Over-The-Counter- Medications - Buckeye Health Plan

Commonly used over-the-counter (OTC) items

As a commitment to your overall health and well being, Buckeye Health Plan is pleased to offer our Members a benefit of $25 per month in commonly used OTC items at no cost to you. Please note: These items should only be used as directed, and you should talk to your primary care doctor if you have any questions on the safe use of these items. Prices and product list are subject to change.

Order up to

$25

per month!

Ordering is simple and easy.

You simply select the items you want from the list on the opposite side of this sheet, call the toll-free order line at 1-877-851-3994 (TTY:711) and let our operator know which items you would like. You can order up to $25 per month. Each item is numbered for your convenience in ordering. Operators are available from 9 a.m. ? 5 p.m. CST, Monday through Friday.

When you call, please be sure to have your Buckeye Health Plan ID card available. The operator will need your Member ID number to complete the order. After the ordering process is complete, your items should arrive at your home in 5 to 12 business days.

mmp.

Buckeye Health Plan - MyCare Ohio (MedicareMedicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.

Limitations and restrictions may apply. For moreinformation, call Buckeye Member Services or read the Buckeye Member Handbook. Benefits may change on January 1 of each year.

You can get this information for free in other languages. Call 1-866-549-8289 from 8 a.m. to 8 p.m., Monday through Friday. TTY users call 711. On weekends and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

Puede obtener esta informaci?n en otros idiomas gratis. Llame al 1-866-549-8289 de 8:00 a. m. a 8:00 p. m., de lunes a viernes. Los usuarios de TTY deben llamar al 711. Los fines de semana y los d?as feriados nacionales, es posible que se le pida que deje un mensaje. Le devolveremos la llamada durante el pr?ximo d?a h?bil. La llamada es gratuita.

Buckeye Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-866-549-8289 (TTY: 711).

ATENCI?N: si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1-866-549-8289 (TTY: 711).

1-866-549-8289 (TTY: 711)

? 2020 Buckeye Health Plan. All rights reserved. BHP-MMP-021020

Over-The-CounterMedications

You can order commonly used over-the-counter (OTC) items at no cost to you!

# DESCRIPTION

PAIN RELIEVERS 1 Ibuprofen200mgtab 2 Naproxensod220mg

tab

COMPARE TO: $

Motrin IB

$6

Aleve

$9

3 Aspirin325mgtab BayerAspirin $5

4 Aspirinec325mgtab Ecotrin

$6

5 Aspirinec81mg

Halfprin

$5

(low-dose)

6 Acetaminophen500mg TylenolExtra $6

tab

Strength

7 Mentholatedointment BenGay

$6

ANTACIDS

8 Simethicone80mgtab Mylanta

$6

Anti-Gas

9 Calccarb500mgchew- TUMS

$6

able

10 Famotidine10mgtab PepcidAC $9

ANTI-DIAHRRHEALS

11 Loperamide2mgcap Imodium $5

12 Bismuthmixture

Pepto-Bismol $8

ANTI-FUNGALS

13 Clotrimazole1% vaginal cream

Gyne-Lotrimin $9

14 Tolnaftate1%

Tinactin

$7

ANTI-HEMORRHOIDALS

15 Hemorrhoidal ointment

Preparation-H $8

COUGH / COLD / ALLERGY

24 Diphenhydramine

Benadryl

$5

25mg caps

caps

Simply select the commonly-used over-thecounter (OTC) items you want from the list. Call the toll-free order line at 1-877-851-3994 (TTY:711); order up to the limit of $25 per

# DESCRIPTION

COMPARE TO: $

25 Diphenhydramineelixir BenadrylElixir $5

26 Sorethroatlozenges Chloraseptic $5 Lozenges

27 Medicatedchestrub VicksVap $7 Rub

28 Guiafenesinsyrup Robitussin $5

29 Oxymetazoline0.05% Afrin

$5

30 Loratadine10mgtab Claritin

$10

EYE CARE

31 Tetrahydrozolinedrops Visine

$4

61 Lubricatingeyedrops RefreshTears $7

FIRST AID CREAMS & OINTMENTS

32 Calaminelotion

Calaminelotion $7

33 Hydrocortisone1% CORTAID

$4

crm

34 Tripleantibioticoint- Neosporin $5 ment

60 Medicatedlipbalm Carmex

$3

78 Psoriasiscream

Eucerin

$12

Cream

79 Eczema cream

Exederm

$13

Anti itch

FIRST AID SUPPLIES

35 Athleticbandage AceBandage $7

36 Adhesivetape

First-AidTape $3

37 Adhesivebandage Band-Aids $4

38 Carbamideperoxide DebroxDrops $4

39 Gauzepads

J&JGauzePads $3

month. Each item is numbered for your convenience in ordering. Operators are available from 9 a.m. ? 5 p.m. CST, Monday through Friday.

# DESCRIPTION COMPARE TO: $

40 Cottonswab

Q-Tips

$4

41 Oralthermometer Thermometer $6

43 Icebag9inch

Ice Bag

$9

80 EarThermometer EarThermom- $25 eter

85 HydrogenPeroxide HydrogenPerox- $8

Solution

ide Solution

LAXATIVES

44 Docusate100mg ColaceStool $6 Softener

45 Bisacodyl suppositories

Dulcolax

$4

Suppositories

46 Bisacodyltab

DulcolaxTabs $4

82 IronPlusStool Softener

Iron Plus Stool $10 Softener

ORAL CARE

66 Toothbrush

Toothbrush $4

67 DentureTabs

Efferdent

$6

68 DentureAdhesive PoliGrip

$6

86 WaxedDentalFloss WaxedDental $3 Floss

PERSONAL CARE

75 SunblockSPF15 SunblockSPF15 $9

PEDICULICIDES

48 Ridlicetreatment RID

$9

SMOKING CESSATION GUM

57 NicotinePolacrilex Nicorette

$15

Gum 2mg

58 NicotinePolacrilex Nicorette

$15

Gum 4mg

Allow 5 to 12 business days for shipping. Unused amounts cannot be carried over month to month.

# DESCRIPTION

COMPARE TO: $

VITAMINS & MINERALS

49 *Calccarb600mgtabs Caltrate600 $6

50 *Multivitaminw/miner- Theragran-M $10 als

59 *SeniorMultivitaminw/ CentrumSilver $11 minerals

52 *VitaminA10,000u VitaminA $5 caps

53 *VitaminC500mgtabs VitaminC $5

54 *VitaminE400iugels VitaminE $9

62 *VitaminD(400UI) VitaminD $7

63 *Glucosamine/Chon- Joint

$12

droitin (500/400 mg Supplement

caps)

64 *IronSupplement

Iron

$4

Supplement

65 *Omega-3FishOil 1000mg

Omega-3 Fish $7 Oil 1000mg

81 *FolicAcidTabs400 FolicAcidTabs $6

mcg

400 mcg

83 MultivitaminLiquidw/ Multivitamin $8

Iron

Liquid w/ Iron

87 *LactoseChewable Lactaid

$9

Tabs

*Dual-Purpose Items: Prior to order/purchase (1) you must have appropriate conversations with your doctor, and (2) your doctor must verbally recommend the OTC item for a specific diagnosable condition. Other items on this order form are classified as eligible. These eligible items may be ordered/ purchased by you without further action.

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