanser Cleanser 40ct $4.00 Fixodent Denture Adhesive Cream 2.5oz Fixodent Denture Adhesive Cream 2.5oz $7.00 Original Original Fixodent Fresh 2.5oz Fixodent Fresh 2.5oz $7.00 Orajel Maximum Orajel Maximum 0.25oz Strength Gel Strength Gel 0.25oz $7.00 Orajel Mouth Sore Orajel Mouth Sore 0.18oz Gel Gel 0.18oz $6.50 Polident 3 Minute Polident 3 Minute 120ct ct $10.00 Polident Overnight Polident Overnight 120ct Cleanser Cleanser 120ct $10.00 Sea-Bond Denture Adhesive Lowers Original 15ea Sea-Bond Denture Adhesive Lowers Original 15ea $4.00 Sea-Bond Denture Adhesive Uppers Original Sensodyne Toothpaste Original Flavor Super Poligrip Denture Adhesive Cream Zinc Free Formula Toothpaste Crest Large 15ea oz oz oz Sea-Bond Denture Adhesive Uppers Original Sensodyne Toothpaste Original Flavor Super Poligrip Denture Adhesive Cream Zinc Free Formula Toothpaste Crest Large 15ea $4.00 4oz $ oz $ oz $ Call Customer Service to order your OTC items

17 PAIN RELIEVERS Acetaminophen Tylenol 325mg 100ct $ mg 100ct $ Acetaminophen Extra Strength 500mg 100ct $ Tylenol Extra Strength 500mg 100ct $14.50 Caplets Acetaminophen Acetaminophen Extra Strength Rapid 100ct $7.50 Extra Strength Rapid Release Gels 500mg Release Gels 500mg Arthritis Pain Relief Arthritis Pain Relief ct $7.50 Caplet Caplet Aspirin 325mg 100ct $ Bayer 325mg 100ct $ Bayer Adult 81mg Aspirin Adult Enteric 120ct $ Enteric Coated Low Coated 81mg Dose Aspirin 120ct $10.00 Aspirin Child Chew Bayer Child Chew ct $ mg Aspirin Low Dose 36ct $ Aspirin Enteric Coated 325mg Headache Relief Added Strength Ibuprofen 200mg Caplet Ibuprofen 200mg Caplet Ibuprofen 200mg Ibuprofen Child Susp Berry Migraine Relief Caplet Naproxen Sodium Caplet Non-Aspirin Child Chewable 80mg Fruit 125ct $ ct $5.50 Ecotrin 325mg Regular Strength Headache Relief Added Strength 125ct $ ct $ Advil 200mg Caplet 100ct $ ct $ Advil 200mg Caplets 50ct $ ct $ Advil 200mg 100ct $ oz $ ct $4.00 Advil Child Suspension Fruit Migraine Relief Caplet 4oz $ ct $ Aleve 220mg Caplet 100ct $ ct $4.00 Non-Aspirin Child Chewable 80mg Fruit Call Customer Service to order your OTC items 15

18 PAIN RELIEVERS Pain Reliever PM Pain Reliever PM 50ct $4.00 Extra Strength Caplet Extra Strength Caplet Sleep Aid 16ct $3.50 Sleep Aid Advil 200mg Gel Advil 200mg Gel 24ct Caplets Caplets 24ct $5.50 Advil 200mg Liqui-Gel 80ct Advil 200mg Liqui-Gel 80ct $16.00 Advil 200mg Liqui-Gel 20ct Advil 200mg Liqui-Gel 20ct $6.00 Advil 200mg Advil 200mg 20ct Migraine Liqui-Gels Migraine Liqui-Gels 20ct $6.00 Advil 200mg 24ct Advil 200mg 24ct $5.50 Advil 200mg Advil 200mg 150ct EZ Open EZ Open 150ct $19.00 Advil PM Caplet 40ct Advil PM Caplet 40ct $10.50 Aleve 220mg Arthritis Aleve 220mg Arthritis 40ct Gelcaps Easy Open Gelcaps Easy Open 40ct $9.50 Aleve 220mg Caplets 50ct Aleve 220mg Caplets 50ct $9.50 Aleve 220mg Caplets 24ct Aleve 220mg Caplets 24ct $5.50 Aleve 220mg Liqu-Gels 40ct Aleve 220mg Liqu-Gels 40ct $12.00 Aleve 220mg 24ct Aleve 220mg 24ct $5.50 Aleve 220mg 100ct Aleve 220mg 100ct $15.00 Anacin 100ct Anacin 100ct $11.50 Bayer 325mg 200ct Bayer 325mg 200ct $14.00 BC Arthritis Powder 24ct BC Arthritis Powder 24ct $5.00 BC Headache Powder 24ct BC Headache Powder 24ct $5.00 Midol Maximum Midol Maximum Strength Menstrual Form Caplet 24ct Strength Menstrual Form Caplet 24ct $7.00 Midol Maximum Strength Menstrual Form Gelcap Motrin IB 200mg Caplet Pamprin Cramp Max Relief Caplet Pamprin Multi- Symptom Caplets 24ct ct ct ct Midol Maximum Strength Menstrual Form Gelcap Motrin IB 200mg Caplet Pamprin Cramp Max Relief Caplet Pamprin Multi- Symptom Caplets 16 Call Customer Service to order your OTC items 24ct $ ct $ ct $ ct $5.00

