2016 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 such as bandages, cold
and allergy medicines, pain relievers, and vitamins – at no cost to you. Benefit amounts do
not roll over, so be sure to use them before the end of every quarter. Simply call the toll-free
number OR fill out and mail the order form provided. Your order will be shipped directly to
your door.
Special Benefit
for Care1st Health
Plan Members
Get Over-the-Counter
Products Every
Quarter at
No Cost
to You!
Information on how to
place your OTC order can be
found on the last page.
*B - May be covered by Medicare Part B.
*D - May be covered by Medicare Part D.
H5928_16_013_PD_OTC Accepted
You can get the following items without having to talk with
your doctor, but we always recommend that you talk with
your doctor before starting a new product regimen.
Acne Treatment
Acne Gel 10%
Benzoyl Peroxide 1.5 oz
1076
$7.20
Allergy, Cold, Flu, Decongestant and Sinus
All Day Allergy Tablets
14 tabs
1090
$7.90
All-Nite Cold/Flu 500-15-6.25 mg 1361
$8.30
Children's Dimaphen 4 oz
1426
$6.10
Children's
Diphenhydramine HCL
1428
$6.60
Chlorpheniramine Maleate
100 tabs, 4 mg
1008
$6.00
1356 $21.40
Cough & Cold for High
Blood Pressure 16 tabs
1166
Diphenhydramine HCL
24 capsules, 25 mg
Aspirin 100 tabs, 325 mg
1095
$4.90
Aspirin Enteric Coated
100 tabs, 325 mg
1096
$7.10
1002
$7.10
Children's Acetaminophen
30 chewables, 80 mg
1423
$6.20
Children's Ibuprofen
100 mg/ 5 ml
1421
$8.20
Ibuprofen 100 tabs, 200 mg
1004
$8.70
Menstrual Relief 24 tabs
1257
$6.90
Aspirin Low Dose
120 tabs, 81 mg
1308
1009
Pain Reliever PM
Extra Strength 100 tabs
1332 $11.60
Antacids and Acid Reducers
$9.30
Alka-Seltzer 36 tabs
1313 $15.20
$7.90
Chewable Antacid
150 tabs, 500mg
1346
$7.00
$8.30
Effervescent Pain
Reliever 36 tabs
1314
$8.90
Famotidine *D 30 tabs
1108
$7.30
Gas-X 36 chewables, 80 mg
1312
$8.60
$9.50
Multi Symptom
Cold Formula 24 tabs
1357
$8.40
Nasal Decongestant
Spray 12 Hr, 1oz
1091
$9.50
Antacid/Anti-Gas Liquid
1006
Nasal Spray (Saline) 1.5 oz
1052
$9.50
Omeprazole *D 28 caps
1110 $39.80
Anti-Arthritic
Sudogest PE 36 tabs, 10 mg
(Nasal and Sinus Decongestant) 1352
$6.00
Vapor Rub 1 oz
$8.40
1164
Arthritis Pain Reliver
100 tabs
1311 $19.40
Capsaicin
1367 $11.40
1114 $13.30
$8.60
Glucosamine Joint/Muscle
60 capsules
$6.00
Glucosamine/Chondroitin
60 capsules
Pain Relievers and Fever Reducers
Acetaminophen
100 tabs, 325 mg
2.
