Over-the-Counter. (OTC) Items. Benefit
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1 Over-the-Counter (OTC) Items Benefit
2 Get up to $120 in FREE over-the-counter (OTC) items each year! That s $10 each month! Para solicitar este documento en español o para escuchar la traducción, llame al Servicio al Cliente al (TTY/TDD: ). It s EASY to get your items. Just follow these steps: 1 Choose what you and your family need. 2 Call Member Services with your order. 3 The toll-free phone number is (TTY/TDD: ). 4 Or visit our website at kentucky.wellcare.com, log into the member portal and place your order. That s it! Your order will be mailed to your home at NO CHARGE to you! For more information, call (TTY/TDD: ).
3 ALLERGY PREVENTION AND TREATMENT 1 Loratadine 10mg Claritin 10 $ Cetirizine 10mg Zyrtec 14 $ Diphenhydramine 25mg Capsules Benadryl 24 $ Chlorpheniramine 4mg Allergy Chlor-Trimeton 24 $3.00 ANALGESICS/ANTIPYRETICS 4 Aspirin 325mg Bayer Aspirin 100 $ Aspirin Enteric Coated 81mg Bayer EC Aspirin (Adult Regimen) 120 $ Enteric Coated Aspirin 325mg Ecotrin 60 $ Acetaminophen 325mg Tylenol Regular Strength 100 $ Acetaminophen 500mg Tylenol Extra Strength Caplets 50 $ Pre-Menstrual Relief Midol 24 $ Pain Relief PM Tylenol PM 24 $3.00 ANTACIDS AND ACID REDUCERS 10 Gas Relief 80mg Mylanta Gas 80mg 100 $ Omeprazole 20mg Prilosec 14 $ Calcium Carbonate 500mg Tums 150 $4.00 Amount is for each head of household, not each family member. If you do not use your $10 in a month, it does not carry over to the next month. Items, quantities and prices may change depending on availability. Brand items may be supplied in place of generic items. The brand names of the OTC items listed are trademarks of their respective owners. OTC Items Benefit 1 OTC Items Benefit 2
4 13 Ranitidine HCL 75mg Zantac 30 $ Famotidine 10mg Pepcid 18 $ Gas Relief (Extra Strength) Gas-X Extra Strength 30 $5.00 ANTI-ARTHRITICS 16 Acetaminophen 650mg Tylenol Arthritis Pain 50 $ Glucosamine 1500mg/Chondroitin Glucosamine/Chondroitin 1200mg DS 60 $9.00 ANTICANDIALS (YEAST) 18 Clotrimazole Vaginal 1% Cream 1 Application Gyne-Lotrimin 6oz $8.00 ANTIDIARRHEALS AND LAXATIVES 20 Docusate Sodium 100mg Capsules Colace Softgels 60 $ Adult Glycerin Suppositories Fleet Adult Suppositories 50 $ Bisacodyl 10mg Suppositories Dulcolax Suppositories 12 $ Bisacodyl 5mg Dulcolax 25 $ Loperamide 2mg Capsules Imodium Caplets 12 $ Antinausea Liquid Emetrol 4oz $ Bismuth Subsalicylate 262mg Pepto-Bismol Chewable 30 $4.00 MOTION SICKNESS MEDICATION 28 Dimenhydrinate 50mg Dramamine Motion Sickness 12 $4.00 TOPICAL OINTMENTS AND CREAMS 29 Diphenhydramine Anti-Itch Cream Benadryl Cream 1oz $ Menthol 10%/Methyl Salicylate 15% Cream Bengay 1.25oz $ Triple Antibiotic Ointment Neosporin Ointment 0.5oz $ Clotrimazole 1% Cream Lotrimin AF 0.5oz $6.00 OTC Items Benefit 3 OTC Items Benefit 4