19 St. Joseph Adult Aspirin 81mg Chew Tab Tylenol Extra Strength 500mg Caplets PAIN RELIEVERS St. Joseph Adult 36ct Aspirin 81mg Chew Tab Tylenol Extra 24ct Strength 500mg Caplets SKIN CARE / SUNSCREEN 8oz Banana Boat Sport Sunblock SPF 30 Banana Boat 6oz Ultramist Sport Clear SPF 50 36ct $ ct $5.00 Banana Boat Sport Sunblock SPF 30 8oz $10.50 Banana Boat Ultramist Sport Clear 6oz $12.00 SPF 50 SMOKING CESSATION Nicotine Gum 2mg 50ct $25.00 Nicotine Gum 2mg Nicotine Gum 4mg 50ct $25.00 Nicotine Gum 4mg Nicotine Patch Step 1 21mg Nicotine Patch Step 2 14mg Nicotine Patch Step 3 7mg Futuro Ankle Support Wrap Around Medium Futuro Ankle Support Wrap Around Large Futuro Knee Support Stabilizing Large Futuro Knee Support Stabilizing Medium Jobst Women s Sheer Knee High 8-15mmHg Medium Silky Beige Jobst Women s Sheer Knee High 8-15mmHg Small Silky Beige 7ct $24.50 Nicotine Patch Step 1 21mg 7ct $24.50 Nicotine Patch Step 2 14mg 7ct $24.50 Nicotine Patch Step 3 7mg SUPPORT 1ea Futuro Ankle Support Wrap Around Medium 1ea Futuro Ankle Support Wrap Around Large 1ea Futuro Knee Support Stabilizing Large Futuro Knee Support 1ea Stabilizing Medium Jobst Women s 1ea Sheer Knee High 8-15mmHg Medium Silky Beige Jobst Women s Sheer 1ea Knee High 8-15mmHg Small Silky Beige 1ea $ ea $ ea $ ea $ ea $ ea $13.00 Call Customer Service to order your OTC items 17

20 TOPICAL Muscle Rub Ultra Bengay Pain Relieving oz $ Strength Cream Ultra Strength 2oz $7.00 Abreva Cold Sore Abreva Cold Sore 2gm Cream Cream 2gm $24.50 Activon Ultra Strength Arthritis 2oz Activon Ultra Strength Arthritis 2oz $11.50 Topical Analgesic Topical Analgesic Aspercreme Heat Aspercreme Heat 2.5oz Pain Relieving Gel Pain Relieving Gel 2.5oz $7.00 Aspercreme Pain Aspercreme Pain 3oz Relieving Rub Relieving Rub 3oz $7.00 Bengay Pain Relieving Cream Ultra 4oz Bengay Pain Relieving Cream Ultra 4oz $10.00 Strength Strength Bengay Ultra Bengay Ultra Strength Pain Strength Pain 5ct Relieving Patch Reg Relieving Patch Reg 5ct $9.50 Size Size Bengay Vanishing Bengay Vanishing 2oz Scent Rub Scent Rub 2oz $5.50 Capzasin Topical Analgesic Liquid No- 1oz Capzasin Topical Analgesic Liquid No- 1oz $10.00 Mess Applicator Mess Applicator Icy Hot Balm 3.5oz Icy Hot Balm 3.5oz $7.00 Icy Hot Cream 1.25oz Icy Hot Cream 1.25oz $5.00 Icy Hot Medicated Icy Hot Medicated Patches Extra 5ct Patches Extra 5ct $8.50 Strength Large (Back) Strength Large (Back) Icy Hot Patches Icy Hot Patches 5ct Arm/Neck/Leg Arm/Neck/Leg 5ct $7.00 Icy Hot Sleeve Large Icy Hot Sleeve Large 3ct Knee/Ankle/Elbow Knee/Ankle/Elbow 3ct $8.00 Stopain (Now Cryoderm ) SX 10% MSM Pain Relief Spray 4oz Stopain (Now Cryoderm ) SX 10% MSM Pain Relief Spray 4oz $ Call Customer Service to order your OTC items