1104 $14.20
Naproxen *D 100 tabs, 220 mg 1097 $14.40
Cromolyn Sodium
(Allergy Nasal Spray)
Diphenhist
(Antihistamine) 100 tabs
Aleve 100 tabs, 220 mg
Acetaminophen
50 tabs, 500 mg
1001
1105
1003 $16.50
Contact Lens Supplies
Anticandial (Yeast)
Clotrimazole Vaginal Cream
w/applicator *D
1115 $12.80
Micanozole 3 Day Treatment 1117 $16.90
Tioconazole 1 Day Treatment
with applicator
1119 $29.10
Antidiarrheal
Multi Purpose Contact
Lens Solution
1468
$8.40
Cough Suppressants and Expectorants
Cherry Cough Drop
30 lozenges
1056 $10.10
Diabetic Tussin DM
1323
1180 $11.00
$9.60
Bismatrol
(Bismuth Subsalicylate) 30 tabs 1045
$7.90
Guaifenesin
Cough Expectorant 60 tabs
Loperamide HCL *D 12 tabs
1133
$5.90
Cough Syrup, Expectorant
1054
$5.00
Pepto-Bismol
1317 $15.40
Pink Bismuth
1318
Mucus Relief DM
(Guaifenesin Expectorant
and Dextromethorphan
Cough Suppressant)
30 tabs, 400-20 mg
1178
$8.00
Sore Throat Lozenges
Cherry 18 lozenges
1176
$7.10
Sugar Free Cough
Drop Cherry 25 lozenges
1182
$6.40
Dental Floss 55 yards
1455
$5.90
Denture Cleaning Tablets
40 tabs
1032
$7.90
Fixodent
1187
$9.10
$8.40
Antifungal
Clotrim Antifungal Cream
1047 $13.00
Miconazole 2% Cream
1135 $13.60
Terbinafine HCL Tube
1046 $16.70
Tolnaftate Cream
1064
$5.90
Anti-Itch Lotions and Creams
Bactine Solution
1142 $12.60
Pramoxine Topical Analgesic 1144 $10.80
Dental/Denture Care
Diphenhydramine HCL/
Zinc Acetate
1140
$5.80
Oral Pain Relief
1286
$8.70
Hydrocortisone 1% Cream
1074
$5.80
Orajel Pain Relief
1454
$9.30
Rechargeable Toothbrush
1450 $38.20
Tooth Brush • Colgate
Clean Adult Soft
1413
$5.20
Tooth Brush • Tek Pro
Straight Soft
1412
$4.80
Tooth Paste • Pepsodent
1414
$5.90
Polident Denture Cream
1324 $11.20
Cold Sore, Fever Blister and Other
Medicated Lip Products
Abreva
1152 $20.60
Blistex Lip Ointment
1256
$5.90
Carmex
1255
$5.40
Herpecin-L Lip Balm
1153
$9.10
Releev Cold Sore Treatment
1359 $40.10
*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D.
3.
Digestive Health
Beano 30 tabs
1316
$9.40
Enema 4.5 oz
1733
$8.00
Lactase Capsules 60 capsules 1067 $12.30
Ear Care
1732 $22.00
1731 $27.00
Elastic Bandage *B
2” X 5 yd
3” X 5 yd
4” X 5 yd
6” X 5 yd
1207
1209
1211
1213
$4.50
$4.80
$5.20
$6.10
Ear Drops
1190
$6.30
First Aid Kit 48-piece
1215 $10.60
Ear Wax Removal System
with Rubber Bulb
1363
$9.90
Folding Cane
with Ergonomic Handle
1726 $22.00
Hot/Cold Pack for Injury
1062
$8.50
$5.10
Eye Care
Artificial Tears Drops
1192
$6.10
Hydrogen Peroxide
1228
Clear Eyes Eye Drops
1199
$8.20
Eye Drops (Redness Relief)
1061
$6.10
Lantiseptic Skin
Protectant Ointment
1202 $10.60
Eye Wash Solution
1196
$7.00
Knee Stabilizer
1465 $27.10
Artificial Tears Ointment
1194 $11.40
Neosporin Plus
1326 $14.70
Night Wrist Support
Smart Glove
1463 $35.40
Povidone Iodine
1203
Raised Toilet Seat
1729 $36.00
Rib Belt One size fits most
MALE
FEMALE
1456 $25.20
1457 $25.20
Shower Mat (non-skid)
1460 $28.50
1217
1218
$4.70
$5.90
1219
1220
$5.40
$7.20
Tape, Transparent Surgical *B
1” X 10 yd
1221
2” X 10 yd
1222
$5.30
$7.00
First Aid and Medical Supplies
4.
