Hassle-Free and as easy as
1... 2... 3...
1
2
3
Visit our website
or call to place
your order
We process
your order
You receive
medications
by mail
This information is a ailable for free in other languages. Please contact our
customer ser ice number at - -245-53 0. TT TDD - 00- 55- 77 .
Esta informaci n est disponible gratuitamente en otros idiomas.
Por fa or llame al departamento de ser icio de miembros al
- -245-53 0 TT TDD - 00- 55- 77 para m s informaci n.
Select from the items listed herein and log on to:
The Hassle-Free and easy
way to get Over-the-Counter
Health related supplies
Receive from
to $
$15 to
50
every month
*
Check your Summary of Benefits for details.
Toll Free: 1-866-900-2688
TTY/TDD: 1-800-955-8771
Optimum Healthcare is an HMO plan with a Medicare Advantage contract
and a contract with the Florida Medicaid program. Enrollment in Optimum
HealthCare depends on contract renewal.
2014 OTC Benefits
At NO COST To You!
in Over-the-Counter Drugs & Supplies
based on plan selection and county.
That’s a savings between
$180 and $600
over the course of a year!**
And Optimum HealthCare takes
the hassle out of ordering!
www.youroptimumhealthcare.com or call:
Oct 1, 2013 to Feb 14, 2014 - 7 days a week, 8 am to 8 pm
Feb 15, 2014 to Sept 30, 2014 - Mon through Fri, 8 am to 8 pm
Oct 1, 2014 to Dec 31, 2014 - 7 days a week, 8 am to 8 pm
OPT 4OTC
The benefit information pro ided is a brief summary not a complete description
of benefits. For more information contact the plan. Limitations co-payments
and restrictions may apply. Benefits formulary pharmacy network premium
and or co-payments co-insurance may change on anuary of each year.
Amount aries by plan and county. Limitations and restrictions may apply.
Based on a 2 month enrollment.
Receive from
$15 to $50
every month*
in Over-the-Counter Drugs & Supplies
based on plan selection and county.
Amount aries by plan and county. Limitations and restrictions
may apply. 55 4 OTCbrochure20 4 CMS Accepted
Item Brand
Generic Comparable
(1) Allergies
Chlorpheniramine Maleate 4mg
Diphenhydramine HCl 12.5mg
Diphenhydramine HCI 25mg
Deep Sea Nasal Spray Saline 0.65%
(2) Analgesics
2A Tylenol Ex 500mg
Acetaminophen tablets 500mg
2B Bayer Asprin
Asprin 325mg
2C Zostrix
Trixaicin Crm 0.025% (casaicin)
2E Advil
Ibuprofen 200mg FC Tab
2F Ben Gay
Muscle Rub 35g
2G Aleve
Naproxen Sodium 220mg CPL
2H Asprin Low Dose 81mg Asprin EC (delayed reased) 81mg
2I Tylenol PM
Acetaminophen 500mg & Diphenhydramine 25mg
2J Aspirin Low dose Chewable Aspirin Low dose 81mg Chewable
2K Icy Hot Patch
Cold and Hot Patch
2L Excedrin
Headache Formula-Aspirin/Acetaminophen/Caffeine
(3) Antacids
3A Tums-Ex
Calcium Carbonate Chewable Antacid
3B Mylicon- Adults
Acid Gas Relief tablets
3C Zantac 75
Ranitidine Tablets 75mg
3D Alka Seltzer
Effervescent pain relief
(4) Anti-Diarrheals
4A Imodium
Loperamide 2mg
4B Pepto Bismol
Pink Bismuth Tablets (chewable)
(5) Anti-Hemorrhoidals
5A Anusol
Hydrocortisone oint. USP 1%
5B Preparation H
Prompt Relief Hem Ointment
5C Preparation H Suppositories Hemorrhoidal Supositories
(6) Cough/Cold
6A Robitussin Sugar-free Dm Sugar-free cough syrup
6B Vicks
Medicated Chest Rub
6C Mucinex Dm
Mucinex DM 600mg
6D Afrin nasal Spray
Nasal Spray
6E Cough Drops
Cough Drops, Cherry or Honeylemon
6F Robitussin Dm
Q-Tussin DM
6G Sudafed PE Tablets
Nasal Decongestant PE Max Strength
6H Sinus Congestion & Pain Sinus-Acetaminophen/Phenylphrine HCl
1A
1B
1C
1D
Chlortrimeton
Benadryl Elixir
Benadryl Caps
Ayr Nasal
Qty. Price
24
118ml
24
44ml
$4
$3
$3
$3
100
100
60g
24
35g
50
120
50
36
5
100
$4
$3
$9
$3
$3
$7
$3
$5
$3
$8
$7
96
100
30
12
$5
$5
$9
$6
12
30
$6
$5
28g $6
57g $7
12 $13
118ml
100g
20
15ml
30
118ml
36
24
$5
$6
$20
$3
$3
$3
$5
$5
6I
6J
6K
6L
6M
7A
7B
7C
7D
7E
8A
8B
8C
8D
8E
8F
8G
8H
9A
9B
9C
9D
9E
9F
9G
10A
10B
10C
10D
11A
11B
11C
11D
Item Brand
Chloraseptic
Chloraseptic Lozenges
Sugar Free Cough Drops
Mucus Relief
Cepacol
Generic Comparable
Sore throat spray
Sore throat lozenges menthol
Sugar Free Cough Drops
Expectorant- Guaifenesin 400mg
Cepacol
(7) Eye Care
Collyrium Eye Wash Eye Wash
Visine
Eye Drops Irritation Relief
Moisture Eyes
