OTC Product Catalog
We want to make it easy for you to manage your health. To help you do that, we have partnered with CVS/
caremark™ to offer you an over-the-counter (OTC) benefit. Your OTC benefit covers the health and wellness
items that you need most.
Ordering is easy:
Go online to
www.cvs.com/otcmolina
§Order 24/7 from any PC, Mac, tablet, or smartphone with online access
§Type Molina into the search box to see color photos of all Plan-approved OTC products
§Click on any image to read more about the item
§See if an item is in stock
§Select other items to order if it is out of stock
You will need a valid eMail address to order online, view your past orders, or get a tracking number so you know
when your order shipped.
OTC products are shipped right to your door.
This means fewer trips to the store and the gas pump!
To place an order by phone call CVS/caremark toll-free at (888) 700-7662, TTY (877) 279-0371.
If you need, a CVS/caremark OTC Customer Service Agent can get someone on the call who speaks your
language.
The CVS/caremark OTC Customer Service line is open Monday-Friday 8 a.m.-11 p.m. ET and on weekends
from 8:30 a.m.-9 p.m. ET. The line is closed on New Year’s Day, 4th of July, Labor Day, Memorial Day,
Thanksgiving, and Christmas.
You do not need a prescription to purchase any of the OTC items covered under this benefit. Whether you order
online or call in your order, you pay nothing for Plan-approved OTC items as long as you stay within your $30
quarterly (i.e., January-March, April-June, July-September, and October-December) OTC benefit amount and
order once a quarter. No out-of-pocket costs. No waiting for refunds. No trips to the store. When you order
once a quarter by phone or online at www.cvs.com/otcmolina.
Make sure to spend your entire OTC benefit amount each quarter. What you don’t use expires at the end of each
quarter. If the entire amount is not used, the remaining balance does not carryover. You will not have a larger
amount to spend the following quarter.
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Key Things to Keep in Mind
ID Cards and Ordering
§Once you become a Molina Medicare Options Plus HMO SNP member, CVS/caremark will mail you a
CVS/caremark ExtraCare® Health card. Your card should arrive within 3-4 weeks.
§You will need your ExtraCare Health card number (found on the back of your ExtraCare Health card) to
order OTC items covered under this benefit.
§If you have an ExtraCare card or an ExtraCare Health card because you purchased items from CVS/
caremark before becoming a member, you will receive a new ExtraCare Health card in the mail. This new
card will reflect your current OTC benefit. Your card will also have your new ExtraCare Health number.
§It can take 7-10 days after you are enrolled in the Plan to show up as an active member in the CVS/
caremark system. Don’t worry. Until you get your ExtraCare Health card, you can call CVS/caremark
to place your order. The CVS/caremark OTC Customer Service Agent will simply ask you for your
member number (found on your Plan ID card). The agent will call us to confirm that you are still
enrolled in the Plan, then help you place your order. To make your order process as simple as possible
please be sure to make a list of the items you would like to order prior to calling to place your order.
§Even though you can create an online account without your ExtraCare Health card number, you will not
be able to order OTC items online without it.
§Once you receive your ExtraCare Health card, go back to the website, update your account with your
ExtraCare Health card number, and you will be ready to place your next order online.
§If you have an existing CVS.com® account because you ordered from CVS.com before becoming a
member you do not need to setup a new account. You only have to setup an account once. Simply update
your existing account with your new ExtraCare Health card number once your new card arrives.
§For online support or to place an order by phone call CVS/caremark for help.
§You can also choose to buy any of the covered Plan-approved OTC items at a store (retail, drugstore, or
online store) and get a refund.
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We do not suggest that you choose this option for a number of reasons.
You will have to pay the full retail price charged by the store upfront out-of-pocket. This also applies to
any Plan-approved OTC items that you buy at a CVS/pharmacy® drugstore. Plan pricing is only applied
to the Plan-approved OTC items you order online or by phone from CVS/caremark. Claims for all OTC
products are not paid. We will only refund your out-of-pocket costs for Plan-approved OTC items up to
your quarterly benefit amount. Plan discounts are not applied to refunds.
After you purchase your Plan-approved items you will have to call us to get a Direct Member OTC
Refund Form. You will have to pay the postage to mail the completed form along with a copy of your
receipts. You will have to wait for a refund check. Once you get your check you will then have to get in
the car again to cash your check.
