2018 Over-the-Counter (OTC) Benefit Catalog Over-the-Counter (OTC) Beneit Catalog As a member of Care1st Health Plan, you have an ... Toothpaste, Pepsodent . 5.5 oz -$5.90 : 1744 :

2018 Over-the-Counter (OTC)

Benefit Catalog

As a member of Care1st Health Plan you have an Over-the-Counter (OTC) benefit every quarter This benefit allows you to get OTC products you may need Be sure to use your benefit amounts before the end of every quarter Simply call 1-800-355-7913 (TTY 711) or mail your completed order form Your order will be shipped directly to your door

Get Over-the-Counter Products Every Quarter

Special Health Plan Benefit with NO COST TO YOU

Information on how to place your OTC order can be found in the back of the catalog

Remember to Keep this Catalog You will want to reference this catalog each time you place your order

H5928_18_020_OTC_CAAccepted

Care1st is an independent licensee of the Blue Shield Association

2018 Over-the-Counter (OTC) Benefit Catalog

Item Product Description Packaging Strength Price Allergy Cold Flu Decongestant amp Sinus

1361 All-Nite ColdFlu 4 oz 625 mg 15 mg 500 mg $750

1360 Cepacol Sore Throat Lozenges 16 ct - $800

1090 Cetirizine HCL Allergy Relief 14 ct 10 mg $790

1426 Childrenrsquos Dimaphen 4 oz 1 mg 5 ml 3 mg 5 ml $610

1428 Childrenrsquos Diphenhydramine HCL 4 oz 125 mg 5 ml $660

1008 Chlorpheniramine Maleate Antihistamine 100 ct 4 mg $600

1166 Cough amp Cold for High Blood Pressure 16 ct - $930

1056 Cough Drops Cherry 30 ct 58 mg $600

1182 Cough Drops Sugar Free Cherry 25 ct 5 gm $600

1054 Cough Syrup Expectorant 4 oz 200 mg 10 ml $550

1356 Cromolyn Sodium Allergy Nasal Spray 26 ml - $2140

1323 Diabetic Tussin DM 4 oz - $960

1308 Diphenhist Antihistamine 100 ct 25 mg $790

1009 Diphenhydramine HCL Antihistamine 24 ct 25 mg $830

1804 Fexofenadine Allergy Relief 30 ct 180 mg $1600

1180 Guaifenesin Cough Expectorant 60 ct 200 mg $1100

1178 Mucus Relief DM Expectorant amp Cough Suppressant 30 ct 400 mg 20 mg $800

1357 Multi-Symptom Cold Formula 24 ct 10 mg 5 mg 325 mg $840

1091 Nasal Decongestant Spray 12 Hour 1 oz 005 $700

1052 Nasal Spray Saline 15 oz 065 $650

1176 Sore Throat Lozenges Cherry 18 ct - $710

1352 Sudogest PE Nasal amp Sinus Decongestant 36 ct 10 mg $600

1164 Vapor Rub 35 oz 13 9 $840

Antacids amp Acid Reducers

1313 Alka-Seltzer 36 ct - $1000

1006 Antacid Anti-Gas Liquid 12 oz - $950

1346 Antacid Chewables 150 ct 500 mg $700

1314 Effervescent Pain Reliever 36 ct - $890

1108 Famotidine Acid Reducer 30 ct 10 mg $730

1110 Omeprazole Acid Reducer 28 ct 20 mg $2300

1800 Simethicone Anti-Gas Chewables 100 ct 80 mg $860

Anticandidal (yeast)

1115 Clotrimazole 7-Day Treatment Vaginal Cream (with applicator) 45 gm 1 $1280

Dagger ndash See Page 12

Item Product Description Packaging Strength Price 1117 Miconazole 3-Day Treatment 1 kit 2 $1690

