2016 Over-The-counter (OTC) Catalog -English R€¦ · OVER-THE-COUNTER (OTC) CATALOG MEDICARE ADVANTAGE PLANS t the C items. | 1 EC6OTCCAT66586E_0615 The Benefits of Easy Choice

H5087_CA030531_WCM_OTC_ENG_FINAL CMS Accepted 07292015 ©WellCare 2015 CA_06_15 EC6OTCCAT66586E_0615

2016 OVER-THE-COUNTER (OTC) CATALOG

MEDICARE ADVANTAGE PLANS

Get the

OTC items

you need.

| 1 EC6OTCCAT66586E_0615�

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 1-888-979-4319, TTY 711, Monday-Friday, 6:30 a.m.–8:00 p.m. Pacific.

2. Visit us at www.easychoicehealthplan.com. 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

http://www.easychoicehealthplan.com

2 | Call Customer Service to order your OTC items.�

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. 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

Call Customer Service to order your OTC items | 3�

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 $10 501 Zyrtec® 14 $17

2 Allergy Relief (Loratadine) 10mg Tablets

30 $7 502 Claritin® 10 $12

ANALGESICS / ANTIPYRETICS

3 Acetaminophen 325mg Tablets

100 $3 503 Tylenol® 325mg Regular Strength Tablets

100 $10

4 Acetaminophen 500mg Tablets

100 $7 504 Tylenol® 500mg Extra Strength Tablets

100 $16

5 Aspirin 325mg Tablets 100 $3 505 Bayer® Aspirin 325mg 100 $8 6 Aspirin 81mg Chewable 36 $3 NA Bayer® Aspirin 81mg

Chewable NA NA

7 Aspirin Enteric Coated 81mg Tablets

120 $7 507 Bayer® EC Aspirin 81mg (Adult Regimen)

32 $4

8 Aspirin Enteric Coated 325mg Tablets

100 $4 508 Ecotrin® Tablets 100 $6

* = Quantities and brands may vary depending upon availability. ** = Covered under either Part B or Part D

† = Dual-purpose items

Some items may vary depending on manufacturer: Caplets/tablets/capsules/softgels.


ANTACIDS AND ACID REDUCERS

9 Acid Reducer (Famotidine) 10mg Tablets

30 $6 509 Pepcid® AC Tab 30 $11

10 Acid Reducer (Omeprazole) 20mg

14 $10 510 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 $14 515 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 Gel Caps

20 $5 523 Advil® Liquid Gel Caps 20 $6

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 Caplets

24 $5 NA Tylenol® Arthritis NA NA

27 Hot/Cold Patches 5 $5 527 Icy Hot® Patches 5 $7

4 | Call Customer Service to order your OTC items�



BLADDER CONTROL ITEMS

167 Adult Protective Briefs Small/Medium

20 $18 NA Adult Protective Briefs Small/Medium

NA NA

168 Adult Protective Briefs Large

20 $18 NA Adult Protective Briefs Large

NA NA

169 Adult Protective Briefs XL 20 $20 NA Adult Protective Briefs XL NA NA 170 Adult Bladder Control

Pads 28 $9 NA Adult Bladder Control

Pads NA NA

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

Softgel 16 $5 555 Dayquil® Softgel 16 $8

56 Daytime Cold/Flu Relief Liquid

4 oz. $5 556 Dayquil® Liquid 8 oz. $8

174 Daytime/Nite-time Cold/ Flu Caplets

16 $5 674 Mucinex® Day/Night Caplets

30 $16

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 Liquid

4 oz. $5 562 NyQuil® Liquid 8 oz. $8

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

Spray NA NA

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



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

Toothbrush 1 $2 572 Colgate® Toothbrush 1 $4

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.

$9

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 Gummies

90 $18

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 NA



FIRST AID AND MEDICAL SUPPLIES

164 Anti-Embolism Stockings Medium

1 $13 NA Anti-Embolism Stockings Medium

NA NA

165 Anti-Embolism Stockings Small

1 $13 NA Anti-Embolism Stockings Small

NA NA

98 Athletic Bandage* 1 $2 NA Athletic Bandage* NA NA 99 Bandages Assorted 100 $6 599 Band-Aids® 100 $10 100 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

Remover 1 $8

108 Oral Digital Thermometer 60 Second

1 $5 NA Oral Digital Thermometer 60 Second

NA NA

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. $16 112 Hemorrhoid Pads 100 $7 612 Tucks® Medicated Pads 100 $10 113 Hemorrhoid Relief

Suppositories 12 $7 613 Preparation-H®

Suppositories 12 $10

LACTOSE INTOLERANCE

114 Lactase Enzyme 60 $10 614 Schiff® Digestive Advantage Lactose Capsules

32 $10

MOTION SICKNESS MEDICATION

115 Motion Sickness Tablets 12 $3 615 Dramamine® Motion Sickness

12 $6



PEDICULICIDES (HEAD LICE TREATMENTS)

136 Lice Comb 1 $2 NA Lice Comb NA NA 137 Lice Treatment Shampoo 4 oz. $10 637 LiceMD® Lice Shampoo 4 oz. $12

SLEEPING AIDS

138 Night Time Sleep Tablets (Diphenhydramine)

24 $4 638 Sominex® Tablets 16 $7

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. $10

142 Cold Sore Treatment 1 $7 NA Herpecin® NA NA 143 Hydrocortisone 1%

Cream 1 oz. $3 NA Cortaid® NA NA

144 Muscle Rub Cream 1.25 oz. $4 644 Bengay® 2 oz. $6 145 Petroleum Jelly 4 oz. $3 645 Vaseline® Jelly 3.75

oz. $5

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. $10 147 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 600 + Vitamin D 60 $7 649 Caltrate® 600 + D Tablets 60 $14 150 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



VITAMINS AND MINERALS Continued

155 Vitamin A 10,000 IU Softgel

100 $4 NA Vitamin A 10,000 IU Softgel

NA NA

156 Vitamin B-12 100 $8 NA B-12 Vitamins NA NA 157 Vitamin B-Complex 100 $5 NA Vitamin B-Complex NA NA 158 Vitamin B-Complex

Gummy 70 $8 NA Vitamin B-Complex

Gummy NA NA

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

We’re always just a phone call away! If you’re ready to enroll or have enrollment questions, call 1-866-999-3945,

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).................................................... 1-866-999-3945

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 www.easychoicehealthplan.com.�

Nurse Advice Line ..................................................................... 1-800-581-9952 (24 hours, 7 days a week)

TTY for all of the above ..............................................................................................................1-800-735-2929�

http://www.easychoicehealthplan.com

68113

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 31389 | Tampa, FL 33631-3389�

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Documents

2016 Over-The-counter (OTC) Catalog -English R€¦ · OVER-THE-COUNTER (OTC) CATALOG MEDICARE ADVANTAGE PLANS t the C items. | 1 EC6OTCCAT66586E_0615 The Benefits of Easy Choice