Benefit Amount
§You have a fixed amount of $30 to spend each quarter on Plan-approved OTC items.
§Make sure to spend your entire OTC benefit amount each quarter. What you don’t use expires at the end
of each quarter. If the entire amount is not used, the remaining balance does not carryover. You will not
have a larger amount to spend the following quarter.
§Refer to the list of covered OTC items below or go online to find the items that you want to order. Visit
www.cvs.com/otcmolina and type Molina into the search box. This will pull up a list of all Plan-approved
OTC products. Click on any image to read more about the item.
§OTC items and prices can change without notice.
§Total the cost of all your items and be sure to stay within your quarterly OTC benefit amount.
§Your quarterly OTC benefit amount can only be used to buy Plan-approved OTC items. You will have to
pay upfront out-of-pocket for any other items that you purchase. This includes taxes and shipping when
they apply.
o Our Members get a 20% discount on any CVS/pharmacy brand health-related OTC item they buy
online at CVS.com or in a CVS/pharmacy. This is a Plan benefit.
o You can also get other discounts on CVS.com and CVS/pharmacy promo items. This is not a Plan
benefit. Anyone can buy these items. Promo deals are not limited to health-related items. You may
find savings and specials on shampoo, soaps, and other items you need. Promo offers and pricing
vary.
§This OTC benefit is for Plan members only. Your quarterly OTC benefit amount and 20% Plan discount
should not be used to purchase OTC items for anyone else.
Shipping, Payments, and Refunds
§Allow 7-10 days for shipping. If your order does not arrive by this time please contact CVS/caremark at
[email protected] or call (888) 700-7662, TTY (877) 279-0371.
§Shipping is free when you order once a quarter.
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§When you order more than once a quarter you will have to pay a $5.49 flat shipping charge for each extra
order. Surcharges for heavy items may apply. American Express, MasterCard, Discover Card, and Visa are
accepted when you buy online.
§Should you receive a damaged item, please contact CVS/caremark within 72 hours at [email protected]
or call (888) 700-7662, TTY (877) 279-0371.
§If you purchased your OTC items at a store call us to get a Direct Member OTC Refund Form. You will
find our Member Services phone number on the back of your Plan ID card. Follow the steps on the form
and mail your completed form and receipts to the address on the form. Your claim will be reviewed. You
will get a refund for any Plan-approved OTC items you purchased up to your quarterly benefit amount.
There are no refunds for 20% discounted or other promo OTC items. A check will be mailed to your
home address within 4 weeks.
Molina Medicare Options Plus HMO SNP is a Health Plan with a Medicare Contract and a contract with the
state Medicaid program. Enrollment in Molina Medicare Options Plus depends on contract renewal.
This information is available in other formats, such as Braille, large print, and audio.
This information is available for free in other languages. Please call our customer service number at
(800) 665-3086, TTY/TDD 711, 7 days a week, 8 a.m. - 8 p.m., local time. Esta información está disponible
gratuitamente en otros idiomas. Por favor, comuníquese a nuestro número de teléfono para servicio al cliente al
(800) 665-3086,TTY/TDD 711, los 7 días de la semana, de 8:00 a.m. a 8:00 p.m., hora local.
The benefit information provided is a brief summary, not a complete description of benefits. For more
information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary,
pharmacy network, provider network, premium and/or copayments/ co-insurance may change on January 1 of
each year.
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Category / Item Description
CVS
SKU
Price
994280
477066
896248
125507
$5.59
$3.59
$10.23
$5.99
587618
890847
688783
707032
316620
702307
973804
807034
159734
858828
6205
953436
$5.83
$10.63
$8.39
$3.19
$4.63
$16.79
$5.59
$4.39
$3.99
$4.39
$4.39
$8.79
488025
695189
836320
642686
150391
$8.39
$6.79
$3.99
$4.39
$3.59
672550
195560
$4.63
$3.19
186577
977136
690260
690261
305623
209452
707924
488021
304709
$1.34
$1.59
$9.43
$7.99
$4.39
$1.99
$13.03
$4.39
$3.51
OTC items / pricing can change without notice
Eligible OTC Items
Allergy & Asthma - Allergy & Sinus Medicine
CVS Dye-Free Allergy Liquid, Cherry (4 oz.)
CVS Small Size Allergy Tablets (24 ct.)
