2016
OVER-THE-COUNTER (OTC) CATALOG
MEDICARE ADVANTAGE PLANS
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Y0070_NA029704_WCM_OTC_ENG_FINAL CMS Accepted 07192015 ©WellCare 2015 NA_04_15
NA6OTCCAT66586E_0415
The Benefits of WellCare/‘Ohana Add Up.
What is WellCare/‘Ohana’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.
Find the Customer Service number for your state in the back of this catalog, to
place your order.
Option 1: O
ur friendly Customer Service representatives will talk
with you and place your order.
Option 2: U
se our automated phone service to place your order.
Simply follow the instructions to place your order.
2 Order Online
Visit us at www.wellcare.com/medicare or www.ohanahealthplan.com/
medicare. Log on with your username and password. If you don’t have a
username, it’s easy to sign up. Just follow the instructions. Once you’ve logged
in, click on the OTC items link. Order items until they add up to your monthly
benefit amount.
To Get the Most Out of Your OTC Benefit:
1
ake sure to order your items every month. If you skip a month, the benefits
M
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
| 1
NA6OTCCAT66586E_0415
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
• Hormone replacement
• In-home testing and monitoring
• 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
2 | Call Customer Service to order your OTC items.
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
2
Allergy Relief (Cetirizine)
10mg Tablets
Allergy Relief (Loratadine)
10mg Tablets
30
$10
501 Zyrtec®
14
$17
30
$7
502 Claritin®
10
$12
100
$10
100
$16
100
NA
$8
NA
32
$4
100
$6
ANALGESICS / ANTIPYRETICS
3
4
5
6
7
8
Acetaminophen 325mg
Tablets
Acetaminophen 500mg
Tablets
Aspirin 325mg Tablets
Aspirin 81mg Chewable
100
$3
100
$7
100
36
$3
$3
Aspirin Enteric Coated
81mg Tablets
Aspirin Enteric Coated
325mg Tablets
120
$7
100
$4
503 Tylenol® 325mg Regular
Strength Tablets
504 Tylenol® 500mg Extra
Strength Tablets
505 Bayer® Aspirin 325mg
NA Bayer® Aspirin 81mg
Chewable
507 Bayer® EC Aspirin 81mg
(Adult Regimen)
508 Ecotrin® Tablets
* = Quantities and brands may vary depending upon availability. † = Dual-purpose items
** = Covered under either Part B or Part D
Some items may vary depending on manufacturer: Caplets/tablets/capsules/softgels.
Call Customer Service to order your OTC items
| 3
ID# GENERIC NAME
QTY*
AMT
ID#
BRAND NAME
QTY* AMT
ANTACIDS AND ACID REDUCERS
9
10
11
12
13
14
Acid Reducer
(Famotidine) 10mg Tablets
Acid Reducer
(Omeprazole) 20mg
Acid Reducer (Ranitidine)
75mg Tablets
Antacid Tablets
Effervescent Tablets
Gas Relief Softgel ExtraStrength
30
$6
509 Pepcid® AC Tab
30
$11
14
$10
510 Prilosec®
14
$14
30
$7
511
Zantac® Tablets
30
$15
150
36
20
$6
$4
$4
512 Tums® Tablets
513 Alka-Seltzer®
514 Gas-X® Extra Strength
150
24
18
$8
$7
$6
1
$24
ANTICANDIAL (YEAST)
15 Miconazole Vaginal
Cream 3 Day
$14
1
515 Monistat® Vaginal Cream
3 Day
ANTIDIARRHEAL AND LAXATIVES
16 Adult Glycerin
Suppositories
17 Anti-Diarrheal Caplets
18 Anti-Nausea Liquid
19 Bisacodyl 5mg Tablets
20 Laxative (Bisacodyl) 10mg
Suppositories
21 Stomach Relief Flavored
Tablets
22 Stool Softener Softgel
12
$3
516 Fleet® Adult Suppositories 50
$5
12
4 oz.
25
12
$4
$6
$4
$5
NA
518
519
520
Imodium® A-D Caplets
Emetrol®
Dulcolax® Tablets
Dulcolax® Suppositories
NA
4 oz.
