2017 OVER-THE-COUNTER (OTC) CATALOG
MEDICARE ADVANTAGE PLANS
Get the
OTC items
you need.
H5087_CA034506_WCM_OTC_ENG_FINAL_01 CMS Accepted 07272016 WellCare 2016 CA_11_16 EC7OTCCAT80036E_1116
The Benefits of Easy Choice Health Plan Add Up. What is Easy Choices 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. Its 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 well 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 two ways to get your items. No matter how you order them, well ship them right to your door. Its that easy. Allow 7-10 business days to receive your order.
Find the items you want in this catalog, then: Give us a call at 1-888-979-4319, TTY 711, Monday-Friday, 6:30 a.m.8:00 p.m. Pacific.
Visit us at www.easychoicehealthplan.com. Log in using your member ID number and date of birth. You can find your member ID number on your Easy Choice member ID card.
To Get the Most Out of Your OTC Benefit: Make sure to order your items every month. If you skip a month, the benefits dont carry over to the next month. Use your monthly dollar amount to stock up on a variety of items by ordering different items every month.
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Call Customer Service to order your OTC items | 1 EC7OTCCAT80036E_1116
http://www.easychoicehealthplan.com
What Can I Order With My OTC Selection? Eligible items On the next few pages, youll 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? Theyre 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, weve marked dual-purpose items with a ().
Dual-purpose items include but are not limited to: Minerals and vitamins
In-home testing and monitoring
Hormone replacement
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, weve marked these items with a (**).
Whats 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. Well 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 Allergy Relief (Cetirizine) 10mg Tablets
30 $10 501 Zyrtec 14 $17
2 Allergy Relief (Loratadine) 10mg Tablets
30 $7 502 Claritin 10 $12
280 Nasoflow Allergy Relief 60 Sprays
$24 680 Flonase Allergy Relief 9.9 ml $37
ANALGESICS/ANTIPYRETICS
3 Acetaminophen 325mg Tablets
100 $3 503 Tylenol 325mg Regular Strength Tablets
100 $10
4 Acetaminophen 500mg Tablets
100 $5 504 Tylenol 500mg Extra Strength Tablets
100 $16
5 Aspirin 325mg Tablets 100 $3 505 Bayer Aspirin 325mg 100 $8 6 Aspirin 81mg Chewable 36 $3 NA Bayer Aspirin 81mg
Chewable NA NA
7 Aspirin Enteric Coated 81mg Tablets
120 $5 507 Bayer EC Aspirin 81mg (Adult Regimen)
32 $4
8 Aspirin Enteric Coated 325mg Tablets
100 $4 508 Ecotrin Tablets 325mg 100 $6
Items, quantities, sizes and values may change depending on availability * = Quantities and brands may vary depending upon availability. ** = Covered under either Part B or Part D = Dual-purpose items Item cost may change from year to year Some items may vary depending on manufacturer. (For example, caplets, tablets, capsules or soft gels may be substituted for one another.)
Call Customer Service to order your OTC items | 3
ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT
ANTACIDS AND ACID REDUCERS
9 Acid Reducer (Famotidine) 10mg Tablets
30 $6 509 Pepcid AC Tab 10mg 30 $11
10 Acid Reducer (Omeprazole) 20mg
14 $14 510 Prilosec OTC 20mg 14 $12
11 Acid Reducer (Ranitidine) 75mg Tablets
30 $7 511 Zantac Tablets 75mg 30 $15
