Over the Counter Items Guide Do OTC items covered by the plan have any cost?

Transcription

1 Triples-S Advantage- Groups Plan (HMO) and Triples-S Advantage- Groups Plan (PPO) Over the Counter Items Guide This guide is effective from January 1, 2016 through December 31, For more information, contact our Call Center at this information is available for free, Monday to Sunday from 8:00am to 8:00pm. TTY users should call , or visit our website This guide contains a list of some common-use items, but it does not include all the items covered by the plan. This list has been chosen by a team of health care professionals, and represents the non-prescription therapies believed to be important in supplementing your treatment program with prescription drugs. What are Over the Counter (OTC) items? OTC items are non-prescription items that are not normally covered by the Medicare Part D prescription drug benefit. OTC items are used for the treatment of medical symptoms such as cough, cold, pain, diarrhea and upset stomach, among others. Do OTC items covered by the plan have any cost? Triple-S Advantage will provide coverage for these OTC items at no cost to you. The cost to Triple-S Advantage for these OTC items will not count toward your total prescription drugs costs and does not count towards qualifying for your Catastrophic Coverage Stage of the Medicare Part D prescription drugs. What are the rules for getting OTC items? Covered OTC items may have certain coverage limits: 1. Triple-S Advantage will cover up to a maximum dollar amount for OTC items every three months. After the maximum dollar amount is reached, Triple-S Advantage will not cover these items until the following three months, when the maximum quarterly coverage starts again. 2. OTC items must be obtained through the Triple-S Advantage network, and they may only be purchased by the enrollee. Triple-S Advantage Over the Counter Guide 2016 Page 1 of 13

2 3. Although OTC items do not require a prescription, Triple-S Advantage a written notification from your physician, so that the pharmacy may electronically process the OTC item through the pharmacy s payment system. What are the advantages of using OTC items? The use of OTC items allows the patient to have greater access to a variety of items available in the market for the treatment of some medical symptoms. In addition, it helps the patient to save money, because they usually cost less than other drugs. You may use OTC items to treat some medical symptoms. Consult your physician or pharmacist, and remember to always read the package labeling for specific instructions on how to take them, as well as any warnings or precautions you should consider when taking them. How do I use this OTC Items Guide? This guide classifies OTC items by category according to the most common symptoms they are used for. For example, items to treat cough and congestion are classified under the category Cough / Cold / Allergies. If you know what your OTC item is used for, look for the category name in the Table of Contents. Then look for your OTC item under that category. You can also look for the name of some OTC items examples in the alphabetical Index at the end of this document. Triple-S Advantage is a health management organization (HMO) and preferred provider organization (PPO) with a Medicare contract. Triple-S Advantage is an independent Licensee of the Blue Cross and Blue Shield Association. Enrollment in Triple-S Advantage depends on contract renewal. This information is available for free in other languages. Please contact our Member Services number at for additional information. (TTY users should call ) Hours are Monday through Sunday from 8:00am to 8:00pm; calls to these numbers are free. Member Services has free language interpreter services available for non-spanish speakers. Esta información está disponible en otros idiomas. Comuníquese con nuestro número de Servicios al Cliente al para obtener información adicional (Los usuarios del sistema TTY deben llamar al ). El horario de servicio es de lunes a domingo de 8:00am a 8:00pm; las llamadas a estos números son libres de costo. El plan tiene servicios de intérprete libre de costo disponible para personas que no hablan español. Triple-S Advantage Over the Counter Guide 2016 Page 2 of 13

