UCare s MSHO and UCare Connect + Medicare OTC List 2017
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1 UCare s MSHO and UCare Connect + Medicare OTC List 2017 The following list of over-the-counter (OTC) medications are covered for UCare s MSHO and UCare Connect + Medicare members. This drug list only includes the generic version of products. Some brand products are listed in parentheses for reference purposes only. This list is subject to change. If you have questions, please call either UCare s MSHO Customer Services at / , or call UCare Connect + Medicare Customer Services at / , TTY / , 8 a.m. to 8 p.m., seven days a week. ANALGESICS AND ANTI-INFLAMMATORY DRUGS acetaminophen (TYLENOL) aspirin (BAYER) aspirin / acetaminophen/ caffeine (EXCEDRIN) aspirin / buffers (BUFFERIN ibuprofen (MOTRIN) naproxen(aleve) COUGH AND COLD MEDICATIONS ANTIHISTAMINES cetirizine (ZYRTEC) diphenhydramine (BENADRYL) loratadine (CLARITIN) DECONGESTANTS phenylephrine (SUDAFED PE) pseudoephedrine (SUDAFED) ANTIHISTAMINE / DECONGESTANT COMBINATIONS cetirizine / pseudoephedrine (ZYRTEC - D) loratadine / pseudoephedrine (CLARITIN - D) phenylephrine / acetaminophen phenylephrine / guaifenesin pseudoephedrine / ibuprofen psueodoephedrine / acetaminophen ANTITUSSIVES AND EXPECTORANT DRUGS dextromethorphan (ROBITUSSIN) dextromethorphan / phenylephrine dextromethorphan / phenylephrine / acetaminophen dextromethorphan / pseudoephedrine dextromethorphan / pseudoephedrine / acetaminophen guaifenesin (MUCINEX) guaifenesin / dextromethorphan (MUCINEX DM) guaifenesin / dextromethorphan / phenylephrine guaifenesin / dextromethorphan / pseudoephedrine guaifenesin / dextromethorphan / pseudoephedrine / acetaminophen guaifenesin / phenylephrine guaifenesin / pseudoephedrine
2 DERMATOLOGICAL DRUGS ANTIACNE DRUGS benzoyl peroxide benzoyl peroxide / aloe vera KEROLYTIC DRUGS salicylic acid salicylic acid / acetic acid (COMPOUND W) SCABICIDES permethrin (NIX) piperonyl / pyrethrins (RID) TOPICAL ANESTHETICS pramoxine (PROCTO-FOAM) TOPICAL ANTIBACTERIAL DRUGS bacitracin bacitracin / polymyxin b (POLYSPORIN) chlorhexidine neomycin / bacitracin / polymixin (NEOSPORIN) neomycin / bacitracin / polymixin / pramoxine (NEOSPORIN PLUS) TOPICAL ANTIFUNGALS clotrimazole (LOTRIMIN) miconazole (MICATIN) terbinafine (LAMISIL) tolnaftate (TINACTIN) TOPICAL CORTICOSTEROIDS hydrocortisone / aloe vera hydrocortisone OTHER TOPICAL DERMATOLOGICAL DRUGS ammonium lactate (AMLACTIN) calamine calamine / zinc oxide capsaicin (ZOSTRIX) chloroxylenol diphenhydramine diphenhydramine / calamine diphenhydramine / zinc glyceryl / dimethicone / petrolatum (CETAPHIL) hydrogen peroxide methyl salicylate / menthol / camphor (BENGAY) salonpas mineral oil / petrolatum (AQUAPHOR, EUCERIN) petrolatum (VASELINE) povidone-iodine (BETADINE) pramoxine / calamine trolamine salicylate (MYOFLEX)