1119 Tioconazole 1-Day Treatment Vaginal Cream (with applicator) 1 ct 65 $2500

Anti-diarrheal Laxatives amp Digestive Health

1316 Beano 30 ct - $940

1128 Bisacodyl Enteric Coated Laxative 100 ct 5 mg $650

1045 Bismatrol Chewable Tablets 30 ct 262 mg $790

1126 Docusate Sodium Stool Softener 100 ct 100 mg $1200

1733 Enema 45 oz - $800

1124 Ex-Lax 8 ct 15 mg $820

1125 Glycerin Suppository 25 ct 2 gm $680

1067 Lactase Capsules 60 ct 9000 FCC units $1230

1133 Loperamide HCL Anti-Diarrheal 12 ct 2 mg $590

1354 Methylcellulose Fiber Therapy 16 oz - $1850

1011 Milk of Magnesia 12 oz 400 mg $840

1340 Natural Vegetable Laxative 13 oz - $1200

1317 Pepto-Bismol Cherry 12 oz 525 mg 30 ml $1200

1318 Pink Bismuth 8 oz 525 mg 30 ml $840

1012 Polycarbophil Fiber Tablets 90 ct 625 mg $1370

1130 Senna Plus Stool Softener Plus Laxative 60 ct 86 mg 50 mg $870

Anti-fungal amp Anti-itch

1142 Bactine Solution 4 oz - $1260

1144 Caldyphen Clear Lotion Local Analgesic 6 oz 1 $1080

1047 Clotrimazole Antifungal Athletersquos Foot Cream 15 oz 1 $800

1140 Diphenhydramine HCL Zinc Acetate Anti-Itch Cream 1 oz - $580

1074 Hydrocortisone 1 Cream 1 oz 1 $580

1135 Miconazole Nitrate 2 Antifungal Cream 1 oz 2 $1100

1046 Terbinafine HCL Antifungal Cream 5 oz 1 $1670

1064 Tolnaftate Antifungal Cream 125 oz 1 $590

Cold Sore amp Medicated Lip Products

1152 Abreva 2 gm 10 $2500

1256 Blistex Lip Ointment 6 gm - $650

1255 Carmex 75 gm - $540

1153 Herpecin-L Lip Balm 1 oz 1 $910

1359 Releev Cold Sore Treatment 6 ml 013 $2500

Item Product Description Packaging Strength Price Dental amp Denture Care

1032 Denture Cleaning Tablets 40 ct - $650

1187 Fixodent 75 oz - $800

1751 Interdental Flossups 90 ct - $650

1454 Orajel Pain Relief 7 gm 20 $950

1286 Oral Pain Relief 5 oz 20 $870

1324 Polident Denture Cream 39 oz - $1000

1455 Reach Waxed Dental Floss - Mint 55 yd - $550

1413 Toothbrush Colgate Adult Soft 1 ct - $520

1450 Toothbrush Rechargeable 1 ct - $3820

1412 Toothbrush Tek Pro Straight Soft 1 ct - $480

1414 Toothpaste Pepsodent 55 oz - $590

1744 Water Jet 1 ct - $4500

1743 Water Jet Replacement Tips 5 ct - $1800

Diabetes

1491 Diabetic Socks Black Medium 1 pair - $900

1492 Diabetic Socks Black Large 1 pair - $900

1489 Diabetic Socks White Medium 1 pair - $900

1490 Diabetic Socks White Large 1 pair - $900

Ear Care

1742 Cotton Tipped Swabs 300 ct - $700

1190 Ear Wax Removal Drops 15 ml 65 $630

1363 Ear Wax Removal System with Rubber Bulb 15 ml - $990

Eye Care

1192 Artificial Tears Drops 5 oz - $610

1194 Artificial Tears Ointment 35 gm - $1140

1199 Clear Eyes Eye Drops 2 oz - $820

1196 Eye Wash Solution 4 oz - $700

1468 Multi-Purpose Contact Lens Solution 4 oz - $840

1061 Redness Relief Eye Drops 15 ml 005 $610

First Aid amp Medical Supplies

1344 Adhesive Bandages 60 ct - $700

1764 Adjustable Transfer Bench 1 ct - $6500

1200 Alcohol Pads 100 ct 70 $600

1201 Antiseptic Towelettes 100 ct - $760

1020 Bacitracin Ointment 1 oz 500 U gm $625

Item Product Description Packaging Strength Price 1728 Bath Bench with Back 1 ct - $6500