Artificial Tears
Isopto Tears
LiquiTear Eye drops
Zaditor
Eye-Itch Relief Antihistamine
(8) First Aid Creams & Ointments & Antiseptics
Benadryl Cream
Anti-Itch Cream
Bacitracin
Bacitracin
Lotrimin
Clotrimazole 1% Cream
Cortizone
Hydrocortisone Cream
Zinc Oxide
Zinc Oxide Ointment
Neosporin
Triple-Antibiotic Ointment
Micatin
Miconazole Nitrate 2% Cream
Debrox
Ear wax removal
(9) First Aid Supplies
Ace Bandage 3"
Elastic bandage w/clips 5yards
Butterfly Closure
Butterfly Closures
Cotton Balls
Cotton Balls
Ice Bag
Ice Bag 9" (1 quart capacity)
J&J Gauze
Gauze Rolls - Assorted sizes
Sun Block 4oz
Sun Screen Lotion SPF 30
Q-Tips
Cotton Swabs
(10) Laxatives
Colace
Docusate Sodium 100mg
Fibercon
Fiber-Lax 500mg
Miralax
Clear Lax Powder 4.1oz
Fleet Enema
Enema-Saline Laxative
(11) Miscellaneous Items
Sleep-Aid
Sleep-tabs 25mg
Blood Pressure Kit *
Manual Self Taking Blood Pressure kit
Band Aid
Adhesive Bandages
Digital Themometer Digital Themometer
Qty. Price
180ml
18
25
30
16
$5
$4
$4
$7
$5
11E
11F
11G
11H
11I
118ml
15ml
15ml
15ml
5ml
$4
$3
$7
$4
$15
35g
14g
28g
28g
28g
1oz
28g
.5oz
$3
$6
$7
$5
$8
$6
$4
$7
12A
12C
12E
12F
12G
12H
12I
12J
1
10
100
1
3
113g
300
$4
$2
$3
$9
$3
$15
$5
100
60
119g
133ml
$5
$9
$11
$2
24
1
50
1
$4
$19
$3
$5
13A
13B
13C
13D
13E
13F
13G
13H
13I
13J
13K
13L
13M
13N
13O
13P
13Q
13R
13S
14A
14B
Item Brand
Generic Comparable
Dramamine
Motion Sickness Tablets
Pill Organizer
One Day At a time Medicine Organizer-Weekly
DEX4 Glucose Tablets Glucose Chewable Tablets
Melatonin-Sleep Aid
Melatonin Tablet 3mg
Eye Glass Wipes
Wipes and lens cleaner pack
(12) Topical Foot & Topical Oral
Callus Remover
Callus Remover
Callus Cushion
Callus Pad
Plackers Dental flossers Dental flossers
Pill Splitter
Pill Spitter
Polident
Denture Cleaners - 3 minutes
Toothpaste
Toothpaste
Toothbrush
Toothbrush
Fixodent
Denture Adhesives ADH CRM fresh
(13) Vitamins & Minerals*
Fish oil 1200mg
Fish oil 1200mg
Prosight
Supplement for eyes
Allbee With C
B Complex with C
Vitamin B
B Complex with B12
Vitamin C
Vitamin C Chewable 500mg
Centrum
Multivitamin & Mineral
Folic Acid
Folic Acid 800mcg
Glucosamine Chondroitin Glucosamine Chondroitin
Acidophilus
Acidophilus
Vitamin E
Vitamin E 400 IU
Vitamin D
Vitamin D 1000 IU
Antioxidant tablets
Antioxidant tablets
Selenium
Selenium 200 mcg
Timed Release Niacin Timed Release Niacin 500 mg
Lactaid Tab
Dairy Digestive Supplement-Lactase Enzyme
Ferrous Sulfate
Ferrous Sulfate 325mg
Calcium Citrate & Vitamin D* Calcium Citrate & Vitamin D
One A Day Women's* One A Day Women's Multivitamin
Os-Cal*
Oyster Calcium + Vitamin D
(14) Smoking Cessation
Nicorette 2mg
Stop Smoking Gum-Nicotine Polacrilex gum
Stop Smoking Gum-Nicotine Polacrilex gum
Nicorette 4mg
Qty. Price
12
1
50
60
1 box
$4
$7
$8
$8
$3
6
6
36
1
40
2.7oz
1
1.4oz
$4
$3
$3
$5
$7
$4
$2
$5
90
60
100
100
100
60
100
60
100
100
100
50
60
60
60
100
60
60
100
$9
$6
$8
$6
$8
$6
$5
$15
$5
$8
$5
$7
$7
$10
$9
$3
$7
$10
$4
50 $20
50 $24
These items are considered dual purpose items. Prior to ordering these items the enrollee must ha e an appropriate con ersation with the enrollee s personal pro ider who orally recommends the OTC item for a specific diagnosable condition. OTC items
may only be purchased for the enrollee it is prohibited to purchase supplies for family members and friends. The following supplies are not co ered as they are non-eligible supplies Alternati e Medicines (Includes botanicals herbals probiotics homeopathic
and neutraceuticals) baby supplies contracepti es con enience comfort supplies (insoles glo es etc.) cosmetics food products or supplements replacement attachments such as contact lens containers or batteries. To minimi e mailing costs the plan
may impose a limited ordering quantity per purchase. This list is sub ect to change. This benefit is only a ailable if your plan offers the OTC ser ice as a benefit. Orders will be shipped ia PS or SPS Please allow 7- 0 business days to recei e your order
from the time the order is placed. Please consult with your doctor before using any OTC products. All OTC Supplies are generic comparable to the item brand and shipped based on manufacturer a ailability.