2023 Over-the-Counter (OTC) Benefit Catalog - AmeriHealth Caritas VIP Care

[Pages:24]2023 Over-the-Counter (OTC) Benefit Catalog

Your AmeriHealth Caritas VIP Care (HMO-SNP) health plan membership includes an Over-theCounter (OTC) benefit every quarter. This benefit allows you to get OTC products you may need. Be sure to use your benefit amounts before the end of every quarter. Simply order online, mail your completed order form or call 1-800-824-9713 (TTY: 711). Your order will be shipped directly to your door.

Order Online at

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Order Guidelines

ORDER ONLINE

You may place an order online at . Remember to save your username and password to order again during your next benefit period.

ORDER BY MAIL

You may place your order by mailing in the order form to: AmeriHealth Caritas VIP Care OTC Orders 4613 N. University Drive, #586 Coral Springs, FL 33067 If the end of the benefit period is approaching, you can order online or call us if you do not think your order form will be received in time.

ORDER BY PHONE

If you have questions or would like to place an order over the phone, call the FlexCard Services Line Monday ? Friday from 8 a.m. to 8 p.m. EST at 1-800-824-9713 (TTY: 711).

RETAIL DEBIT CARD OPTION

Visit a participating pharmacy or retailer to buy eligible OTC items with your available funds. Participating retailers and OTC categories can be found under the Over-the-Counter Benefit Section of the online portal at .

? Your benefit amount is offered at the beginning of each quarter. Please refer to your Summary of Benefits for your quarterly benefit amount.

? Members may purchase up to 6 products per category per quarter. There is no limit on the total number of items a member may purchase. OTC catalog and online ordering portal orders are limited to 3 orders per quarter. Additional limits may apply to some items. Any unused balance will automatically expire at the end of each quarter or upon disenrollment from the plan.

? Your order total may not exceed your benefit amount. Cash, checks, credit cards or money orders are not accepted under this OTC benefit.

? Your order total will be applied to the benefit period in which the order is received. ? OTC products are intended for member use only to help with a health or medical need. AmeriHealth

Caritas VIP Care prohibits the use of this benefit to order OTC items for anyone other than the member. ? Due to the personal nature of these products, returns are not accepted. ? Items in the OTC catalog occasionally change during the year. For the most up-to-date listing of OTC

products available, go to . ? The health information provided in the catalog is general in nature and is not medical advice or a substitute

for professional health care. All product and company names are trademarksTM or registered? trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them.

FOR DELIVERY Allow 7-10 business days from the time order is placed.

2 2023 Over-the-Counter (OTC) Benefit Catalog

Online and Retail Ordering Options

Online Access to Your OTC Benefit is Fast, Easy, and Secure!

Your AmeriHealth Caritas VIP Care plan website, , offers many convenient features.

? Browse the OTC products that are available to you ? Access a digital copy of your OTC catalog ? Monitor your available balance while you shop ? Track your order and view your order history ? Manage your account ? And more!

If you have already created an account online, just log in to get started! If it's your first time ordering online, you will need to register and set up your account.

Registration is easy and takes only a few minutes to complete.

Visit , indicate that you are a first-time user by clicking on Register Here on the Member Login tab. Enter your information exactly as it appears on your AmeriHealth Caritas VIP Care member ID card. You will need the following:

? AmeriHealth Caritas VIP Care member ID number ? Date of birth (e.g., MM/DD/YYYY) ? Current email address ? Current phone number You will then create a unique username and password for your account. Now you can log in and access your OTC benefit online, 24/7. Remember to save your username and password for future orders. If you need any assistance, please call the FlexCard Services Line 1-800-824-9713 (TTY: 711) Monday ? Friday from 8 a.m. to 8 p.m. EST and our friendly and knowledgeable Customer Service Representatives will be happy to help you take full advantage of your OTC benefit. Please note: Orders for the benefit period must be placed prior to midnight Eastern Time of the last day of the period.