1727 Bath Bench without Back 1 ct - $5500

1459 Bath Mat Non-Skid 1 ct - $1850

1730 Bath Tub Safety Rail 1 ct - $3800

1223 Conforming Gauze Sterile Pads - 3rdquo x 41 yd 12 ct - $1100

1836 CPAP Pillow Fiber Filled 1 ct - $6000

1732 Cushion Foam Ring 1 ct - $2200

1466 Cushion Gel Foam Seat 1 ct - $3000

1731 Cushion Lumbar 1 ct - $2700

1207 Elastic Bandage - 2rdquo x 45 yd 1 ct - $450

1215 First Aid Kit 75 Pieces 1 ct - $1060

1726 Folding Cane Ergonomic Handle 1 ct - $2200

1062 HotCold Pack 1 small amp 1 large 1 ct - $850

1795 Humidifier Ultra-Sonic Cool Mist 1 ct - $7000

1228 Hydrogen Peroxide 16 oz 3 $510

1796 Insect Repellant Spray - Deet 4 oz 30 $1500

1229 Isopropyl Alcohol Wintergreen 16 oz 70 $650

1202 Lantiseptic Skin Protectant Ointment 4 oz 50 $1060

1326 Neosporin Plus 5 oz - $1200

1203 Povidone Iodine Solution Antiseptic 4 oz - $700

1729 Raised Toilet Seat 1 ct - $3600

1460 Shower Mat Non-Skid 1 ct - $2000

1217 Tape Paper Surgical - 1rdquo x 10 yd 1 ct - $470

1219 Tape Silk Surgical - 1rdquo x 10 yd 1 ct - $540

1221 Tape Transparent Surgical - 1rdquo x 10 yd 1 ct - $530

1063 Thermometer Digital 60 seconds 1 ct - $700

1285 Thermometer Digital Ear 1 ct - $2100

1925 Thermometer Talking Ear and Forehead 1 ct - $5000

1014 Triple Antibiotic Ointment 1 oz - $800

Item Product Description Packaging Strength Price Foot Care

1238 Callus Remover Pads 6 ct - $700

1236 Corn Remover Pads 9 ct - $980

1240 Medicated Foot Powder 6 oz - $740

Hemorrhoidal Preparations

1066 Hemorrhoidal Ointment 2 oz - $900

1247 Hemorrhoidal Suppository 12 ct - $660

1364 Pre-moist Hemorrhoid Pads 100 ct - $1210

1248 Preparation H Cream 26 gm - $1500

Incontinence Supplies

1300 A amp D Ointment 2 oz - $660

1303 Adult Briefs Medium - 32rdquo to 44rdquo 12 ct - $1260

1304 Adult Briefs Large - 45rdquo to 58rdquo 12 ct - $1560

1305 Adult Briefs X-Large - 59rdquo to 64rdquo 15 ct - $1560

1811 Attends Discreet Menrsquos Guard 20 ct - $1600

1810 Attends Discreet Menrsquos Shield 20 ct - $1500

1812 Attends Discreet Womenrsquos Maximum Bladder Control Pad 20 ct - $2000

1813 Attends Discreet Womenrsquos Moderate Bladder Control Pad 20 ct - $1800

1815 Attends Discreet Womenrsquos Panty Liner 28 ct - $1400

1814 Attends Discreet Womenrsquos Ultimate Bladder Control Pad 20 ct - $2000

1816 Attends Discreet Womenrsquos Ultrathin Pad 20 ct - $1400

1302 Barrier Cream 4 oz - $1050