3 urea (CARMOL) zinc oxide (DESITIN) EAR / NOSE / THROAT MEDICATIONS DRUGS AFFECTING THE EAR carbamide peroxide (DEBROX) DRUGS AFFECTING THE NOSE cromolyn (NASALCROM) Nasacort AQ 24hr oxymetazoline (AFRIN) phenylephrine (NEO-SYNEPHRINE) sodium chloride DRUGS AFFECTING THE THROAT zinc GASTROINTESTINAL DRUGS ANTACIDS aluminum hydroxide (ALTERNAGEL) calcium carbonate (TUMS) calcium carbonate / magnesium hydroxide (MYLANTA SUPREME) magnesium carbonate / aluminum hydroxide (GAVISCON) magnesium hydroxide / aluminum hydroxide / simethicone (MYLANTA) magnesium hydroxide / aluminum hydroxide (MAALOX) magnesium oxide (URO-MAG) sodium bicarbonate ANTIDIARRHEAL DRUGS bismuth subsalicylate (PEPTO-BISMOL) loperamide (IMMODIUM) ANTIULCER DRUGS famotidine (PEPCID) lansoprazole (PREVACID) ranitidine (ZANTAC) omeprazole (PRILOSEC) LAXATIVES AND CATHARTICS bisacodyl (DULCOLAX) docusate calcium (SURFAK) docusate sodium (COLACE) glycerin magnesium citrate (CITROMA) magnesium hydroxide (PHILLIPS' MOM) methylcellulose (CITRUCEL) mineral oil polycarbophil polyethylene glycol 3350 (MIRALAX) psyllium (METAMUCIL) senna / docusate sodium (PERI-COLACE)
4 sennosides / calcium (EX-LAX) OTHER GI DRUGS hamamelis leaf / glycerin (TUCKS) lactase (LACTAID) phenylephrine phenylephrine / shark liver / petrolatum (PREPARATION H) simethicone (MYLICON) sorbitol witch hazel MISCELLANEOUS (OTHER) PRODUCTS dimenhydrinate (DRAMAMINE) levonorgestrel (PLAN B) meclizine phenazopyridine (AZO) OPHTHALMIC DRUGS carboxymethylcellulose drops dextran 70/he-cell drops (TEARS NATURALE-II) glycerin/propylene glycol drops hydroxypropylmethylcellulose drops (GENTEAL) hypromellose drops (GENTEAL MILD) ketotifen drops (ZADITOR) lanolin/mineral oil/petrolatum ointment mineral oil/petrolatum ointment (LACRI-LUBE S.O.P.) naphazoline /pheniramine drops (NAPHCON-A) polyvinyl alcohol / povidone drops (REFRESH) polyvinyl alcohol drops (HYPOTEARS) propylene glycol (SYSTANE) propylene glycol / PEGs (SYSTANE ULTRA) sodium chloride sodium chloride / petrolatum / mineral oil (REFRESH PM) tetrahydrazoline drops (VISINE) SMOKING CESSATION PRODUCTS nicotine (NICODERM) nicotine gum nicotine polacrilex (COMMIT) VAGINAL ANTIFUNGALS clotrimazole (GYNE-LOTRIMIN) miconazole (MONISTAT) VITAMINS AND RELATED PRODUCTS MINERALS/ELECTROLYTES calcium carbonate calcium citrate calcium glubionate
5 calcium gluconate calcium lactate calcium / magnesium calcium / magnesium / zinc chromium electrolyte solution (pediatric) ferrous gluconate ferrous sulfate magnesium chloride magnesium gluconate magnesium oxide potassium chloride potassium gluconate selenium sodium chloride zinc gluconate zinc sulfate MISCELLANEOUS NUTRIENTS beta-carotene biotin glucose VITAMINS cyanocobalmin (vitamin B12) folic acid niacin niacinamide pantothenic acid pyridoxine (vitamin b6) riboflavin (vitamin b2) thiamine (vitamin b1) vitamin a vitamin c vitamin d vitamin e VITAMIN COMBINATION PRODUCTS beta carotene / vitamin c / vitamin e / minerals calcium carbonate / vitamin d calcium carbonate / vitamin d / minerals folic acid / vitamin b complex / vitamin c multivitamins multivitamins / iron multivitamins / minerals multivitamins / minerals / iron prenatal vitamin vitamin a / vitamin d vitamin a / vitamin c / vitamin d vitamin b complex
6 vitamin b complex / folic acid vitamin b complex / minerals vitamin b complex / vitamin c vitamin b complex / vitamin c / vitamin e / zinc vitamin c / vitamin e
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