25
8
NA
$9
$7
$13
30
$3
521
Pepto-Bismol® Tablets
30
$5
100
$4
522 Colace® Capsules
30
$13
ANTI-INFLAMMATORY
23 Ibuprofen 200mg Liquid
Gel Caps
24 Ibuprofen 200mg Tablets
25 Naproxen Sodium 220mg
Caplets
20
$5
523 Advil® Liquid Gel Caps
20
$6
50
50
$6
$8
524 Advil® Tablets
525 Aleve® Caplets
50
24
$10
$7
ARTHRITIS MEDICINE
26 Arthritis Pain Relief
Caplets
27 Hot/Cold Patches
24
$5
NA Tylenol® Arthritis
NA
NA
5
$5
527 Icy Hot® Patches
5
$7
4 | Call Customer Service to order your OTC items
ID# GENERIC NAME
QTY*
AMT
ID#
BRAND NAME
QTY* AMT
BLADDER CONTROL ITEMS
167 Adult Protective Briefs
Small/Medium
168 Adult Protective Briefs
Large
169 Adult Protective Briefs XL
170 Adult Bladder Control
Pads
200 Disposable Bed
Underpads
20
$18
20
$18
20
28
$20
$9
5
$6
NA Adult Protective Briefs
Small/Medium
NA Adult Protective Briefs
Large
NA Adult Protective Briefs XL
NA Adult Bladder Control
Pads
NA Disposable Bed
Underpads
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
24
25
16
$8
$3
$8
8 oz.
$8
30
$16
COLD/COUGH/FLU REMEDIES
53 APAP Sinus Congestion
54 Cough / Throat Drops
55 Daytime Cold/Flu Relief
Softgel
56 Daytime Cold/Flu Relief
Liquid
174 Daytime/Nite-time Cold/
Flu Caplets
57 Mucus Relief DM Tablets
58 Mucus Relief Tablets
59 Nasal Decongestion
Spray
60 Nasal Decongestion PE
Tablets
61 Nite-Time Cold/Flu Relief
Softgel
62 Nite-Time Cold/Flu Relief
Liquid
63 Saline Nasal Spray
64 Sore Throat Spray
65 Tussin DM Syrup SF
66 Tussin Syrup
67 Vapor Rub
24
30
16
$4
$3
$5
553 Tylenol® Sinus Congestion
554 Halls® Cough Drops
555 Dayquil® Softgel
4 oz.
$5
556 Dayquil® Liquid
16
$5
30
30
1 oz.
$8
$7
$4
674 Mucinex® Day/Night
Caplets
557 Mucinex-DM®
558 Mucinex®
559 Afrin® Nasal Spray
36
$4
NA Sudafed® PE
NA
NA
16
$5
561 NyQuil® Softgel
16
$8
4 oz.
$5
562 NyQuil® Liquid
8 oz.
$8
1.5 oz.
6 oz.
$3
$4
1.5 oz. $6
NA NA
4 oz.
4 oz.
3.53 oz.
$6
$4
$5
563 Ocean® Nasal Spray
NA Chloraseptic® Sore Throat
Spray
565 Robitussin® DM Syrup
NA Robitussin® Syrup
NA Vicks Vaporub®
Call Customer Service to order your OTC items
| 5
20
$15
20
$15
0.5 oz. $10
4 oz.
NA
NA
$8
NA
NA
ID# GENERIC NAME
QTY*
AMT
ID#
BRAND NAME
QTY* AMT
DENTAL AND DENTURE CARE
69
70
71
72
Denture Adhesive Cream
Denture Cleaner
Fluoride Toothpaste
Premium Adult
Toothbrush
73 Premium Dental Floss
75 Sensitive Teeth
Toothpaste
76 Toothache Relief Liquid/
Gel
2.4 oz.
40
6 oz.
1
$5
$4
$4
$2
569
570
571
572
1
4 oz.
$2
$5
573 Reach® Dental Floss
NA Sensodyne
1
NA
$3
NA
0.33 oz.
$4
576 Anbesol® Liquid/Gel
0.41
oz.
$9
Fixodent®
Efferdent®
Colgate®
Colgate® Toothbrush
2.4 oz. $7
16
$5
4 oz. $5
1
$4
EAR CARE
77 Ear Syringe
78 Ear Wax Drops
1
0.5 oz.
$3
$6
NA Ear Syringe
578 Debrox® Ear Wax Drops
NA NA
0.5 oz. $8
EYE CARE
79 Artificial Tears
93 Red Eye Relief Drops
0.5 oz.
0.5 oz.