1478 Bladder Control Shaped Pad Moderate Absorbency 24 ct - $1600

1479 Bladder Control Shaped Pad Heavy Absorbency 24 ct - $1600

1480 Bladder Control Shaped Pad Maximum Absorbency 18 ct - $1600

1021 Disposable Underwear Medium - 34rdquo to 44rdquo 20 ct - $1300

1026 Disposable Underwear Large - 44rdquo to 58rdquo 18 ct - $1300

1027 Disposable Underwear X-Large - 58rdquo to 68rdquo 14 ct - $1300

1476 Underpad Disposable - 23rdquo x 24rdquo 50 ct - $1700

1348 Washcloth with Lanolin 64 ct - $960

In-Home Diagnostics

1253 Desktop Automatic Blood Pressure Monitor Dagger 1 ct - $4000

1503 Desktop Talking Blood Pressure Monitor - 87rdquo to 134rdquo Dagger 1 ct - $5000

1416 EZ Detect Colon Cancer Test Kit Dagger 1 ct - $1860

Item Product Description Packaging Strength Price 1505 Finger Pulse Oximeter Dagger 1 ct - $3000

1251 Home Access Cholesterol Test Dagger 2 ct - $3000

1501 Wrist Blood Pressure Monitor Dagger 1 ct - $3500

1502 Wrist Talking Blood Pressure Monitor - 9rdquo to 146rdquo Dagger 1 ct - $4000

Motion Sickness

1264 Dramamine Chewables Orange 8 ct 50 mg $1070

1263 Driminate Antiemetic 12 ct 50 mg $600

1366 Meclizine HCL Antiemetic 100 ct 125 mg $1200

Pain Relievers amp Fever Reducers

1001 Acetaminophen 100 ct 325 mg $700

1104 Aleve 100 ct 220 mg $1700

1311 Arthritis Pain Reliever 100 ct 650 mg $1500

1095 Aspirin 100 ct 325 mg $490

1096 Aspirin Enteric Coated 100 ct 325 mg $710

1002 Aspirin Enteric Coated Low Dose 120 ct 81 mg $710

1802 Aspirin Low Dose Chewables 36 ct 81 mg $710

1367 Capsaicin External Analgesic 2 oz 003 $1140

1423 Childrenrsquos Acetaminophen Chewables 30 ct 80 mg $620

1421 Childrenrsquos Ibuprofen 4 oz 100 mg 5 ml $820

1861 Heating Pad 12rdquo X 15rdquo 1 ct - $2500

1004 Ibuprofen 100 ct 200 mg $750

1871 Lidocaine Patch 5 ct - $1700

1257 Menstrual Relief 24 ct - $690

1365 Migraine Relief 100 ct 250 mg 250 mg 65 mg $990

1097 Naproxen 100 ct 220 mg $1440

1332 Pain Reliever PM - Extra Strength 100 ct - $1160

1475 Pain Relieving Muscle Rub 2 oz 25 $700

1739 Salonpas Pain Relief Patches 5 ct - $1400

1261 Wellpatch Migraine 4 ct - $1110

Pediculicide (lice treatment)

Personal Care

1271 Lice Treatment Shampoo 4 oz - $1400

1269 Permethrin Lice Treatment 59 ml 1 $1770

1076 Acne Gel 10 Benzoyl Peroxide 15 oz 10 $720

Item Product Description Packaging Strength Price 1368 Ammonium Lactate Moisturizing Lotion 8 oz 12 $1430