CVS Non-Drowsy Sinus Relief Daytime and Multi-Symptom Nighttime Softgels (48 ct.)
CVS Nasal Spray Sinus (1 oz.)
Cough, Cold, & Flu
CVS Medicated Chest Rub (3.53 oz.)
CVS Non-Drowsy Daytime & Multi-Symptom Cold & Flu Relief, Combo Pack (24 oz.)
CVS Cold Remedy Fast Melting Quick Dissolving Tablets, Cherry (25 ct.)
CVS Maximum Strength Sore Throat Lozenges, Cherry (18 ct.)
CVS Sore Throat Spray, Cherry (6 oz.)
CVS All Natural Flu Relief Quick Dissolving Pellets (12 ct.)
CVS AirShield Gummies (42 ct.)
CVS Medicated Cold Sore Treatment Maximum Strength (.23 oz.)
CVS Nasal Decongestant Inhaler (.01 oz.)
CVS No-Drip Maximum Strength Nasal Mist (.5 oz.)
CVS Saline Nasal Spray (3 oz.)
CVS Nasal Strips Large, Tan (30 ct.)
Digestive Health - Antacid / Heartburn Relief
CVS Omeprazole Magnesium Acid Reducer 20.6 mg Delayed Release Capsules (14 ct.)
CVS Acid Reducer Tablets 75mg (30 ct.)
CVS Antacid Tablets Extra Strength, Assorted Fruit (96 ct.)
CVS Stomach Relief ChewableTablets ( 48 ct.)
CVS Antacid & Pain Reliever Tablets Effervescent, Original (36 ct.)
Digestive Health - Anti-Diarrhea
CVS Anti-Diarrheal Caplets (12 ct.)
CVS Bismuth Liquid (8 oz.)
Digestive Health - Fiber & Laxitives / Constipation Relief
CVS Disposable Enema, Latex Free (4.5 oz.)
CVS Epsom Salt, Unscented (16 oz.)
CVS Easy Fiber (62 doses)
CVS Easy Fiber Chewable Tablets, Wild Berry (90 ct.)
CVS Milk of Magnesia Saline Laxative, Original Flavor (12 oz.)
CVS Oral Solution Magnesium Citrate, Lemon (10 oz.)
CVS Senna Plus Laxative/Stool Softener Tablets Value Size (180 ct.)
CVS Stool Softener Capsules, Original (30 ct.)
CVS Glycerin Suppositories, Adult Size (50 ct.)
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Category / Item Description
CVS
SKU
Price
660019
$7.19
690659
$10.79
333336
$9.59
322436
209478
152074
$3.99
$1.42
$1.82
383505
580365
336846
$2.87
$5.03
$4.39
460423
$5.19
845675
$4.23
457931
125815
961468
$5.19
$5.99
$5.59
955322
690242
695911
$6.39
$4.39
$7.19
460702
$11.19
181257
903693
$14.63
$7.19
211344
310410
$12.79
$8.47
110163
893119
893132
$2.39
$3.59
$2.55
OTC items / pricing can change without notice
Eligible OTC Items
Digestive Health - Gas Relief
CVS Gas Relief Chew Tablets, Mint (100 ct.)
Digestive Health - Lactose Intolerance
CVS Fast Acting Dairy Relief Chewable Tablets, Vanilla Twist Flavor (60 ct.)
Feminine Care - Yeast Infections
CVS Miconazole Nitrate Vaginal Cream 2% Disposable Applicators (1.59 oz.)
First Aid - Antibiotic & Antiseptic
CVS Antibiotic Ointment, Original (.5 oz.)
CVS Hydrogen Peroxide Solution (16 oz.)
CVS 70% Isopropyl Rubbing Alcohol (16 oz.)
First Aid - Bandages
CVS Clear Bandages, Assorted Sizes (45 ct.)*
CVS Elastic Bandage 4 Inches (1 ct)*
CVS Liquid Bandage (0.3 oz.)
First Aid - Burn Treatment
CVS Medicated Instant First Aid Spray (3 oz.)
First Aid - Corn Removal
CVS One Step Medicated Corn Removers, Maximum Strength
First Aid - Hemorrhoid Treatment
CVS Hemorrhoidal Ointment (1 oz.)
CVS Medicated Pads for Hemorrhoidal Relief (100 ct.)
CVS Hemorrhoidal Suppositories (12 ct.)