5 33 Tolnaftate 1% Cream Tinactin Cream 0.5oz $ Hydrocortisone 1% Maximum Strength Cream Cortaid Cream 0.5oz $ Capsaicin Cream Zostrix Cream 1 $ Benzoyl Peroxide Cream 10% Clearasil 10% Cream 1 $6.00 COLD, FLU, DECONGESTANT AND SINUS REMEDIES 36 Oxymetazoline Hydrochloride 0.05% Solution Afrin Nasal Spray 1oz $ Saline Nasal Spray Ocean Nasal Spray 1.5oz $ Throat Lozenges Assorted Flavors Halls Cough Drops 30 $ Guaifenesin 100mg/5ml Robitussin Syrup 4oz $ Guaifenesin 100mg/5ml Sugar-Free Robitussin Sugar-Free Syrup 4oz $ Vicks Vaporub Vicks Vaporub 3.53oz $ Acetaminophen 325mg/ Dextromethorphan 10mg/Phenylephrine DayQuil Caplets 20 $6.00 5mg 43 Acetaminophen 325mg/ Dextromethorphan 15mg/Doxylamine NyQuil Caplets 12 $ mg 44 ASA 325mg/Sodium Bicarbonate 1916mg/Citric Acid 1000mg Alka-Seltzer 20 $ Guaifenesin 600mg Mucinex 30 $ Guaifenesin 600mg/Dextromethorphan 30mg Mucinex-DM 30 $10.00 COLD, FLU, DECONGESTANT AND SINUS REMEDIES 47 Phenylephrine HCL 10mg Sudafed PE 18 $ APAP Sinus Congestion Tylenol Sinus and Congestion 24 $5.00 OTC Items Benefit 5 OTC Items Benefit 6
6 DENTAL/DENTURE CARE 49 Benzocaine 20% Oral Anesthetic Anbesol 0.5oz $ Denture Adhesive Cream Fixodent 2.4oz $ Toothbrush Toothbrush 1 $ Fluoride Toothpaste Colgate 6.4oz $ Waxed Dental Floss Waxed Dental Floss 1 $2.00 EAR CARE 54 Ear Syringe Ear Syringe 3oz $ Carbamide Peroxide (6.5%) Solution Debrox Ear Wax Removal 0.5oz $7.00 EYE CARE 56 Polyvinyl Alcohol 0.5%/Povidone 0.6% Lubricant Eye Drops Murine Tears 0.5oz $ Tetrahydrozoline HCl 0.05% Visine Drops 0.5oz $4.00 FIBER SUPPLEMENTS 58 Psyllium Husk, Approximately 0.52g Metamucil 90 $9.00 FIRST AID/MEDICAL SUPPLIES 59 Athletic Bandage Ace Bandage 1 $ Adhesive Tape 1/2 Inch x 5 Yards Adhesive Tape 1 $ Alcohol Swabs Alcohol Swabs 100 $ Bandages Assorted Band-Aids 30 $ Butterfly Closures Butterfly Closures 10 $ Cotton Balls Cotton Balls 100 $ Cotton Swabs Q-Tips Cotton Swabs 200 $ Ice Bag Ice Bag 1 $ Stretch Gauze Bandage 2 Inches x 5 Johnson & Johnson Yards Gauze 1 $ Oral Thermometer Oral Thermometer 1 $ Flexible Tip Thermometer Flexible Tip Thermometer 1 $10.00 OTC Items Benefit 7 OTC Items Benefit 8
7 70 Thermometer Probe Covers Thermometer Probe Cover 30 $ Menthol 5% Patches Icy Hot Patches Large 5 $6.00 FIRST AID/MEDICAL SUPPLIES 72 Corn and Callus Remover Dr. Scholl s Corn and Callus Remover 0.33oz $ Salicylic Acid (17% w/w) Liquid Compound W Wart Remover 0.31oz $7.00 HEMORRHOIDAL PREPARATIONS 74 Mineral Oil 46.6%/Pramoxine HCL 1%/ Tucks Hemorrhoidal Zinc Oxide 12.5% Ointment 0.7oz $4.00 Mineral Oil 14%/Petrolatum 71.9%/ 75 Phenylephrine 0.25%/Shark Oil 3% Preparation H Ointment 2oz $8.00 Cream 76 Witch Hazel 50% Pads Tucks Medicated Pads 100 $8.00 HEADACHE RELIEF 78 Acetaminophen 250mg/Aspirin 250mg/ Caffeine 65mg Excedrin Migraine 24 $ Acetaminophen 500mg/ Diphenhydramine Citrate 38mg Excedrin PM 50 $6.00 ANTI-INFLAMMATORY 80 Ibuprofen 200mg FC Advil 50 $ Naproxen Sodium 220mg Caplets Aleve Caplets 50 $ Ibuprofen 200mg Liquid Gel Caps Advil Liquid Gel Caps 20 $5.00 PEDICULICIDES 83 Lice Treatment Maximum Strength Rid Extra Strength Shampoo Shampoo 4oz $ Lice Comb Lice Comb 1 $5.00 OTC Items Benefit 9 OTC Items Benefit 10
