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

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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

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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

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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

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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

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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

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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.

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P.O. Box 31389 | Tampa, FL 33631-3389