3 TABLE OF CONTENT (TABLA DE CONTENIDO) ANALGESICS AGENTS (ANALGESICOS)... 4 ANORECTAL AGENTS (PRODUCTOS PARA LAS HEMORROIDES)... 4 ANTIBIOTICS-TOPICAL (ANTIBIOTICOS TOPICOS)... 4 ANTIDIARRHEALS (ANTI-DIARREICOS)... 4 ANTIEMETICS (ANTIEMETICOS)... 4 ANTIFUNGALS - TOPICAL (ANTIFUNGALES TOPICOS)... 4 ANTIHISTAMINES-TOPICAL (ANTIHISTAMINICOS TOPICOS)... 5 CORTICOSTEROIDS - TOPICAL (CORTICOSTEROIDES TOPICOS)... 5 COUGH/COLD/ALLERGY (SUPRESORES DE TOS/ ANTI CATARRALES/ANTI ALERGICOS)... 5 LAXATIVES (LAXANTES)... 8 OTIC AGENTS (AGENTES OTICOS)... 8 SCABICIDES & PEDICULICIDES (ESCABICIDAS/PEDICULOSIS)... 8 URINARY ANALGESICS (ANALGESICOS URINARIOS)... 9 VAGINAL PRODUCTS (PRODUCTOS VAGINALES)... 9 VITAMINS (VITAMINAS)... 9 Triple-S Advantage Over the Counter Guide 2016 Page 3 of 13

4 OTC Formulary 2016 [Formulario OTC 2016] Triple-S Advantage Drug (Medicamento) ANALGESICS AGENTS (ANALGESICOS) aspirin chew tab 81 mg, dr tab 325 mg, 81 mg, tab 325mg, 81mg BAYER / ECOTRIN /ASPIRIN ANORECTAL AGENTS (PRODUCTOS PARA LAS HEMORROIDES) phenylephrine-witch hazel rectal gel % PREPARATION H phenylephrine in hard fat rectal supp 0.25% ANUSOL pramox-pe-glycerin-petrolatum rectal cream % PREPARATION H phenyleph- shark liver oil- cocoa butter supp % PREPARATION H SUPP phenylephrine- shark liver oil-mo pet oint % PREPARATION H OINT pramxine hcl-zinc oxide rectal cream 1-5% TRONOLANE pramoxine w/ zinc oxide in mineral oil rectal oint % TUCKS starch supp 51% TUCKS ANTIBIOTICS-TOPICAL (ANTIBIOTICOS TOPICOS) bacitracin oint 500 unit/gm bacitracin zin oint 500 unit/gm bacitracin polymycin b oint, powder neomycin- bacitracin-polymycin oint neomycin-polymycin w/pramoxine cream 1% neomycin-bacitracin-polymycin-pramoxine oint 1% BACIGUENT/ BACITRACIN BACITRACIN ZIN POLYSPORIN NEOSPORIN NEOSPORIN NEOSPORIN/ TRIPLE ANTIBIOTIC ANTIDIARRHEALS (ANTI-DIARREICOS) attapulgite tab 600 mg DIARREST bismuth subsalicylate tab 262 mg, chew tab 262 mg, susp PEPTO BISMOL 262mg/15ml, susp 525mg/15ml lactobillus caps INTESTINEX loperamide- simethicone tab 2mg, chew tab 2mg, liquid 1mg/7.5ml IMODIUM A-D loperamide- simethicone tab 2-125mg, chew tab 2-125mg IMODIUM MULTI-SYMPTOM ANTIEMETICS (ANTIEMETICOS) fructose-dextrose- phosphoric acid oral soln ANTIFUNGALS - TOPICAL (ANTIFUNGALES TOPICOS) clotrimazole soln 1%, cream 1% miconazole nitrate gel 2%, lotion 2% miconazole nitrate soln 2% miconazole nitrate powder 2% miconazole nitrate oint 2% EMETROL LOTRIMIN AF ZEASORB-AF FUNGOID TINCTURE ZEASORB-AF/ LOTRIMIN AF DERMAFUNGAL Triple-S Advantage Over the Counter Guide 2016 Page 4 of 13