1065 Hand Sanitizer 8 oz 62 $720

Sleep Aids

1725 Nasal Strips Large 30 ct - $1400

1724 Nasal Strips Medium 30 ct - $1400

1276 Sleep Tablets 50 ct 25 mg $710

Smoking Cessation

1372 Nicorelief Gum Dagger 50 ct 4 mg $2700

1369 Nicotine Patch Step 1 Dagger 14 ct 21 mg 24 hr $4030

Supportive Items

1225 Ankle Support 1 ct - $1050

1765 Arthritis Gloves Large 1 pair - $2300

1766 Arthritis Gloves Medium 1 pair - $2300

1767 Arthritis Gloves Small 1 pair - $2300

1487 Back Support Elastic - 24rdquo to 46rdquo 1 ct - $2500

1398 Compression Knee High Socks Menrsquos Black Medium (Shoe Size 8 - 10) Dagger 1 pair 15 - 20 mmHg $1750

1399 Compression Knee High Socks Menrsquos Black Large (Shoe Size 105 - 12) Dagger 1 pair 15 - 20 mmHg $1750

1400 Compression Knee High Socks Menrsquos White Medium (Shoe Size 8 - 10) Dagger 1 pair 15 - 20 mmHg $1750

1401 Compression Knee High Socks Menrsquos White Large (Shoe Size 105 - 12) Dagger 1 pair 15 - 20 mmHg $1750

1409 Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5) 1 pair 8 - 15 mmHg $1750

1410 Compression Knee High Socks Womenrsquos Black Medium (Shoe Size 55 - 75) 1 pair 8 - 15 mmHg $1750

1411 Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105) 1 pair 8 - 15 mmHg $1750

1406 Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5) 1 pair 8 - 15 mmHg $1750

1407 Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75) 1 pair 8 - 15 mmHg $1750

1408 Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105) 1 pair 8 - 15 mmHg $1750

1224 Elbow Support 1 ct - $1460

1862 Hip Protector Small 1 ct - $4000

1863 Hip Protector Medium 1 ct - $4000

1864 Hip Protector Large 1 ct - $4000

Item Product Description Packaging Strength Price 1865 Hip Protector X-Large 1 ct - $4000

1465 Knee Stabilizer 1 ct - $2710

1481 Knee Support Elastic Small 1 ct - $1000

1482 Knee Support Elastic Medium 1 ct - $1000

1483 Knee Support Elastic Large 1 ct - $1000

1463 Night Wrist Support Smart Glove 1 ct - $3540

1457 Rib Belt - Female (one size fits most) 1 ct - $2520

1456 Rib Belt - Male (one size fits most) 1 ct - $2520

1230 Wrist Splint 1 ct - $2390

1227 Wrist Support 1 ct - $1350

Therapeutic Skin amp Sun Care

1070 Aloe Vera Cream 8 oz - $800

1893 Moisturizing Body Lotion with Aloe 8 oz - $800

1852 Scar Gel 52 gm - $1800

1284 Sunscreen Lotion SPF 30 35 oz - $800

Vitamins amp Minerals

1820 Biotin Gummy Dagger 60 ct 5000 mcg $1300

1373 Calcium + Vitamin D Dagger 60 ct 600 mg 400 u $650

1291 Calcium Carbonate Supplement Tablets Dagger 60 ct 600 mg $830

1420 Centrum Silver Chewables Dagger 60 ct - $2000

1422 Childrenrsquos Multivitamin Chewables Dagger 100 ct - $750

1829 Coenzyme Q-10 Dagger 30 ct 50 mg $1100

1385 Daily Multiple Vitamin Tablets with Minerals Dagger 100 ct - $710

1393 Daily Multivitamin Dagger 100 ct - $810

1375 Ferrous Gluconate Iron Supplement Dagger 100 ct 240 mg $760

1376 Ferrous Sulfate Iron Supplement Dagger 100 ct 325 mg $760

1741 Fish Oil Soft Gels Dagger 60 ct 1000 mg $1200

1849 Flaxseed Dagger 100 ct 1000 mg $1400

1850 Folic Acid Dagger 100 ct 800 mcg $650

1003 Glucosamine Chondroitin Dagger 60 ct 250 mg 200 mg $1300

1114 Glucosamine Joint Muscle Dagger 60 ct 500 mg $1330

1417 Iron Dagger 110 ct 27 mg $1000

1869 Leg Cramps Pain Relief Caplets Dagger 50 ct - $1400

1418 Magnesium Dagger 110 ct 250 mg $840

1377 Magnesium Oxide Dagger 100 ct 250 mg $930

Item Product Description Packaging Strength Price 1378 Niacin Dagger 100 ct 100 mg $700