Cushion
FOAM RING
LUMBAR
Adhesive Bandages
60 bandages
1344
$8.00
Alcohol Pads *D
100 pads
1200
$7.10
Ankle Support
1225 $11.50
Antiseptic Towelettes
100 pack
1201
Automatic Blood
Pressure Monitor Desktop
1253 $44.40
Tape, Paper Surgical *B
1” X 10 yd
2” X 10 yd
Bath Bench
WITH Back
WITHOUT Back
1728 $71.00
1727 $55.00
Tape, Silk Surgical *B
1” X 10 yd
2” X 10 yd
Bath Mat (non-skid)
1459 $18.50
Bath Tub Safety Rail
1730 $38.00
Conforming Gauze Sterile *B
12 pads, 3” X 4 yd
1223 $15.00
$7.60
Thermometer
DIGITAL
DIGITAL - EAR
$5.30
1063 $9.60
1285 $16.70
Laxatives
Wintergreen Isopropyl
Alcohol
1229
Wrist Splint
1230 $23.90
Docusate Sodium 100 capsules 1126 $18.10
Wrist Support
1227 $13.50
Ex-Lax 8 tabs
1124
$8.20
Glycerin Suppository
25 tabs, 2 gm
1125
$6.80
Methylcellulose
1354 $19.90
Milk of Magnesia 12 oz
1011
Natural Vegetable Laxative
1340 $16.00
1012 $13.70
$7.40
Foot Care
Bisacodyl 100 tabs
1128
Callus Remover Pads 6 pads 1238
$9.80
Corn Remover Pads 9 pads
1236
$9.80
Medicated Foot Powder
1240
$7.40
Hemorrhoidal Ointment
1066
$9.00
Polycarbophil Fiber Tablets
90 tabs
Hemorrhoidal Suppository
box of 12
1247
$6.60
Senna Plus 60 tabs, 8.6-50 mg 1130
Preparation H Cream
1248 $18.50
Pre-Moist Hemorrhoid Pads
100 pads
1364 $12.10
Hemorrhoidal Preparations
Home Diagnostics
$6.50
$8.40
$8.70
Migraine Relief
Migraine Relief 100 tabs
1365
$9.90
Wellpatch Migraine box of 4
1261 $11.10
Minerals
Colon Cancer Test
1416 $18.60
Calcium Carbonate Tabs
60 tabs
1291
$8.30
Home Access
Cholesterol Test
1251 $38.10
Calcium-Vitamin D 60 tabs
1373
$6.50
Ferrous Sulfate
100 tabs, 325 mg
1376
$7.60
Niacin 100 tabs, 100 mg
1378
$7.00
Niacin 100 tabs, 500 mg
1394
$9.60
Magnesium 110 tabs, 250 mg 1418
$8.40
$9.30
Incontinence Supplies
A&D Ointment
1300
$6.60
Adult Briefs
Med 32" - 44” waist, 12 pk
LG 45” - 58” waist, 18 pk
XL 59” - 64” waist, 15 pk
1303 $12.60
1304 $15.60
1305 $15.60
Barrier Cream
1302 $10.50
Magnesium Oxide
100 tabs, 250 mg
1377
Underpad 23" x 36"
1299 $16.00
Rena-Vite 100 tabs
1395 $21.40
Washcloth w/Lanolin
1348
$9.60
Zinc Chelated 100 tabs, 50 mg 1419
$7.40
*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D.
5.
Motion Sickness
Support Items
Dramamine Orange 8 chews
1264 $10.70
Driminate 12 tabs
1263
Meclizine 100 tabs
1366 $12.00
$6.00
Pediculicide
Lice Treatment Shampoo
1271 $14.00
Permethrin Cream Rinse
1269 $17.70
Personal Care
Ammonium Lactate
1368 $14.30
Aloe Vera Cream
1070 $10.70
Hand Sanitizer
1065
Sunscreen Lotion SPF 30
1284 $12.80
$7.20
Sleep Aids
1724 $14.00
1725 $14.00
Sleep Tabs 24 tabs
1276
$7.10
Smoking Cessation
Nicotine Patches box of 14
STEP 1 21 mg/24 hr
STEP 2 14 mg/24 hr
STEP 3 7 mg/24 hr
6.
Women's Compression Knee Hi Socks
NUDE - SM Shoe Size 4-5
(8-15 mmhg)
1406 $16.60
NUDE - MED Shoe Size 51/2-71/2
(8-15 mmhg)
1407 $16.60
NUDE - LG Shoe Size 8-101/2
(8-15 mmhg)
1408 $16.60
BLACK - SM Shoe Size 4-5
(8-15 mmhg)
1409 $16.60
1/2
1/2
BLACK - MED Shoe Size 5 -7 2
(8-15 mmhg)
1410 $16.60
1/2
BLACK -LG Shoe Size 8-10
(8-15 mmhg)
1411 $16.60
Topical Antibiotics
Nasal Strips box of 30
SMALL/MEDIUM
MEDIUM/LARGE
Nicorelief Gum
Men's Compression Knee Hi Socks
BLACK - LG Shoe size 101/2-12
(15-20 mmhg)
1399 $27.40
WHITE - MED Shoe Size 8-10
(15-20 mmhg)
1400 $27.40
1/2
WHITE - LG Shoe Size 10 -12
(15-20 mmhg)
1401 $27.40
1372 $27.00
1369 $40.30
1370 $40.30
1371 $40.30
Bacitracin Ointment
1020
$5.80
Triple Antibiotic Ointment
1014
$9.90
Wart Remover
Dr. Scholl’s Wart
Removal System
1288 $19.70
Wart Remover
1075
Wartners Wart
Removal System Kit
1289 $27.90
*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D.