5 Drug (Medicamento) miconazole nitrate aerosol 2%, aerosol powder 2% miconazole nitrate cream 2% terbinafine hcl gel 1%, lotion 1%, cream 1% tolnaftate soln 1%, aerosol 1%, cream 1% tolnaftate powder 1%, aerosol powder1% tolnaftate cream 1% w/revitalizer cream kit DESENEX/ LOTRIMIN AF MICONAZOLE LAMISIL / LAMISIL AT TINACTIN TINACTIN- LAMISIL AF FUNGAL NAIL ANTIHISTAMINES-TOPICAL (ANTIHISTAMINICOS TOPICOS) diphenhydramine hcl cream 2%, soln 2 BENADRYL diphenhydramine hcl gel 2%, BENADRYL/ DERMAREST CORTICOSTEROIDS - TOPICAL (CORTICOSTEROIDES TOPICOS) hydrocortisone lotion 0.25% BALNEOL hydrocortisone gel 1%, oint 1% CORTIZONE-10 hydrocortisone cream 0.5%, 1%, oint 0.5%, lot 1%, soln 1% HYDROCORTISONE hydrocortisone- aloe vera cream 0.5%, 1%, oint 1%, HYDROCORTISONE/ALOE hydrocortisone acetate cream 0.5%, 1%, oint 1%, HYDROCORTISONE ACETATE hydrocortisone acetate- aloe vera cream 0.5%, oint 1%, HYDROCORTISONE ACETATE/ALOE COUGH/COLD/ALLERGY (SUPRESORES DE TOS/ ANTI CATARRALES/ANTI ALERGICOS) acetaminophen w/dm liquid mg/15ml DAYTIME COLD MEDICINE acetaminophen-guaifenesin liquid mg /15ml, tabs mg TYLENOL CHEST CONGESTION DAYTIME brompheniramine & phenylephrine chew tab 1-2.5mg, elixir 1- DIMETAPP COLD & ALLERGY 2.5mg/5ml, mg/5ml chlorpheniramine- acetaminophen tab 2-325mg CORICIDIN HBP COLD & FLU chlorpheniramine-dm liquid 2-15mg/15ml VICKS NYQUIL CHILDRENS COLD/COUGH chlorpheniramine-dm Syrup 1-7.5mg/5ml chlorpheniramine-dm tab 4-30mg DIMETAPP LONG ACTING COUGH PLUS COLD CORICIDIN HBP COUGH & COLD chlorphen-pe-apap tab diphenhyd-pe-apap tab day/night pack TYLENOL ALLERGY MULTI- SYMPTOM DAY/NIGHT chlorpheniramine-pseudoephedrine-ibuprofen tab mg ADVIL ALLERGY SINUS chlorphen-pseudoephedrine w/apap tab mg CORICIDIN D chlorphen-pseudoephedrine w/apap tab mg TYLENOL ALLERGY SINUS dextromethorphan hbr liquid 15mg/15 ml, 10 mg/15mg VICKS dextromethorphan hbr cap 15mg ROBITUSSIN COUGHGELS dextromethorphan-apap-chlorphen liquid mg/15ml, 7.5- VICKS FORMULA 44 MULTI mg/15ml dextromethorphan-apap-chlorpheniramine cap mg, liquid mg/5ml SYMPTOM DIABETIC TUSSIN COLD/FLU Triple-S Advantage Over the Counter Guide 2016 Page 5 of 13