12 Antacid Tablets 150 $5 512 Tums Tablets 150 $8 13 Effervescent Tablets 36 $4 513 Alka-Seltzer 24 $7 14 Gas Relief Softgel Extra-
Strength 30 $4 514 Gas-X Extra Strength 18 $6
NA Acid Reducer (Omeprazole) NA NA 686 Nexium 22.3mg 14 $26 NA Acid Reducer (Omeprazole) NA NA 687 Nexium 22.3mg 28 $48 NA Acid Reducer (Omeprazole) NA NA 688 Nexium 22.3mg 42 $64
ANTICANDIDAL (YEAST)
15 Miconazole Vaginal Cream 3 Day
1 $14 515 Monistat Vaginal Cream 3 Day
1 $24
ANTIDIARRHEAL AND LAXATIVES
16 Adult Glycerin Suppositories
25 $3 516 Fleet Adult Suppositories
50 $5
17 Anti-Diarrheal Caplets 12 $4 NA Imodium A-D Caplets NA NA 18 Anti-Nausea Liquid 4 oz. $6 518 Emetrol 4 oz. $9 19 Bisacodyl 5mg Tablets 25 $4 519 Dulcolax Tablets 25 $8 231 Enema, Mineral Oil 4.5 oz. $4 NA Enema, Mineral Oil NA NA 279 Enema, Saline
Laxative 4.5 oz. $2 679 Fleet Enema A24,
Saline 4.5 oz. $4
20 Laxative (Bisacodyl) 10mg Suppositories
12 $5 520 Dulcolax Suppositories 8 $13
21 Stomach Relief Flavored Tablets
30 $3 521 Pepto-Bismol Tablets 30 $6
290 Stomach Relief Flavored Liquid
8 oz. $6 690 Pepto-Bismol 8 oz. $9
NA Stomach Relief Flavored Liquid
NA NA 691 Pepto-Bismol 16 oz. $15
22 Stool Softener Softgel 100 $4 522 Colace Caplets 30 $13
4 | Call Customer Service to order your OTC items
ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT
ANTI-INFLAMMATORY
23 Ibuprofen 200mg Liquid Gel Caps
20 $5 523 Advil Liquid Gel Caps 200mg
20 $6
24 Ibuprofen 200mg Tablets 50 $6 524 Advil Tablets 200mg 50 $10 25 Naproxen Sodium 220mg
Caplets 50 $8 525 Aleve Caplets 220mg 24 $7
ARTHRITIS MEDICINE
26 Arthritis Pain Relief Caplets
24 $5 NA Tylenol Arthritis NA NA
27 Hot/Cold Patches 5 $5 527 Icy Hot Patches 5 $7
BLADDER CONTROL ITEMS
167 Adult Protective Briefs Small/Medium
20 $18 NA Adult Protective Briefs Small/Medium
NA NA
168 Adult Protective Briefs Large
20 $18 NA Adult Protective Briefs Large
NA NA
169 Adult Protective Briefs XL 20 $20 NA Adult Protective Briefs XL NA NA 170 Adult Bladder Control
Pads 28 $9 NA Adult Bladder Control
Pads NA NA
200 Disposable Bed Underpads
5 $6 NA Disposable Bed Underpads
NA NA
COLD/COUGH/FLU REMEDIES
53 APAP Sinus Congestion 24 $4 553 Tylenol Sinus Congestion 24 $8 54 Cough/Throat Drops 30 $3 554 Halls Cough Drops 30 $3 55 Daytime Cold/Flu Relief
Softgel 16 $5 555 DayQuil Caplets 16 $8
56 Daytime Cold/Flu Relief Liquid
4 oz. $5 556 DayQuil Liquid 8 oz. $8
174 Daytime/Nite-time Cold/ Flu Caplets
20 $5 674 DayQuil/NyQuil Caplets
32 $18
230 Diphenhydramine 25mg Capsules
24 $3 NA Benadryl NA NA
57 Mucus Relief DM Tablets 30 $9 557 Mucinex-DM 20 $17 58 Mucus Relief Tablets 30 $8 558 Mucinex 20 $15 59 Nasal Decongestion
Spray 1 oz. $4 559 Afrin Nasal Spray 0.5 oz. $10
60 Nasal Decongestion PE Tablets
36 $4 NA Sudafed PE NA NA
Call Customer Service to order your OTC items | 5
ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT
COLD/COUGH/FLU REMEDIES Continued
61 Nite-Time Cold/Flu Relief Softgel
16 $5 561 NyQuil Caplets 16 $8
62 Nite-Time Cold/Flu Relief Liquid
4 oz. $7 562 NyQuil Liquid 8 oz. $8
63 Saline Nasal Spray 1.5 oz. $3 563 Ocean Nasal Spray 1.5 oz. $6
64 Sore Throat Spray 6 oz. $4 NA Chloraseptic Sore Throat Spray
NA NA
65 Tussin DM Syrup SF 4 oz. $6 565 Robitussin DM Syrup 4 oz. $8
66 Tussin Syrup 4 oz. $4 NA Robitussin Syrup NA NA
67 Vapor Rub 3.53 oz. $5 NA Vicks Vaporub NA NA
211 Sugar-Free Cough/Throat Drops