8 SLEEPING AIDS 85 Diphenhydramine 25mg Capsules Unisom Sleep 16 $5.00 VITAMINS AND MINERALS 86 B-Complex/B-12 Vitamins B-Complex/B-12 Vitamins 100 $ Adult Multi-Vitamin Centrum Multi-Vitamin 100 $ Prenatal Vitamins Stuart Prenatal Vitamins 100 $ Vitamin C 500mg Vitamin C 500mg 100 $ Vitamin E 400 IU Caplets Vitamin E 400 IU Caplets 100 $ Vitamin A 10,000 IU Caplets Vitamin A 10,000 IU Caplets 100 $ Elemental Iron 65mg Feosol 100 $ Folic Acid 500mcg Folic Acid 400mcg 100 $ Magnesium 250mg Magnesium 250mg 100 $ Zinc 50mg Zinc 50mg 100 $ Synthetic Vitamin B-1 100mg Vitamin B-1 100mg 100 $4.00 VITAMINS AND MINERALS 97 Synthetic B mcg Vitamin B mcg 100 $ Synthetic Vitamin B-6 100mg Vitamin B-6 100mg 100 $ Calcium Carbonate 600mg/Vitamin D 400 IU Caltrate D 60 $ Calcium Carbonate 600mg Caltrate $5.00 CHILDREN S PRODUCTS 101 Orajel Baby Orajel Baby 0.33oz $ Tooth and Gum Cleanser Tooth and Gum Cleanser 1.4oz gel $ Diaper Rash Ointment Balmex Ointment 1oz $ Salicylic Acid 17% w/v 0.5oz Liquid Duofilm 0.5oz $7.00 OTC Items Benefit 11 OTC Items Benefit 12
9 105 Gas Relief Drops Mylicon drops 1oz $ Baby Poly Vitamin Drops 50ml Poli-Vi-Sol Drops 50ml $ Children s Chewable Multi-Vitamins Flintstones Multi- Vitamins 100 $ Children s Ibuprofen Suspension 100mg Motrin Suspension for Children 4oz $ Junior Strength Pain Ibuprofen Chewable 100mg Motrin Jr. Strength 24 $ Junior Strength Pain Relief Apap Chewable 160mg Tylenol Jr. Strength 24 $ Acetaminophen Children s Elixir 160mg/5ml Tylenol Children s Elixir 4oz $ Acetaminophen Chewable Tylenol Children s Chewable 30 $ Children s Cold and Allergy Elixir 5ml Dimetapp Cold and Flu Elixir 4oz $ Infant Ibuprofen Oral Suspension 50mg Motrin Infant Drops Dye Free 1 $ Acetaminophen Children s Elixir 30ml Tylenol Infant Drops 1oz $ Childen s Glycerin Suppositories Children s Glycerin Suppositories 25 $ Diphenhydramine Liquid 5ml Alcohol Free Benadryl Elixir 4oz $4.00 OTHER ITEMS 120 Condoms Condoms 3 $ Pill Box Pill Box 1 $ Throat Lozenges Chloraseptic 18 $ Hand Sanitizer Wipes Hand Sanitizer Wipes 24 $ Feminine Hygiene Wipes Feminine Hygiene Wipes 12 $2.00 OTC Items Benefit 13 OTC Items Benefit 14
10 125 Premium Medium Baby Diapers Premium Medium Baby Diapers 18 $ Premium Large Baby Diapers Premium Large Baby Diapers 16 $ Premium Extra Large Baby Diapers Premium Extra Large Baby Diapers 14 $ SPF 30 Sunblock SPF 30 Sunblock 1 $ Preference Facial Tissue Preference Facial Tissue 1 $2.00 OTHER ITEMS 130 Pregnancy Test Pregnancy Test 1 $ Fever Strip Thermometer Fever Strip Thermometer 1 $ Premium Baby Wipes Pampers Baby Wipes 1 pkg $ Premium Antibacterial Hand Soap Soft Soap Antibacterial Soap 1 $ Dry Skin Therapy Moisturizing Cream Eucerin Cream 1 $8.00 OTC Items Benefit 15 OTC Items Benefit 16
11 P.O. Box Louisville, KY KY017502_CAD_OTC_ENG State Approved WellCare 2011 KY_12_11 WC
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