6 Drug (Medicamento) dextromethorphan-apap-chlorpheniramine tab mg dextromethorphan & doxylamine-apap liquid mg/15ml dextromethorphan & doxylamine-apap liquid dextromethorphan & guafenesin cap mg dextromethorphan & guafenesin liquid 10/100mg/5ml dextromethorphan & guafenesin liquid mg/15ml dextromethorphan & guafenesin liquid mg/5ml dextromethorphan & guafenesin liquid mg/5ml dextromethorphan & guafenesin syrup mg/15ml dextromethorphan & guafenesin syrup mg/5ml dextromethorphan & guafenesin syrup mg/5ml dextromethorphan & guafenesin tab sr 12hr mg dextromethorphan & phenylephedrine-apap cap mg dextromethorphan & phenylephedrine-apap liquid mg/15ml dextromethorphan & phenylephedrine-apap tab mg dm-doxylamine -apap liquid & dm -apap tab day/night therapy pack dextromethorphan polistirex liquid cr 30 mg/5ml diphenhydramine-acetaminophen liquid mg /15ml diphenhydramine-acetaminophen liquid mg/15m, tabs mg, mgl diphenhydramine & phenylephrine liquid mg/5ml diphenhydramine & phenylephrine tabs mg, soln 12.5mg/5ml, diphenhydramine & phenylephrine- apap liquid mg/5ml diphenhydramine & phenylephrine- apap tabs mg diphenhydramine & phenylephrine- apap tabs mg doxylamine-dm liquid mg-15ml CORICIDIN HBP FLU NYQUIL COLD & FLU TYLENOL COUGH & SORE THROAT NIGHTTIME CORICIDIN HBP CHEST CONGESTION & COUGH CHERACOL PLUS DAY TIME MUCUS RELIEF DM ROBITUSSIN COUGH & CHEST CONGESTION DM MAX DOUBLE-TUSSIN DM ROBITUSSIN DM VICKS FORMULA 44 E COUGH/CHEST CONGESTION RELIEF VICKS FORMULA 44E PEDIATRIC COUGH/CHEST CONGESTION RELIEF MUCINEX DM DAY TIME MULTI-SYMPTOM COLD/FLU RELIEF TYLENOL COLD MULTI-SYMPTOM DAYTIME COMTREX COLD & COUGH MAXIMUM STRENGTH TYLENOL COUGH & SORE THROAT DAY/NIGHT DELSYM CORICIDIN NIGHTTIME COLD/COUGH TYLENOL COLD RELIEF NIGHTTIME TRIAMINIC COLD & COUGH NIGHT TIME CHILDRENS BENADRYL-D ALLERGY & SINUS ROBITUSSIN NIGHT TIME COUGH COLd & FLU TYLENOL ALLERGY MULTI- SYMPTOM NIGHTTIME BENADRYL ALLERGY & COLD VICKS NYQUIL COUGH Triple-S Advantage Over the Counter Guide 2016 Page 6 of 13

7 Drug (Medicamento) doxylamine-phenylephrine-apap cap mg guafesenesin liquid 100mg/6.25ml guafesenesin liquid 200mg/5ml guafesenesin syrup 100mg/5m guafesenesin tabs sr 12hr 600 mg, 1,200 mg guafesenesin tabs 400 mg PE-DM-apap & PE-CPM-DM-apap tab day/night therapy pack PE-DM-GG liquid mg/5ml & DPH_Pe liquid mg/5ml pack phenylephrine w/acethaminophen cap mg phenylephrin-ibuprofen tab mg phenylephrin-ibuprofen tab mg phenylephedrine-chlorpheniramine-dm w/apap liquid mg/5ml phenylephedrine-chlorpheniramine-dm w/apap susp mg/5ml phenylephedrine-chlorpheniramine-dm w/apap tab mg phenylephedrine w DM_GG liquid mg/5ml, mg/5ml phenylephedrine & brompheniramine -DM liquid mg/5ml phenylephedrine-dm liquid mg/15ml phenylephedrine-dm-gg w/apap liquid mg/15ml phenylephedrine-doxylamine-dm-apap liquid mg/15ml pseudoephedrine -chlorpheniramine-dm w/apap tab mg pseudoephedrine -chlorpheniramine-dm w/apap tab mg pseudoephedrine-doxylamine-dm w/apap liquid mg/30ml pseudoephedrine -chlorpheniramine-dm liquid mg/5ml pseudoephedrine- w//dm-gg liquid mg/5ml pseudoephedrine-dm-gg w/apap tab mg pseudoephedrine-guaifenesin tab sr 12hr mg, 12hr mg VICKS NYQUIL SINUS VICKS DIABETIC TUSSIN MUCUS REFLIEF ROBITUSSIN CHEST CONGESTION MUCCINEX ALLFEN COMTREX COLD & COUGH DAY/NIGHT MAXIMUM STRENGTH ROBITUSSIN COUGH & COLD DAY/NIGHT PACK VICKS DAYQUIL SINUS ADVIL CONGESTION RELIEF DIMETAPP MULTI-SYMPTOM COLD & FLU TYLENOL CHILDRENS PLUS MULTI- SYMPTOM COLD COMTREX COLD & COUGH NIGHTTIME MAXIMUM STRENGTH ROBITUSSIN COUGH/COLD CF DIMETAPP DM COLD & COUGH VICKS FORMULA 44D COUGH/NASAL CONGESTION RELIEF TYLENOL COLD MULTI-SYMPTOM SEVERE DAYTIME TYLENOL COLD HEAD CONGESTION SEVERE DAYTIME TYLENOL COLD MULTI-SYMPTOM NIGHTTIME TYLENOL COLD CONVENIENCE PACK TYLENOL COLD NYQUIL CHILDRENS NYQUIL ROBITUSSIN COUGH & COLD D TYLENOL COLD SEVERE CONGESTION MUCINEX D Triple-S Advantage Over the Counter Guide 2016 Page 7 of 13