First Aid - Itch & Rash Treatment
CVS No-Rub Calamine Plus Spray (6 oz.)
CVS Maximum Strength Cortisone Intense Healing Anti-Itch Cream (1 oz.)
CVS Jock Itch Spray (4.6 oz.)
First Aid - Medical ID Bracelets
CVS Medical ID Bracelet (1 ct.)
First Aid - Pinworm & Lice Treatment
CVS Lice Solution Kit, Maximum Strength (1 ct.)
CVS Antifungal Ringworm Cream (.5 oz.)
First Aid - Sterile Gloves & Masks
CVS Latex-Free Super-Soft Vinyl Gloves, One Size Fits Most, Mega Pack (120 ct.)
CVS Procedural Face Masks with Earloops (50 ct.)
First Aid - Tape, Gauze, & Pads
CVS Cotton Balls (130 ct.)
CVS Sterile Latex-Free Gauze Pads, 2” x 2” (25 ct.)*
CVS Sterile Latex-Free Non-Stick Pads, 2” x 3” (10 ct.)*
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Category / Item Description
CVS
SKU
Price
482021
$6.63
211037
334067
$7.99
$6.63
945987
968645
$7.19
$5.59
420928
149650
$2.39
$1.59
251606
735607
715130
791257
$2.63
$4.79
$8.39
$3.99
324111
318180
827058
440188
351297
$4.79
$11.99
$5.83
$5.59
$4.39
420029
$2.79
978991
$4.63
975085
975088
975091
$2.39
$2.39
$2.39
208334
171322
317912
$5.43
$6.39
$2.55
OTC items / pricing can change without notice
Eligible OTC Items
CVS Maximum Strength Invisible Wart Remover Strips (14 ct.)
Foot Care - Antifungal & Health
CVS Clotrimazole Cream Usp 1% (1 oz.)
CVS Athlete’s Foot Powder Spray (4.6 oz.)
Health & Medicine - Compression Hosiery & Stockings
CVS Men’s Over-the-Calf Length Compression Socks, Size 7-12 (1 pair)
CVS Ladie’s Non-Binding Crew Socks, Size 6-10 (3 pairs)
Health & Medicine - Diabetic
CVS Glucose Liquid Shot, Berry Blast (2 oz.)
CVS Glucose Tablets Orange (10 ct.)
Health & Medicine - Medicine Accessories
CVS Eye Droppers and Ear Medicine (1 ct.)
CVS Medicine Bottle Magnifier (1 ct.)
CVS Weekly AM/PM Pill Case (1 ct.)
CVS Pill Splitter (1 ct.)
Hot and Cold Therapy
CVS Cold Pain Relief Pack, Reusable (1 ct.)
CVS Reusable Hot Cold Pain Relief Compress (1 ct.)
CVS Extra Strength Cold & Hot Medicated Patch XL (3 ct.)
CVS Arthritis Heatwraps, Hand & Wrist (2 ct.)
CVS Heatwraps, Neck, Shoulder, & Wrist (3 ct.)
Incontinence - Cleaners, Cloths, & Creams
Total Home by CVS Flushable Moist Wipes Tub (42 ct.)
Incontinence - Pads & Liners
CVS Maximum Absorbency Protective Pads, Long (12 ct.)
Incontinence - Protective Underwear & Briefs
CVS Men’s 4-Piece Maximum Absorbency Sizing Kit (4 ct.)
CVS Women’s 4-Piece Maximum Absorbency Lifestyle Kit, L/XL (4 ct.)
CVS Women’s 4-Piece Maximum Absorbency Lifestyle Kit, S/M (4 ct.)
Opthalmic (eyes)
CVS Eye Allergy Relief Eye Drops (15 ml)
CVS Artificial Tears Lubricant Eye Drops (1 oz.)
CVS Redness Relief Eye Drops (0.5 oz)
Oral Care (mouth)
CVS Oral Anesthetic Gel Maximum Strength (2 oz.)
CVS Extra Strength Denture Adhesive Cream (2.4 oz.)
CVS Denture Cleanser Anti-Bacterial Tablets (40 ct.)
CVS Dental Floss, Waxed (100 yd.)
CVS Dry Mouth Mouthwash, Mint (16 oz.)
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122344
$4.63
953690
$3.43
213330
$2.55
102319
$2.14
813104
$6.23
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Category / Item Description
CVS
SKU
Price
OTC items / pricing can change without notice
Eligible OTC Items
CVS Maximum Strength Oral Pain Reliever for Severe Toothaches (45 oz.)