$4
$3
579 Visine® Tears
593 Visine® Drops
0.5 oz. $7
0.5 oz. $6
FIBER SUPPLEMENTS
94 N/A - Brand Only
NA
NA
95 Fibertab Caplets
90
$9
594 Vitafusion® Fiber Well
Gummies
595 FiberCon® Caplets
90
$18
90
$16
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
FIRST AID AND MEDICAL SUPPLIES
96
189
191
192
166
190
97
162
Adhesive First-Aid Tape*
Aid Ankle Support
Aid Elbow Support
Aid Hand/Wrist Support
Aid Knee Support
Aid Wrist Support
Alcohol Pads*
Anti-Embolism Stockings
Extra Large
163 Anti-Embolism Stockings
Large
1
1
1
1
1
1
100
1
$2
$7
$7
$7
$7
$7
$3
$13
1
$13
NA
NA
NA
NA
NA
NA
NA
NA
Adhesive First-Aid Tape*
Aid Ankle Support
Aid Elbow Support
Aid Hand/Wrist Support
Aid Knee Support
Aid Wrist Support
Alcohol Pads*
Anti-Embolism Stockings
Extra Large
NA Anti-Embolism Stockings
Large
6 | Call Customer Service to order your OTC items
ID# GENERIC NAME
QTY*
AMT
ID#
BRAND NAME
QTY* AMT
FIRST AID AND MEDICAL SUPPLIES
164 Anti-Embolism Stockings
1
Medium
165 Anti-Embolism Stockings
1
Small
98 Athletic Bandage*
1
99 Bandages Assorted
100
100 Butterfly Closures*
10
101 Corn and Callus Remover 0.5 oz.
$13
102
103
104
105
106
107
$4
$4
$8
$10
$4
$6
Cotton Balls
100
Cotton Swabs
150
First Aid Kit
1
Flexible Tip Thermometer 1
Ice Bag
1
Liquid Wart Remover
0.5 oz.
108 Oral Digital Thermometer
60 Second
109 Stretch Gauze Bandage*
$13
$2
$6
$2
$4
1
$5
1
$2
NA Anti-Embolism Stockings
Medium
NA Anti-Embolism Stockings
Small
NA Athletic Bandage*
599 Band-Aids®
NA Butterfly Closures*
NA Dr. Scholl’s® Corn and
Callus Remover
NA Cotton Balls
603 Q-Tips® Cotton Swabs
NA First Aid Kit
NA Flexible Tip Thermometer
NA Ice Bag
607 Compound W® Wart
Remover
NA Oral Digital Thermometer
60 Second
NA Stretch Gauze Bandage*
NA
NA
NA
NA
NA
100
NA
NA
NA
$10
NA
NA
NA
170
NA
NA
NA
1
NA
$5
NA
NA
NA
$8
NA
NA
NA
NA
24
$6
HEADACHE RELIEF
110 Headache Relief Tablets
24
$4
610 Excedrin® Migraine
HEMORRHOIDAL PREPARATIONS
111 Hemorrhoid Ointment
112 Hemorrhoid Pads
113 Hemorrhoid Relief
Suppositories
2 oz.
100
12
$7
$7
$7
611 Preparation-H® Ointment 2 oz.
612 Tucks® Medicated Pads
100
613 Preparation-H®
12
Suppositories
$16
$10
$10
LACTOSE INTOLERANCE
114 Lactase Enzyme
60
$10
614 Schiff® Digestive
Advantage Lactose
Capsules
32
$10
12
$6
MOTION SICKNESS MEDICATION
115 Motion Sickness Tablets
12
$3
615 Dramamine® Motion
Sickness
Call Customer Service to order your OTC items
| 7
ID# GENERIC NAME
QTY*
AMT
ID#
BRAND NAME
QTY* AMT
PEDICULICIDES (HEAD LICE TREATMENTS)
136 Lice Comb
1
137 Lice Treatment Shampoo 4 oz.
$2
$10
NA Lice Comb
637 LiceMD® Lice Shampoo
NA
4 oz.
NA
$12
SLEEPING AIDS
138 Night Time Sleep Tablets
(Diphenhydramine)
139 Sleep Aid Tablets
(Doxylamine)
24
$4
638 Sominex® Tablets
16
$7
16
$5
639 Unisom® Tablets
16
$7
NA
NA
NA
NA
1 oz.
0.42
oz.
NA
NA
$6
$10
2 oz.
3.75
oz.
NA
$6
$5
SMOKING CESSATION PRODUCTS
196 Nicotine Gum 2mg
197 Nicotine Gum 4mg
20
20
$10
$10
NA Nicotine Gum 2mg
NA Nicotine Gum 4mg
TOPICAL OINTMENTS AND CREAMS
140 Anti-Itch Cream
141 Clotrimazole 1% Cream
142 Cold Sore Treatment
143 Hydrocortisone 1%
Cream
144 Muscle Rub Cream
145 Petroleum Jelly
171 SPF 50 Sunblock
146 Tolnaftate 1% Cream
147 Triple Antibiotic
Ointment
1 oz.
0.5 oz.
$3
$5
640 Benadryl® Cream
641 Lotrimin® AF
1
1 oz.
$7
$3
NA Herpecin®
NA Cortaid®
1.25 oz.
4 oz.
$4
$3
644 Bengay®
645 Vaseline® Jelly
4 oz.
$6
1.25 oz.
1 oz.