8 Drug (Medicamento) pseudoephedrine-ibuprofen cap mg LAXATIVES (LAXANTES) bisacodyl tab dr 5mg, supp 10mg docusate calcium cap 240 mg docusate sodium cap 50 mg, 100 mg, liq 150mg/15ml, syrup 60mg/15ml glycerin supp 2.1 gm guar gum oral powder, oral pack inulin oral powder methylcellulose powder laxative, laxative pack, tab 500 mg psyllium cap 0.52 gm, powder 28.3%, 30.9% psyllium powder 48.57%, 55.46%, 58.6% 63% psyllium wafer 1.7 gm, wafers psyllium powder pack 28%, 28.12%, 58.6% psyllium w/calcium cap sennosides chew tab 15 mg sennosides liq 25 mg//15ml sennosides tabs 15 mg sennosides tabs 25 mg sennosides tabs 8.6 mg, 17.2mg sennosides-docusate sodium tabs mgg wheat dextrin chew tab, oral powder, pack, tabs wheat dextrin-calcium chew tab, oral powder wheat dextrin-vitamin B6-B12-folic acid powder, tabs OTIC AGENTS (AGENTES OTICOS) carbamide peroxide 6.5% otic soln. isopropyl alcohol otic liquid 95% ADVIL COLD & SINUS DULCOLAX DOCUSATE CALCIUM COLACE COLACE ADULT BENEFIBER METAMUCIL CLEAR & NATURAL CITRUCEL KONSYL METAMUCIL METAMUCIL METAMUCIL METAMUCIL PLUS CALCIUM EX-LAX AGORAL SENNA-EX SENNA-MAX SENOKOT SENNA S BENEFIBER BENEFIBER PLUS CALCIUM BENEFIBER PLUS DEBROX SWIM EAR SCABICIDES & PEDICULICIDES (ESCABICIDAS/PEDICULOSIS) nit remover gel CLEAR LICE permethrin liquid spray 0.25% NIX LICE permethrin creme rinse 1% NIX CREME RINSE permethrin aerosol 0.4% PRONTO permethrin aerosol 0.5% RID permethrin spray & pyrethins-piperonyl butoxide shampoo kit A-200 pyrethrins- piperonyl butoxide liquid %, foam %, RID LICE KILLING pyrethrins- piperonyl butoxide gel % A-200 pyrethrins- piperonyl butoxide shampoo %, shampoo kit PRONTO % pyreth-piperonyl butox sham-permeth aero-nit remover gel kit RID COMPLETE KIT Triple-S Advantage Over the Counter Guide 2016 Page 8 of 13