21 ThermaCare Heatwraps 8HR Lower Back & Hip ThermaCare Heatwraps 8HR Neck/ Shoulder/Wrist ThermaCare Heatwraps Menstrual Zostrix High Potency Arthritis Pain Relief Cream Zostrix Original Strength Arthritis Pain Relief Cream Miconazole 7 Vaginal Cream Miconazole 7 Vaginal Suppositories Monistat 3 Cream Prefilled Applicator 3ct Vagistat-3 Combination Pack TOPICAL ThermaCare 2ct Heatwraps 8HR Lower Back & Hip ThermaCare 3ct Heatwraps 8HR Neck/ Shoulder/Wrist 3ct ThermaCare Heatwraps Menstrual Zostrix High Potency 2oz Arthritis Pain Relief Cream Zostrix Original 2oz Strength Arthritis Pain Relief Cream VAGINAL Monistat 7 Cream 45gm $ With Disposable Applicator 7ct $6.00 Miconazole 7 Vaginal Suppositories Monistat 3 Cream 3ct Prefilled Applicator 3ct 1ea Vagistat-3 Combination Pack VITAMINS 60ct $5.00 Caltrate 600mg + D ct $6.00 Cerovite Senior 100ct $6.00 Ferrous Sulfate 325mg Call Customer Service to order your OTC items 19 2ct $9.50 3ct $9.50 3ct $9.50 2oz $ oz $ oz $ ct $ ea $13.00 Calcium Carbonate mg + D 60ct $ Cerovite Senior Ferrous Sulfate 325mg Oyst-Cal + D 500mg 60ct $3.50 Oyst-Cal + D 500mg Prosight 60ct $8.50 Prosight Vitamin B mcg Vitamin B mcg ct $ Vitamin C 500mg 250ct $11.00 Vitamin C 500mg

22 VITAMINS Vitamin D Tab 400IU 100ct $5.00 Vitamin D Tab 400IU Vitamin E 400IU Vitamin E 400IU ct $11.50 Softgel Softgel Windmill Vitamin A Windmill Vitamin A 100ct $ IU Softgel 10000IU Softgel Windmill Vitamin B Complex With 100ct $8.00 Windmill Vitamin B Complex With Vitamin C + Iron Vitamin C + Iron Windmill Calcium Windmill Calcium 60ct $6.50 Chewable 500mg Tab Chewable 500mg Tab Windmill Folic Acid Windmill Folic Acid ct $ mcg Tabs 400mcg Tabs Centrum Silver 50+ Centrum Silver ct Ultra Men s Ultra Men s 100ct $15.50 Centrum Silver Centrum Silver 60ct Chewable Chewable 60ct $16.50 Centrum Silver 50+ Centrum Silver ct Ultra Women s Ultra Women s 100ct $15.50 Ester-C 500mg Ester-C 500mg 60ct ct $8.50 Ocuvite 60ct Ocuvite 60ct $11.50 Viactiv Calcium Viactiv Calcium 60ct Chew Carmel + D Chew Carmel + D 60ct $10.00 Viactiv Calcium Chew Milk Chocolate + D Vitafusion B Complex Chew Energy 60ct ct Viactiv Calcium Chew Milk Chocolate + D Vitafusion B Complex Chew Energy 60ct $ ct $5.00 WART REMOVAL Compound W Fast- Compound W Fast- 0.31oz Acting Liquid Acting Liquid 0.31oz $9.50 Compound W Gel 0.25oz Compound W Gel 0.25oz $9.50 Dr. Scholl s Clear Dr. Scholl s Clear Away One Step Wart Remover 1ea Away One Step Wart Remover 1ea $ Call Customer Service to order your OTC items

23 Easy Choice Health Plan Easy Choice Health Plan allows for the submission of retail receipts for items purchased that follow the Centers for Medicare & Medicaid Services (CMS) guidelines. Our catalog is representative of these types of items. Please refer to the catalog for the listings of items that are eligible for reimbursement and those that are not. Receipt totals will be deducted from the member s monthly benefit allowance for the month in which the purchase occurred. If the member s monthly benefit allowance has been exhausted, the request for reimbursement will be denied. To have a receipt reimbursement form sent to you, call , TTY 711, Monday-Friday, 6:30 a.m. 8:00 p.m. Pacific. Or visit to print the form. Completed forms should be mailed to: Drug Source PO.. Box 1366 Elk Grove Village, IL Please allow 30 days from the date the receipt and form were received for payment. For a list of eligible items, please refer to this catalog. Call Customer Service to order your OTC items 21

24 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: All Plans 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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27 Easy Choice Health Plan, a WellCare company, (HMO/HMO SNP) is a Medicare Advantage organization with a Medicare contract and a contract with the California Medicaid program. Enrollment in Easy Choice (HMO/HMO SNP) depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, co-payments and restrictions may apply. Benefits, premium and/ or co-payments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Please contact Easy Choice for details. P.O. Box Tampa, FL