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Item # Product ALLERGY

163 Allergy Nasal Spray, 24-hour 34 Cetirizine 406 Children's Allergy Liquid 701 Chlorpheniramine Maleate Antihistamine 609 Diphenhydramine Antihistamine 29 Diphenhydramine Antihistamine 25 Loratadine Allergy Tabs 482 Nasal Decongestant Inhaler 176 Nasal Decongestant Spray, 12-Hour 104 Nasal Spray, Saline ANTACIDS & ACID REDUCERS 121 Antacid Chewables 254 Antacid Chewables Extra Strength 625 Antacid/Anti-Gas Liquid 126 Effervescent Antacid & Pain Relief 159 Famotidine (Acid Reducer)* 222 Omeprazole (Acid Reducer)* 323 Simethicone (Gas Relief) ANTICANDIDAL (YEAST) 392 Miconazole (3-Day Cream w/Applicator) ANTI-DIARRHEAL, LAXATIVES & DIGESTIVE HEALTH 49 Anti-Diarrheal 634 Anti-Nausea Liquid 250 Bisacodyl E.C. 133 Bismuth Chewable Tablets 185 ClearLax

Packaging

60 spray 30 ct 4 oz 24 ct 100 ct 24 ct 30 ct 1 1 oz 1.5 oz

150 ct 96 ct 12 oz 36 ct 30 ct 14 ct 100 ct

1

12 ct 4 oz 100 ct 30 ct 4 oz

Strength 50mcg 10mg 4mg 25mg 25mg 10mg

500mg 500mg

10mg 20mg 80mg

2mg 5mg 262mg

Price

$19.00 $8.00 $5.00 $3.00 $6.00 $3.00 $6.00 $9.00 $5.00 $4.00

$6.00 $5.00 $7.00 $6.00 $7.00 $16.00 $6.00

$15.00

$5.00 $7.00 $5.00 $7.00 $9.00

4 2023 Over-the-Counter (OTC) Benefit Catalog

Item # Product 171 Enema Saline 298 Fiber Tablets 303 Glycerin Suppository, Adult 449 Lactase Capsules 291 Milk of Magnesia 111 Pink Bismuth Liquid 432 Psyllium Powder 152 Stool Softener

ANTI-FUNGAL 505 Clotrimazole (Athlete's Foot Cream) 497 Miconazole Nitrate (Anti-fungal Cream) 180 Tolnaftate

BATHROOM SAFETY & FALL PREVENTION 1067 Adjustable Transfer Bench 1068 Bath Bench with Back 1066 Bath Bench without Back 414 Bath Mat, Non-Skid 1069 Bath Tub Safety Rail 1071 Bedside Commode* 343 Folding Cane Ergonomic Handle* 453 Knurled Chrome Grab Bar - 12 507 Knurled Chrome Grab Bar - 24 57 Nightlight 1 ct 1048 Quad Cane, Large Base* 1049 Quad Cane, Small Base* 1065 Raised Toilet Seat 456 Shower Mat, Non-Skid 1070 Toilet Safety Rails

Packaging 4.5 oz 90 ct 25 ct 60 ct 12 oz 8 oz 13 oz 100 ct

Strength 625mg

1,200mg 525mg/30ml

100mg

Price $4.00 $9.00 $5.00 $12.00 $5.00 $6.00 $14.00 $9.00

.5 oz 2 oz 1.25 oz

$9.00 $9.00 $4.00

1

$60.00

1

$50.00

1

$40.00

1

$15.00

1

$40.00

1

$50.00

1

$20.00

1

$19.00

1

$22.00

1

$4.00

1

$35.00

1

$25.00

1

$20.00

1

$20.00

1

$45.00

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Item # Product COLD & FLU

206 Cough & Cold for High Blood Pressure 327 Cough Drops 107 Cough Drops, Sugar Free 119 Cough Syrup 595 Guaifenesin Tablets 292 Mucus Relief DM Tablets 221 Mucus Relief Tablets 252 Multi-Symptom Cold Formula 304 Nasal Decongestant PE 213 Night Time Cold & Flu 93 Sore Throat Lozenges, Cherry 236 Sore Throat Spray 62 Tussin DM Sugar Free 422 Tussin DM Syrup 37 Vapor Rub COLD SORE & MEDICATED LIP PRODUCTS 12 Lip Balm DENTAL & DENTURE CARE 40 Dental Floss 73 Dental Travel Kit 150 Denture Adhesive Cream 207 Denture Brush 66 Denture Cleaning Tablets 616 Fingertip Tooth & Gum Massager 72 Interdental Flossups 599 Interdental Gum Brushes 112 Mouthwash