$5
$6
NA Coppertone® SPF 50
Sunblock
646 Tinactin® Cream
647 Neosporin® Ointment
NA
NA
NA
0.5 oz. $10
0.5 oz. $7
VITAMINS AND MINERALS
148
149
150
151
Adult Multi-Vitamins
Calcium 600 + Vitamin D
Calcium Tablets
Ferrous Sulfate (Iron)
325mg Tablets
152 Folic Acid 400mcg Tablets
153 Magnesium 500mg
Tablets
100
60
60
100
$8
$7
$5
$6
100
100
$4
$4
NA
649
NA
NA
Adult Multi-Vitamins
Caltrate® 600 + D Tablets
Calcium Tablets
Ferrous Sulfate (Iron)
325mg Tablets
NA Folic Acid 400mcg Tablets
NA Magnesium 500mg Tablets
8 | Call Customer Service to order your OTC items
NA
60
NA
NA
NA
$14
NA
NA
NA
NA
NA
NA
ID# GENERIC NAME
QTY*
AMT
ID#
BRAND NAME
QTY* AMT
VITAMINS AND MINERALS Continued
155 Vitamin A 10,000 IU
Softgel
156 Vitamin B-12
157 Vitamin B-Complex
158 Vitamin B-Complex
Gummy
159 Vitamin C 500mg Tablets
193 Vitamin C Gummy
160 Vitamin E 400 IU Softgel
161 Zinc 50mg Tablets
100
$4
100
100
70
$8
$5
$8
100
60
100
100
$4
$8
$7
$5
NA Vitamin A 10,000 IU
Softgel
NA B-12 Vitamins
NA Vitamin B-Complex
NA Vitamin B-Complex
Gummy
NA Vitamin C 500mg Tablets
NA Vitamin C Gummy
NA Vitamin E 400 IU Softgel
NA Zinc 50mg Tablets
Call Customer Service to order your OTC items
| 9
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
We’re always just a phone call away!
If you’re ready to enroll or have enrollment questions, call 1-877-817-5793, 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.
Arkansas:
All Plans ................................................................................................... 1-800-316-2273
Connecticut:
WellCare Access (HMO SNP) ........................................................ 1-866-635-7047
WellCare Value or Rx (HMO) ........................................................ 1-866-579-8006
Florida:
WellCare Access or Liberty (HMO SNP).................................. 1-866-637-8041
WellCare Dividend, Essential or
Value (HMO/HMO-POS) ................................................................ 1-888-888-9355
Georgia:
WellCare Access (HMO SNP) ........................................................ 1-866-482-3361
WellCare Value or Essential (HMO/HMO-POS)................... 1-866-334-7730
Hawai‘i:
‘Ohana Value (HMO-POS) .............................................................. 1-888-505-1201
Illinois:
WellCare Access (HMO SNP) ........................................................ 1-866-439-1190
WellCare Choice, Rx or Value (HMO/HMO-POS) .............. 1-866-334-6876
Kentucky:
WellCare Access (HMO SNP)....................................................... 1-877-560-3206
WellCare Value (HMO-POS)......................................................... 1-877-560-2766
Louisiana:
WellCare Access (HMO SNP) ........................................................ 1-866-530-9488
WellCare Essential (HMO) .............................................................. 1-866-804-5926
Mississippi:
All Plans ................................................................................................... 1-800-316-2273
New Jersey:
WellCare Liberty (HMO SNP) ....................................................... 1-866-530-9496
WellCare Value (HMO)..................................................................... 1-866-687-8570
New York:
WellCare Access (HMO SNP) ........................................................ 1-866-482-3363
WellCare Liberty (HMO SNP) ....................................................... 1-866-491-5746
WellCare Choice or Value (HMO)............................................... 1-800-278-5155
South Carolina:
All Plans ................................................................................................... 1-800-316-2273
Tennessee:
All Plans ................................................................................................... 1-800-316-2273
Texas:
WellCare Access (HMO SNP) ........................................................ 1-866-530-9495
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.wellcare.com/medicare or www.ohanahealthplan.com/medicare.
Nurse Advice Line ............................................................................ 1-800-581-9952 (24 hours, 7 days a week)
TTY for all of the above ......................................................................................................................1-877-247-6272
‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare (HMO/HMOPOS/HMO SNP/HMO-POS SNP) is a Medicare Advantage organization with a Medicare contract and
a contract with the state Medicaid program. Enrollment in WellCare/‘Ohana (HMO/HMO-POS/HMO
SNP/HMO-POS 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, premium and/or co-payments/coinsurance may change on January 1 of each year. You must
continue to pay your Medicare Part B premium. Please contact WellCare/‘Ohana for details.
66586
P.O. Box 31389 | Tampa, FL 33631-3389