1394 Niacin Dagger 100 ct 500 mg $960

1886 One Daily Menrsquos Multivitamin Dagger 100 ct - $1200

1887 One Daily Womenrsquos Multivitamin Dagger 100 ct - $1200

1274 Prenatal Vitamins Dagger 100 ct - $1000

1395 Rena-Vite Dagger 100 ct - $1400

1392 Senior Multivitamin Dagger 90 ct - $1310

1379 Vitamin A Dagger 100 ct 10 mu $630

1016 Vitamin B-1 Dagger 100 ct 100 mg $750

1381 Vitamin B-12 Dagger 100 ct 1000 mcg $1120

1382 Vitamin B-Complex Dagger 100 ct - $820

1017 Vitamin C Dagger 100 ct 500 mg $650

1383 Vitamin D Dagger 100 ct 400 iu $800

1384 Vitamin E Soft Gels Dagger 100 ct 400 iu $1050

1419 Zinc Chelated Dagger 100 ct 50 mg $740

Wart Remover

1288 Dr Schollrsquos Wart Removal System 20 ct - $1600

1075 Wart Remover Liquid 9 ml 17 $1000

1289 Wartners Wart Removal System 1 ct - $2000

Care1st Health Plan is an HMO and an HMO SNP plan with a Medicare contract and a contract with the California State Medicaid Program Enrollment in Care1st Health Plan depends on contract renewalThis information is not a complete description of benefits Contact the plan for more information Benefits premium andor co-paymentsco-insurance may change on January 1 of each year Limitations copayments and restrictions may apply

This information is available for free in other languages Please contact Member Services 1-800-544-0088 (TTY 711) 8am - 8pm PST 7 days a week

Esta informacioacuten estaacute disponible gratuitamente en otros idiomas Comuniacutequese con Servicios para los Miembros 1-800-544-0088 (TTY 711) de 800 am a 800 pm los 7 diacuteas de la semana

You can get this information for free in other formats such as large print Braille or audio Call 1-800-544-0088 (TTY 711) 800am ndash 800pm seven days a week The call is free

ORDER GUIDELINES

ORDER BY MAIL ORDER BY PHONE

You may place your order by mailing in the If you have questions or would like to place order form that comes with your catalog an order over the phone OTC Advocates are

available Monday ndash Friday from 800am toIf the end of the benefit period is 500pm PST at 1-800-355-7913 (TTY 711) approaching and you do not think your

order form will be received in time you may call in your order

bull For delivery please allow 7 - 10 business days from the time your order is placed

bull You must use your full quarterly benefit amount in one order

bull Your order total may not exceed your quarterly benefit amount Cash checks credit cards or money orders are not accepted under this OTC benefit

bull Your order total will be applied to the benefit period in which the order is received

bull OTC products are intended for member use only to help with a health or medical need Care1st Health Plan prohibits the use of this benefit to order OTC items for family members and friends

bull Due to the personal nature of these products returns are not accepted

bull Items in the 2018 OTC Benefit Catalog may change throughout the year A copy of this catalog is also available on the Care1st Health Plan website at wwwcare1stcom For up-to-date information please call our OTC Advocates from Monday - Friday from 800am to 500pm PST at 1-800-355-7913 (TTY 711)

bull OTC items are available through home delivery only Products may not be purchased at a local retail pharmacy or through any source other than the Care1st Health Plan OTC benefit channels listed above

NOTICES

bull If you disenroll from Care1st Health Plan your OTC benefit will automatically terminate

bull This information is not a complete description of benefits Contact the plan for more information

bull Limitations copayments and restrictions may apply

bull Benefits may change on January 1 of each year

bull The health information provided in the catalog is general in nature and is not medical advice or a substitute for professional health care

These items may also be covered by the plan or Medicare if you are not enrolled in the plan if your health care provider determines it to be medically necessary For all other purposes these items may be covered under your supplemental Part C OTC benefit

Dagger Dual-purpose items are medicines and products that can be used for either a medical condition or for general health and well-being In order to purchase these items under your plan your personal physician must recommend them to you for a specific diagnosed condition Please speak to your physician before ordering these items