6 2023 Over-the-Counter (OTC) Benefit Catalog

Packaging Strength

Price

16 ct 30 ct 25 ct 4 oz 100 ct 30 ct 30 ct 20 ct 36 ct 8 oz 18 ct 6 oz 4 oz 4 oz 3.5 oz

200mg/10ml 200mg

400mg/20mg 400mg

10mg

$6.00 $3.00 $3.00 $7.00 $12.00 $6.00 $6.00 $7.00 $5.00 $8.00 $4.00 $6.00 $7.00 $9.00 $4.00

1

$4.00

1 1 2.4 oz 1 40 ct 1 90 ct 10 ct 4 oz

$3.00 $6.00 $9.00 $3.00 $4.00 $6.00 $5.00 $6.00 $2.00

Item # Product

194 Oral Pain Relief

587 Rechargeable Toothbrush Replacement Heads

468 Tongue Cleaner

4 Toothbrush - Adult

617 Toothbrush, Colgate - Soft

287 Toothbrush, Rechargeable

95 Toothpaste, Colgate

52 Toothpaste, Sensitive Teeth

563 Water Jet Rechargable Replacement Tips

188 Water Jet, Battery Operated

317 Water Jet, Rechargeable

DIABETES CARE

295 Diabetic Skin Relief Foot Cream

202 Diabetic Socks, Black, Large

201 Diabetic Socks, Black, Medium

199 Diabetic Socks, White, Large

198 Diabetic Socks, White, Medium

390 Glucose Tablets

DIAGNOSTICS

508 Activity Tracker

460 Blood Pressure Monitor, Arm Talking

71 Blood Pressure Monitor, Fully Auto (Arm)

187

Blood Pressure Monitor, Fully Auto (Arm) with XL Cuff

626 XL Cuff for Fully Auto Arm BPM (Cuff Only)

85 Blood Pressure Monitor, Wrist

499 Blood Pressure Monitor, Wrist Talking

1047 Digital Bathroom Scale

Packaging .33 oz 2 ct 1 1 1 1 4 oz 4.3 oz 5 ct 1 1

4 oz 3-pack 3-pack 3-pack 3-pack 50 ct

1 1 1 1 1 1 1 1

Strength

Price $4.00 $10.00 $6.00 $3.00 $3.00 $30.00 $4.00 $4.00 $20.00 $30.00 $50.00

$12.00 $8.00 $8.00 $8.00 $8.00 $7.00

$40.00 $40.00 $35.00 $50.00 $15.00 $30.00 $35.00 $40.00

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Item # Product 394 Fever Strip Thermometer 270 Finger Pulse Oximeter 360 Flexible Tip Thermometer 559 Heart Rate Monitor Watch 514 Peak Flow Meter 399 Thermometer Probe Covers 48 Thermometer, Digital 60 Seconds 105 Thermometer, Digital Ear 283 Thermometer, Talking Ear and Forehead

EYE & EAR CARE 61 Artificial Tears Drops 245 Cosmetic Tweezer 220 Cotton Tipped Swabs 148 Ear Wax Removal Drops 483 Ear Wax Removal System w/Rubber Bulb 32 Eyeglass Cleaner 106 Irritation & Redness Relief Eye Drops 560 Multi-Purpose Contact Lens Solution 731 Reading glass Diopter 1.0 732 Reading glass Diopter 1.25 733 Reading glass Diopter 1.5 734 Reading glass Diopter 1.75 735 Reading glass Diopter 2.0 736 Reading glass Diopter 2.25 737 Reading glass Diopter 2.50 738 Reading glass Diopter 2.75 739 Reading glass Diopter 3.0 740 Reading glass Diopter 3.25

8 2023 Over-the-Counter (OTC) Benefit Catalog

Packaging 1 1 1 1 1

30 ct 1 1 1

Strength

Price $6.00 $30.00 $10.00 $40.00 $15.00 $5.00 $7.00 $30.00 $45.00

.5 oz 1

300 ct .5 oz

1 1 15 ml 12 oz 1 1 1 1 1 1 1 1 1 1

Diopter 1.0 Diopter 1.25 Diopter 1.5 Diopter 1.75 Diopter 2.0 Diopter 2.25 Diopter 2.50 Diopter 2.75 Diopter 3.0 Diopter 3.25

$5.00 $3.00 $5.00 $4.00 $7.00 $4.00 $4.00 $10.00 $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 $4.00

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