9 Drug (Medicamento) URINARY ANALGESICS (ANALGESICOS URINARIOS) phenazopyridine hcl tab 95 mg phenazopyridine hcl tab 97 mg phenazopyridine hcl tab 97.5 mg URO-TRIN BARIDIUM AZO STANDARD VAGINAL PRODUCTS (PRODUCTOS VAGINALES) clotrimazole vaginal cream 1%, 2%, tabs 100 mg GYNE-LOTRIMIN clotrimazole vaginal tabs 100 mg &1% cream kit MYCELEX-7 miconazole nitrate vaginal supp 1,200 mg & 2% cream kit MONISTAT 1 KIT miconazole nitrate vaginal supp 1,200 mg & 2% cream& wipes kit MONISTAT 1 COMBINATION KIT miconazole nitrate vaginal cream 2%, supp 100 mg MONISTAT 7 miconazole nitrate vaginal cream 2% & supp 100 mg kit, MONISTAT 7 KIT miconazole nitrate vaginal applicator 100 mg (2%) & cream 2% MONISTAT 7 COMBINATION KIT & wipes kit, tioconazole vaginal oint 6.5% MONISTAT 1/ VAGISTAT-1 VITAMINS (VITAMINAS) ascorbic acid tabs 250mg, 500mg, 1000 mg b-complex vitamin caps, tabs, cr tas, sublingual liquid b-complex w/ C & calcium tab b-complex w/ C & folic acid tabs, cr tabs b-complex w/ C & folic acid tabs, cr tabs b-complex w/ iron tabs b-complex w/biotin & folic acid cap, tabs, cr tabs b-complex w/c caps, tabs, cr tabs biotin tabs 800 mcg bioflavonoid products caps bioflavonoid products cr caps bioflavonoid products tabs bioflavonoid products cr tabs bioflavonoid products chew tabs bioflavonoid products liquid bioflavonoid products chew wafers calcium carbonate tabs 1,500 mg calcium carbonate-vitamin D tabs 600 mg-400 unit, chew tabs 600 mg-400 unit calcium carbonate-vitamin D w/ minerals tabs 600 mg-400 unit cholecalciferol tabs 400 unit, 1000 unit multiple vitamins tabs multiple vitamins w/ minerals caps multiple vitamins w/ minerals tabs, chew tabs, liquid VITAMIN C B-COMPLEX B-COMPLEX PLUS B-PLEX B COMPLEX MAXI B-COMPLEX/VITAMIN C/IRON B-COMPLEX B-COMPLEX-C BIOTIN TROMBONEX M2 C BIOFLEX C COMPLEX VITAMIN C LIQUID C C-ROLLA CALTRATE CALTRATE 600+D CALTRATE 600+D PLUS VITAMIN D MULTIPLE VITAMIN PROTECT PLUS NR CENTRUM Triple-S Advantage Over the Counter Guide 2016 Page 9 of 13

10 Drug (Medicamento) omega-3 fatty acids caps 300 mg, 350 mg, 435 mg, 500mg,, 600 mg, 725mg, 870 mg, 880 mg, 952 mg, 1,000 mg, 1,050 mg, 1,200 mg, 1,205 mg, 1,400 mg FISH OIL/ OMEGA-3 prenatal w/fe FUM-FA tabs mg &omega 3 cap 440 mg pak PRENATAL pyridoxine hcl tabs 50 mg, 100mg, 200mg VITAMIN B-6 specialty vitamins product cap specialty vitamins product tab vitamin A cap unit VITAMIN A vitamin E caps 200 unit, 400 unit, 1000 unit VITAMIN E vitamins w/lipotroics tabs LIPOTRIAD SUPPORT-500 ONE-A-DAY ENERGY FORMULA Triple-S Advantage Over the Counter Guide 2016 Page 10 of 13