2018 OVERndashTHEndashCOUNTER (OTC) BENEFIT

ORDER FORM

Member ID (found on Health ID card) Date of Birth

First Name Last Name MI

Street Number Street Name AptSuite

City State Zip Code

Please check box if this is a new addressDaytime Phone Email (Optional)

STEP 2 - PRODUCT SELECTION

STEP 1 - COMPLETE YOUR INFORMATION BELOW

Cash checks credit cards or money orders are not accepted under this OTC benefit Item Product Name Quantity Price

Total Order $ Please mail this completed form to the following address OTC Servicing Center PO Box 267067 Weston FL 33326-9895

If you place your order using an order form your order total will be applied to the month in which we receive your form For example if you mail your order form on June 29th but we receive it on July 1st your order total will be applied to your July benefit not your June benefit

STEP 2 - PRODUCT SELECTION (continued)

Cash checks credit cards or money orders are not accepted under this OTC benefit

Item Product Name Quantity Price

Subtotal$

Care1st is an independent licensee of the Blue Shield Association H5928_18_020_OTC_CAAccepted

Allergy Cold Flu Decongestant amp Sinus






Dental amp Denture Care

Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES


2018 OVERndashTHEndashCOUNTER (OTC) BENEFIT ORDER FORM



Item Product Description Packaging Strength Price Allergy Cold Flu Decongestant amp Sinus