876501
$5.59
Otic (ears)
317119
$7.03
CVS Ear Pain Relief Ear Drops (.33 oz.)
973866
$6.39
CVS Earwax Removal Kit (1 ct.)
Pain & Fever - Arthritis Pain Relief
107847
$5.99
CVS Menthol Gel (8 oz.)
213140
$5.03
CVS Arthricream Cream Rub (3 oz.)
200964
$5.03
CVS Muscle Rub (3 oz.)
Pain & Fever - Aspirin Relief
547802
$2.14
CVS Adult Low Dose Aspirin 81 mg Chewable Tablets, Orange (36 ct.)
230268
$5.19
CVS Enteric Aspirin 81 mg Tablets (120 ct.)
419423
$2.06
CVS Aspirin 81 mg Tablets Low Dose (32 ct.)
152314
$1.99
CVS Aspirin 325 mg Coated Tablets, Regular Strength (100 ct.)
Pain & Fever - Migraine Relief
185226
$3.83
CVS Migraine Relief Caplets (24 ct.)
Pain & Fever - Non-Aspirin Relief
594895
$5.19
CVS Backache Relief Caplets, Extra Strength (24 ct.)
235626
$9.03
CVS Ibuprofen Tablets (200 ct.)
711635
$5.59
CVS Leg Cramps Pain Relief Caplets (40 ct.)
299472
$5.03
CVS All Day Pain Relief Tablets (50 ct.)
111047
$4.39
CVS Pain Relief Tablets Extra Strength (60 ct)
Pain & Fever - Thermometers & Accessories
834794
$7.99
CVS Digital Flexible Tip Thermometer (1 ct.)
156053
$2.22
CVS Thermometer Probe Covers (30 ct.)
Under certain circumstances some items may be covered under either Part B or Part D. When you receive
these items under Part B or D you may not purchase these items through your Part C supplemental OTC benefit. For your convenience, we’ve marked these items with an (*).
Dual Purpose OTC Items
All Items listed below are Dual Purpose items. You should only order these products after discussing them
with your health care provider to see if s/he recommends the item for a specific diagnosed condition. Please
speak to your physician before ordering these items.
Health & Medicine - Blood Pressure Monitor
CVS Self-Taking Blood Pressure Monitor (1 ct.)
Vitamins - Minerals
CVS Calcium 600 + D Tablets (120 ct.)
CVS Great Tasting Calcium 500 mg Gummy Vitamins (50 ct.)
CVS Iron 65 mg Tablets (200 ct.)
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800232
$14.39
901330
889908
317150
$9.59
$9.03
$9.19
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Category / Item Description
CVS
SKU
Price
122869
963236
300258
247316
866534
459949
$11.19
$8.79
$3.19
$7.99
$7.19
$11.19
964600
280123
247322
227215
166595
240515
251660
$3.99
$5.59
$5.99
$3.99
$8.39
$7.19
$5.99
OTC items / pricing can change without notice
Eligible OTC Items
Vitamins - Supplements
CVS Coenzyme Q10 50 mg Softgels (30 ct.)
CVS Natural Fish Oil 1000 mg Softgels (120 ct.)
CVS Folic Acid 800 mcg Heart & Reproductive Health Tablets (100 ct.)
CVS Glucosamine 1500 mg Tablets (60 ct.)
CVS Melatonin Sleep Aid Tablets 5 mg (90 ct.)
CVS Niacin Capsules 500 mg (200 ct.)
Vitamins
CVS B-1 100 mg Tablets (100 ct.)
CVS Vitamin B-6 100 mg Tablets (100 ct.)
CVS Vitamin B-12 500 mcg Tablets (100 ct.)
CVS Vitamin C 500 mg Tablets (100 ct.)
CVS Vitamin C 1000 mg Chewable Tablets (100 ct.)
CVS Vitamin E 400 Iu Softgels (100 ct.)
CVS Spectravite Adult Multivitamin Tablets (130 ct.)
Non-Eligiblel OTC Items
Non-Eligible OTC items, if purchased, will not be covered by the Plan.
Alternative Medicines
Baby Items
Contraceptives
Convenience (Non-Medical) Items
Cosmetics
Food Product or Supplements
Replacement Items, Attachments, Peripherals
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