11 INDEX (INDICE) A A acetaminophen... 5 acetaminophen-guaifenesin... 5 ADVIL... 5, 7, 8 AGORAL... 8 ALLFEN... 7 ANUSOL... 4 ascorbic... 9 AZO... 9 B B 9 BACIGUENT/... 4 bacitracin... 4 BACITRACIN... 4 BALNEOL... 5 BARIDIUM... 9 BAYER... 4 bcomplex... 9 b-complex... 9 b-complex... 9 b-complex... 9 b-complex... 9 b-complex... 9 b-complex... 9 B-COMPLEX... 9 B-COMPLEX/VITAMIN... 9 BENADRYL... 5, 6 BENADRYL/... 5 BENADRYL-D... 6 BENEFIBER... 8 bioflavonoid... 9 BIOFLEX... 9 biotin... 9 BIOTIN... 9 bisacodyl... 8 bismuth... 4 B-PLEX... 9 brompheniramine... 5 C C 9 calcium... 9 CALTRATE... 9 carbamide... 8 CHERACOL... 6 CHILDRENS... 7 chlorpheniramine chlorpheniramine-dm... 5 chlorpheniramine-pseudoephedrine 5 chlorphen-pe-apap... 5 chlorphen-pseudoephedrine... 5 cholecalciferol... 9 CLEAR... 8 clotrimazole... 4, 9 COLACE... 8 COMTREX... 6, 7 CORICIDIN... 5, 6 CORTIZONE C-ROLLA*... 9 D DAY... 6 DAYTIME... 5 DEBROX... 8 DERMAFUNGAL... 4 DESENEX/... 5 dextromethorphan... 5, 6 dextromethorphan-apap-chlorphen 5, 6 DIABETIC... 5, 7 DIARREST... 4 DIMETAPP... 5, 7 diphenhydramine... 5, 6 dm-doxylamine... 6 docusate... 8 DOCUSATE... 8 DOUBLE-TUSSIN... 6 doxylamine-phenylephrine-apap. 6, 7 DULCOLAX... 8 Triple-S Advantage Over the Counter Guide 2016 Page 11 of 13

12 E EMETROL... 4 EX-LAX... 8 F FISH fructose-dextrose FUNGAL... 5 FUNGOID... 4 G glycerin... 8 guafesenesin... 7 guar... 8 GYNE-LOTRIMIN... 9 H hydrocortisone... 5 hydrocortisone HYDROCORTISONE... 5 HYDROCORTISONE/ALOE... 5 I IMODIUM... 4 INTESTINEX... 4 inulin... 8 isopropyl... 8 K KONSYL... 8 L lactobillus... 4 LAMISIL... 5 LIPOTRIAD LIQUID... 9 LODINE... 4 loperamide... 4 LOTRIMIN... 4 M M METAMUCIL... 8 methylcellulose... 8 miconazole... 4, 5, 9 MONISTAT... 9 MUCCINEX... 7 MUCINEX... 6, 7 multiple... 9 MULTIPLE... 9 MYCELEX N neomycin-bacitracin-polymycin... 4 neomycin-bacitracin-polymycinpramoxine... 4 neomycin-polymycin... 4 NEOSPORIN... 4 NEOSPORIN/... 4 nit... 8 NIX... 8 NYQUIL... 6, 7 O ONE-A-DAY P p 10 PE-DM-apap... 7 PE-DM-GG... 7 PEPTO... 4 permethrin... 8 phenazopyridine... 9 phenylephedrine... 7 phenylephedrine-chlorpheniramine- DM... 7 phenylephedrine-dm-gg... 7 phenylephedrine-doxylamine-dmapap... 7 Triple-S Advantage Over the Counter Guide 2016 Page 12 of 13

13 phenylephrine... 7 Phenylephrine... 4 phenylephrin-ibuprofen... 7 POLYSPORIN... 4 Pramoxine... 4 Pramxine... 4 prenatal PRENATAL* PREPARATION... 4 PRONTO... 8 PROTECT... 9 pseudoephedrine... 7 pseudoephedrine-guaifenesin... 7 pseudoephedrine-ibuprofen... 8 psyllium... 8 pyreth-piperonyl... 8 pyrethrins pyridoxine R RID... 8 ROBITUSSIN... 5, 6, 7 S sennosides... 8 sennosides-docusate... 8 seudoephedrine... 7 specialty Starch... 4 SUPPORT SWIM... 8 T terbinafine... 5 TINACTIN... 5 TINACTIN/... 5 tioconazole... 9 tolnaftate... 5 TRIAMINIC... 6 TROMBONEX... 9 TRONOLANE... 4 TUCKS... 4 TYLENOL... 5, 6, 7 U URO-TRIN... 9 V VICKS... 5, 6, 7 vitamin VITAMIN... 9, 10 vitamins W wheat... 8 Z ZEASORB-AF... 4 ZEASORB-AF/... 4 Triple-S Advantage Over the Counter Guide 2016 Page 13 of 13