$9.00
Before ordering any of the items below, you should
talk with your doctor.
Vitamins
Centrum Silver 60 tabs
1420 $33.50
Vitamin B-6
100 tabs, 100 mg
1388
$7.10
Daily Multiple Vitamin Tabs
100 tabs
1385
$7.10
Vitamin B-12
100 tabs, 500 mg
1389
$8.20
Ferrous Gluconate
(Iron Supplement) 100 tabs
1375
$7.60
Vitamin B-12
100 tabs, 1000 mcg
1381 $11.20
Iron 110 tabs, 27 mg
1417 $10.00
Vitamin C 500 mg, 100 tabs
1017
Multi Vitamin Children's
100 chewables
1422 $10.00
Vitamin Century Senior
90 tabs
1392 $13.10
Prenatal Vitamins 100 tabs
1274 $10.00
Vitamin D 100 tabs, 1000 iu
1390
$8.10
Vitamin A 100 tabs, 10 mu
1379
$6.30
Vitamin D 100 tabs, 400 iu
1383
$8.00
Vitamin B-Complex 100 tabs
1382
$8.20
Vitamin E 100 tabs, 100 iu
1391
$7.40
Vitamin B-1 100 tabs, 100 mg 1016
$7.50
Vitamin E 100 tabs, 400 iu
1384
14.40
Vitamin B-6 100 tabs, 50 mg
$6.60
Vitamin One A Day 100 tabs
1393
$8.10
1380
$6.50
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
renewal.
This information is not a complete description of benefits. Contact the plan for more information.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-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 información está disponible gratuitamente en otros idiomas. Comuníquese con Servicios para
los Miembros: 1-800-544-0088 (TTY: 711), de 8:00 a.m. a 8:00 p.m., los 7 días de la semana.
這項免費資訊T以其它語言提供。懇請聯絡會員服務Ł處：免費熱線 1-800-544-0088 (聽障及語障人
士h專線 711) 每週七天辦公，早上8:00 點I至晚上8:00 點。
7.
Helpful Information
•
If you have questions or would like to place an order over the phone, OTC
Advocates are available Monday – Friday from 8:00am to 5:00pm PST at
1-800-355-7913 (TTY 711).
•
If you place your order using an order form, your order total will be applied to
the quarter 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 (or third quarter) benefit, not your June (or second quarter) benefit.
If you’re getting close to the end of the quarter and you do not think your
order form will be received in time, you can call in your order.
•
We encourage you to use your full quarterly benefit amount in one order. This
benefit amount does not roll over from quarter to quarter.
•
Your order total may not exceed the quarterly benefit amount shown in the letter
you received with this catalog. Cash, checks or money orders are not accepted
under this OTC benefit.
•
Orders may only be placed by the member, an authorized representative verbally
approved by the member at time of the order, and/or the member’s power of
attorney representative on file.
•
To use your benefit, you must select products from this catalog that will help
you with a health or medical need. Your order total may not exceed your benefit
amount. OTC products are intended for members use only. Care1st Health Plan
prohibits the use of this benefit to order OTC items for family members and friends.
OTC items are available through mail-order only.
•
Once your order is received, please allow 7 - 10 business days for delivery.
•
Products may not be purchased at a local retail pharmacy or through any other
source other than the Care1st Health Plan OTC Benefit Catalog.
•
If you disenroll from Care1st Health Plan, your OTC benefit will automatically
terminate.
•
Returns are not accepted.
•
Some items listed in this catalog may also be covered under your Medicare Part B
(medical) benefit or Part D (pharmacy) benefit. These items have a *B or a *D after
their name. For example, alcohol pads are covered under Part D if they are used
for administering insulin. For all other purposes, this item is covered under your
OTC benefit.
•
Items in the 2016 OTC Benefit Catalog may change throughout the year.
A copy of this catalog is also available on the Care1st Health Plan website at
www.care1st.com/ca/medicare. For up-to-date information, please call our OTC
Advocates from Monday - Friday from 8:00am to 5:00pm PST at 1-800-355-7913
(TTY 711).