25 $3 NA Sugar-Free Halls Cough Drops
NA NA
DENTAL AND DENTURE CARE
69 Denture Adhesive Cream
2.4 oz. $5 569 Fixodent 2.4 oz. $7
70 Denture Cleaner 40 $4 570 Efferdent 20 $5 71 Fluoride Toothpaste 6.4 oz. $3 571 Colgate 4 oz. $5 72 Adult Toothbrush -
Medium 1 $2 572 AIM Toothbrush - Soft 1 $4
73 Dental Floss 1 $2 573 AIM Dental Floss 1 $3 75 Sensitive Teeth
Toothpaste 4.3 oz. $5 NA Sensodyne NA NA
76 Toothache Relief Liquid/ Gel
0.33 oz. $4 576 Anbesol Liquid/Gel 0.41 oz. $9
EAR CARE
77 Ear Syringe 1 $3 NA Ear Syringe NA NA 78 Ear Wax Drops 0.5 oz. $6 578 Debrox Ear Wax Drops 0.5 oz. $8
EYE CARE
79 Artificial Tears 0.5 oz. $4 579 Visine Tears 0.5 oz. $7 238 Collyrium Eye
Wash 118ml 3.9 oz. $4 NA Collyrium Eye Wash NA NA
93 Red Eye Relief Drops 0.5 oz. $3 593 Visine Drops 0.5 oz. $6
6 | Call Customer Service to order your OTC items
ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT
FIBER SUPPLEMENTS
94 Fiber Gummies 60 $10 594 Vitafusion Fiber Well Gummies
90 $18
95 Fibertab Tablets 90 $9 NA FiberCon Caplets NA NA 281 Psyllium Powder, Orange 13 oz. $10 681 Metamucil Orange 114 $40 NA Psyllium Powder, Orange NA NA 682 Metamucil Orange
Sugar Free 114 $40
NA Psyllium Powder, Orange NA NA 683 Metamucil Orange Sugar Free
72 $35
FIRST AID AND MEDICAL SUPPLIES
96 Adhesive First-Aid Tape** 1 $2 NA Adhesive First-Aid Tape** NA NA 189 Aid Ankle Support 1 $7 NA Aid Ankle Support NA NA 191 Aid Elbow Support 1 $7 NA Aid Elbow Support NA NA 192 Aid Hand Support 1 $7 NA Aid Hand Support NA NA 166 Aid Knee Support 1 $7 NA Aid Knee Support NA NA 190 Aid Wrist Support 1 $7 NA Aid Wrist Support NA NA 97 Alcohol Pads** 100 $3 NA Alcohol Pads** NA NA 162 Anti-Embolism Stockings
Extra Large 1 $13 NA Anti-Embolism Stockings
Extra Large NA NA
163 Anti-Embolism Stockings Large
1 $13 NA Anti-Embolism Stockings Large
NA NA
164 Anti-Embolism Stockings Medium
1 $13 NA Anti-Embolism Stockings Medium
NA NA
165 Anti-Embolism Stockings Small
1 $13 NA Anti-Embolism Stockings Small
NA NA
98 Athletic Bandage** 1 $2 NA Athletic Bandage** NA NA 99 Bandages Assorted 100 $4 599 Band-Aids 100 $10 100 Butterfly Closures** 12 $2 NA Butterfly Closures** NA NA 101 Corn and Callus Remover 0.33 oz. $4 NA Dr. Scholls Corn and
Callus Remover NA NA
102 Cotton Balls 100 $3 NA Cotton Balls NA NA 103 Cotton Swabs 150 $3 603 Q-Tips Cotton Swabs 170 $5 249 Diabetic Socks Ladies
Shoe size (5-10) - White 3 Pack $7 NA Diabetic Socks Ladies
Shoe size (5-10) - White NA NA
250 Diabetic Socks Ladies Shoe size (5-10) - Black
3 Pack $7 NA Diabetic Socks Ladies Shoe size (5-10) - Black
NA NA
Call Customer Service to order your OTC items | 7
ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT
FIRST AID AND MEDICAL SUPPLIES Continued
251 Diabetic Socks Men Shoe size (6-12.5) - White
3 Pack $7 NA Diabetic Socks Men Shoe size (6-12.5) - White
NA NA
252 Diabetic Socks Men Shoe size (6-12.5) - Black
3 Pack $7 NA Diabetic Socks Men Shoe size (6-12.5) - Black
NA NA
258 Elastic Knee Support
1 $3 NA Elastic Knee Support
NA NA
104 First Aid Kit 1 $8 NA First Aid Kit NA NA
105 Flexible Tip Thermometer
1 $10 NA Flexible Tip Thermometer
NA NA
235 Gauze Pad Sterile 4x4** 100 (12 ply)
$14 NA Gauze Pad Sterile 4x4** NA NA
236 Gauze Surgical Sponge Sterile 4x4**
25 (12 ply)
$6 NA Gauze Surgical Sponge Sterile 4x4 **
NA NA
237 Gauze Value Surgical Sponges 4x4**
25 (12 ply)