1361 All-Nite ColdFlu 4 oz 625 mg 15 mg 500 mg $750

1360 Cepacol Sore Throat Lozenges 16 ct - $800

1090 Cetirizine HCL Allergy Relief 14 ct 10 mg $790

1426 Childrenrsquos Dimaphen 4 oz 1 mg 5 ml 3 mg 5 ml $610

1428 Childrenrsquos Diphenhydramine HCL 4 oz 125 mg 5 ml $660

1008 Chlorpheniramine Maleate Antihistamine 100 ct 4 mg $600

1166 Cough amp Cold for High Blood Pressure 16 ct - $930

1056 Cough Drops Cherry 30 ct 58 mg $600

1182 Cough Drops Sugar Free Cherry 25 ct 5 gm $600

1054 Cough Syrup Expectorant 4 oz 200 mg 10 ml $550

1356 Cromolyn Sodium Allergy Nasal Spray 26 ml - $2140

1323 Diabetic Tussin DM 4 oz - $960

1308 Diphenhist Antihistamine 100 ct 25 mg $790

1009 Diphenhydramine HCL Antihistamine 24 ct 25 mg $830

1804 Fexofenadine Allergy Relief 30 ct 180 mg $1600

1180 Guaifenesin Cough Expectorant 60 ct 200 mg $1100

1178 Mucus Relief DM Expectorant amp Cough Suppressant 30 ct 400 mg 20 mg $800

1357 Multi-Symptom Cold Formula 24 ct 10 mg 5 mg 325 mg $840

1091 Nasal Decongestant Spray 12 Hour 1 oz 005 $700

1052 Nasal Spray Saline 15 oz 065 $650

1176 Sore Throat Lozenges Cherry 18 ct - $710

1352 Sudogest PE Nasal amp Sinus Decongestant 36 ct 10 mg $600

1164 Vapor Rub 35 oz 13 9 $840

1313 Alka-Seltzer 36 ct - $1000

1006 Antacid Anti-Gas Liquid 12 oz - $950

1346 Antacid Chewables 150 ct 500 mg $700

1314 Effervescent Pain Reliever 36 ct - $890

1108 Famotidine Acid Reducer 30 ct 10 mg $730

1110 Omeprazole Acid Reducer 28 ct 20 mg $2300

1800 Simethicone Anti-Gas Chewables 100 ct 80 mg $860

1115 Clotrimazole 7-Day Treatment Vaginal Cream (with applicator) 45 gm 1 $1280

1316 Beano 30 ct - $940

1733 Enema 45 oz - $800

1124 Ex-Lax 8 ct 15 mg $820

1152 Abreva 2 gm 10 $2500

1255 Carmex 75 gm - $540

1187 Fixodent 75 oz - $800

1744 Water Jet 1 ct - $4500

Diabetes

Ear Care

Eye Care

In-Home Diagnostics

Motion Sickness

1104 Aleve 100 ct 220 mg $1700

1095 Aspirin 100 ct 325 mg $490

1004 Ibuprofen 100 ct 200 mg $750

1097 Naproxen 100 ct 220 mg $1440

Personal Care

Sleep Aids

Smoking Cessation

Supportive Items

1852 Scar Gel 52 gm - $1800

Wart Remover

ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





1316 Beano 30 ct - $940

1733 Enema 45 oz - $800

1124 Ex-Lax 8 ct 15 mg $820

1152 Abreva 2 gm 10 $2500

1255 Carmex 75 gm - $540

1187 Fixodent 75 oz - $800

1744 Water Jet 1 ct - $4500

Diabetes

Ear Care

Eye Care

In-Home Diagnostics

Motion Sickness

1104 Aleve 100 ct 220 mg $1700

1095 Aspirin 100 ct 325 mg $490

1004 Ibuprofen 100 ct 200 mg $750

1097 Naproxen 100 ct 220 mg $1440

Personal Care

Sleep Aids

Smoking Cessation

Supportive Items

1852 Scar Gel 52 gm - $1800

Wart Remover

ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





1187 Fixodent 75 oz - $800

1744 Water Jet 1 ct - $4500

Diabetes

Ear Care

Eye Care

In-Home Diagnostics

Motion Sickness

1104 Aleve 100 ct 220 mg $1700

1095 Aspirin 100 ct 325 mg $490

1004 Ibuprofen 100 ct 200 mg $750

1097 Naproxen 100 ct 220 mg $1440

Personal Care

Sleep Aids

Smoking Cessation

Supportive Items

1852 Scar Gel 52 gm - $1800

Wart Remover

ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





In-Home Diagnostics

Motion Sickness

1104 Aleve 100 ct 220 mg $1700

1095 Aspirin 100 ct 325 mg $490

1004 Ibuprofen 100 ct 200 mg $750

1097 Naproxen 100 ct 220 mg $1440

Personal Care

Sleep Aids

Smoking Cessation

Supportive Items

1852 Scar Gel 52 gm - $1800

Wart Remover

ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





In-Home Diagnostics

Motion Sickness

1104 Aleve 100 ct 220 mg $1700

1095 Aspirin 100 ct 325 mg $490

1004 Ibuprofen 100 ct 200 mg $750

1097 Naproxen 100 ct 220 mg $1440

Personal Care

Sleep Aids

Smoking Cessation

Supportive Items

1852 Scar Gel 52 gm - $1800

Wart Remover

ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





Motion Sickness

1104 Aleve 100 ct 220 mg $1700

1095 Aspirin 100 ct 325 mg $490

1004 Ibuprofen 100 ct 200 mg $750

1097 Naproxen 100 ct 220 mg $1440

Personal Care

Sleep Aids

Smoking Cessation

Supportive Items

1852 Scar Gel 52 gm - $1800

Wart Remover

ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





Sleep Aids

Smoking Cessation

Supportive Items

1852 Scar Gel 52 gm - $1800

Wart Remover

ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





1852 Scar Gel 52 gm - $1800

Wart Remover

ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





Wart Remover

ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





ORDER GUIDELINES

NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





NOTICES

ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





ORDER FORM

City State Zip Code

Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





Subtotal$








Diabetes

Ear Care

Eye Care


Foot Care



In-Home Diagnostics

Motion Sickness



Personal Care

Sleep Aids

Smoking Cessation

Supportive Items



Wart Remover

ORDER GUIDELINES

ORDER BY MAIL

ORDER BY PHONE

NOTICES





Documents

2018 Over-the-Counter (OTC) Benefit Catalog Over-the-Counter (OTC) Beneit Catalog As a member of Care1st Health Plan, you have an ... Toothpaste, Pepsodent . 5.5 oz -$5.90 : 1744 :