$5 NA Gauze Value Surgical Sponges 4x4**
NA NA
239 Heating Pad, Dry Heat, 12x15
1 $21 NA Heating Pad, Dry Heat, 12x15
NA NA
221 Hydrogen Peroxide 8 oz. $2 NA Hydrogen Peroxide NA NA
106 Ice Bag 1 $4 NA Ice Bag NA NA
284 Liquid Bandage 0.0225 oz.
$6 684 New-Skin Liquid 0.3 oz. $9
NA Liquid Bandage NA NA 685 New-Skin Liquid 1 oz. $13
107 Liquid Wart Remover 0.5 oz. $6 607 Compound W Wart Remover
0.31 oz. $8
108 Oral Digital Thermometer 60 Second
1 $5 NA Oral Digital Thermometer 60 Second
NA NA
220 Rubbing Alcohol** 16 oz. $3 NA Rubbing Alcohol** NA NA
109 Stretch Gauze** 1 $2 NA Stretch Gauze** NA NA
HEADACHE RELIEF
110 Headache Relief Tablets 50 $4 610 Excedrin Migraine 24 $6
8 | Call Customer Service to order your OTC items
ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT
HEMORRHOIDAL PREPARATIONS
111 Hemorrhoid Ointment
2 oz. $7 611 Preparation-H Ointment
2 oz. $16
112 Hemorrhoid Pads 100 $7 612 Tucks Medicated Pads 100 $10
113 Hemorrhoid Relief Suppositories
12 $7 613 Preparation-H Suppositories
24 $7
LACTOSE INTOLERANCE
114 Lactase Enzyme 60 $10 614 Lactaid Tablets 32 $10
MOTION SICKNESS MEDICATION
115 Motion Sickness Tablets 12 $3 615 Dramamine Motion Sickness
12 $6
PEDICULICIDES (HEAD LICE TREATMENTS)
136 Lice Comb 1 $3 NA Lice Comb NA NA 137 Lice Treatment Shampoo 4 oz. $10 637 LiceMD Lice Shampoo 4 oz. $12
SLEEPING AIDS
138 Night Time Sleep Tablets (Diphenhydramine)
50 $4 638 Sominex Tablets 16 $7
139 Sleep Aid Tablets (Doxylamine)
16 $5 639 Unisom Tablets 16 $7
SMOKING CESSATION PRODUCTS
196 Nicotine Gum 2mg 20 $10 NA Nicotine Gum 2mg NA NA 197 Nicotine Gum 4mg 20 $10 NA Nicotine Gum 4mg NA NA
TOPICAL OINTMENTS AND CREAMS
140 Anti-Itch Cream 1.25 oz. $3 640 Benadryl Cream 1 oz. $6 278 Benzoyl Peroxide 10% Gel 42.5
Grams $5 678 Clearasil Vanishing Cream 1 oz. $13
141 Clotrimazole 1% Cream 0.5 oz. $5 641 Lotrimin AF 0.42 oz.
$10
142 Cold Sore Treatment 1 $7 NA Herpecin NA NA 143 Hydrocortisone 1%
Cream 1 oz. $3 NA Cortaid NA NA
144 Muscle Rub Cream 1.25 oz. $3 644 Bengay 2 oz. $6 145 Petroleum Jelly 4 oz. $3 645 Vaseline Jelly 3.75
oz. $5
Call Customer Service to order your OTC items | 9
ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT
TOPICAL OINTMENTS AND CREAMS Continued
171 SPF 50 Sunblock 4 oz. $6 NA Coppertone SPF 50 Sunblock
NA NA
146 Tolnaftate 1% Cream 1.25 oz. $5 646 Tinactin Cream 1 oz. $10
147 Triple Antibiotic Ointment
1 oz. $5 647 Neosporin Ointment 0.5 oz. $7
NA Cold Sore Treatment NA NA 675 Abreva Cream 2 g $32
VITAMINS AND MINERALS
148 Adult Multi-Vitamins 100 $8 648 Centrum Vitamins 130 $22
149 Calcium 600 + Vitamin D 60 $7 649 Caltrate 600 + D Tablets 60 $14
150 Calcium Tablets 60 $5 NA Calcium Tablets NA NA 232 FDC Vitamin B Complex
with Vitamin C + Iron 100 $4 NA FDC Vitamin B Complex
with Vitamin C + Iron NA NA
233 FDC Vitamin D Tablets 400IU
100 $6 NA FDC Vitamin D Tablets 400IU
NA NA
234 FDC Vitamin E Softgel Tablets 400IU
100 $9 NA FDC Vitamin E Softgel Tablets 400IU
NA NA
151 Ferrous Sulfate (Iron) 325mg Tablets
100 $6 NA Ferrous Sulfate (Iron) 325mg Tablets
NA NA
152 Folic Acid 400mcg Tablets 100 $4 652 Windmill Folic Acid Tablets - 400mcg.
100 $7
153 Magnesium 250mg Tablets
100 $4 NA Magnesium 500mg Tablets NA NA
NA One-a-Day Multivitamins - Chocolate
NA NA 689 One-a-Day Vitacraves Multivitamins - Chocolate
50 $24
NA Calcium Chewable Tablets
NA NA 692 Windmill Calcium Chewable Tablets 500mg
60 $5
NA Vitamin B + C + Iron NA NA 694 Windmill Vitamin B Complex with Vitamin C + Iron
100 $6
155 Vitamin A 10,000 IU Caplets
100 $4 NA Vitamin A 10,000 IU Softgel
NA NA
156 Vitamin B-12 100mcg 100 $8 NA B-12 Vitamins NA NA 157 Vitamin B-Complex 100 $5 NA Vitamin B-Complex NA NA 158 Vitamin B-Complex
Gummy 70 $8 NA Vitamin B-Complex
Gummy NA NA
10 | Call Customer Service to order your OTC items
ID# GENERIC NAME QTY* AMT ID# BRAND NAME QTY* AMT
VITAMINS AND MINERALS Continued
159 Vitamin C 500mg Tablets 100 $4 NA Vitamin C 500mg Tablets NA NA 193 Vitamin C Gummy 60 $8 NA Vitamin C Gummy NA NA 160 Vitamin E 400 IU 100 $7 NA Vitamin E 400 IU Softgel NA NA 161 Zinc 50mg Tablets 100 $5 NA Zinc 50mg Tablets NA NA NA Silver Multi-Vitamins NA NA 676 Centrum Silver Vitamins 125 $28
Call Customer Service to order your OTC items | 11
Y0070_NA034833_WCM_INS_ENG_NA_07_16_CA_FINAL
Were always just a phone call away! If youre ready to enroll or have enrollment questions, call 1-866-999-3945,
8 a.m. to 8 p.m., 7 days a week.
If youre already a member, call the number listed below.
California: All Plans..................................................................................................................... 1-866-999-3945
Hours of operation are MondayFriday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are available MondaySunday,
8 a.m. to 8 p.m., or visit us anytime at www.easychoicehealthplan.com.
Nurse Advice Line.....................................................................................................1-800-581-9952 (24 hours, 7 days a week)
TTY for all of the above ..........................................................................................................................................1-877-247-6272
http:www.easychoicehealthplan.com
7994
5
14 pt CA036144_WCM_INS_MLT_CA_11_16CA7WCMINS79945M
Easy Choice Health Plan (HMO/HMO SNP), a WellCare company, is a Medicare Advantage organization with a Medicare contract and a contract with the California Medicaid program. Enrollment in Easy Choice (HMO/HMO 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, premiums and/or co-payments/ coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. If you meet certain eligibility requirements for both Medicare and Medicaid, your Part B premiums may be covered in full. Some plans are available to those who have medical assistance from both the state and Medicare. Please contact Easy Choice for details.
ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-866-999-3945 (TTY: 1-877-247-6272).
ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Llame al 1-866-999-3945 (TTY: 1-877-247-6272).
P.O. Box 31389 | Tampa, FL 33631-3389
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