Over-the-Counter Items Guide - 2019

Over-the-Counter Items Guide - 2019

This document applies to the following MCS Classicare coverages: Essential (HMO-POS); InteliCare (HMO);

ExceD (HMO); Activo (HMO); Platino Ideal (HMO SNP); Platino Progreso (HMO SNP); Platino C?modo (HMO SNP);

Platino OTC (HMO SNP); Groups (HMO-POS)

This guide is effective from January 1, 2019 through December 31, 2019. For more information, contact our Call Center at 787-620-2530 (Metro Area) or 1-866-627-8183 (toll free). You can call us Monday through Sunday from 8:00 a.m. to 8:00 p.m. TTY users (hearing impaired) may call 1-866-627-8182.

This guide contains a list of some common-use items, but it does not include all the formulations of the drugs covered by the plan. This list has been chosen by a team of health care professionals, and represents the non-prescription therapies believed to be important in supplementing your treatment program with prescription drugs. It is important to know that this list offers only some examples of the items that are covered in each category. This means that there are other products in the category that are also covered.

What are Over-the-Counter (OTC) items?

OTC items are non-prescription items that are not normally covered by the Medicare Part D prescription drug benefit. OTC items are used for the treatment of common symptoms such as cough, cold, pain, diarrhea and upset stomach, among others.

Do OTC items covered by the plan have any cost?

MCS Classicare will provide coverage for these OTC items at no cost to you. The cost to MCS Classicare for these OTC items will not count toward your total prescription drugs costs and does not count towards qualifying for your Catastrophic Coverage Stage of the Medicare Part D prescription drugs.

What are the rules for getting OTC items?

Covered OTC items may have certain coverage limits:

a. MCS Classicare will cover up to a maximum dollar amount for OTC items every three months. After the maximum dollar amount is reached, MCS Classicare will not cover these items until the following three months, when the maximum quarterly coverage starts again. If you did not use the full amount in a quarter, or you only used a portion of the amount of money allocated, the remaining balance of your OTC coverage is not accumulated for use during the following trimester.

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b. OTC items must be obtained through the MCS Classicare pharmacy network, and they may only be purchased for the enrollee.

c. Although OTC items do not require a prescription, MCS Classicare requires a written notification from your physician, so that the pharmacy may electronically process the OTC item through the pharmacy's payment system.

d. The plan will pay the cost of the OTC item up to the quarterly coverage limit. The member must pay the difference in cost, if any, and any applicable taxes.

e. OTC brands and/or items may vary according to availability at the time of purchase, at the pharmacy chosen by the member.

f. MCS is not responsible for any manufacturing defects of certain products or items. If you identify a factory defect in your product or item, you must contact the manufacturer or the pharmacy where you purchased it.

What are the advantages of using OTC items?

The use of OTC items allows the patient to have greater access to a variety of items available in the market for the treatment of some health symptoms. In addition, it helps the patient to save money, because they usually cost less than other drugs.

You may use OTC items to treat some medical symptoms. Consult your physician or pharmacist, and remember to always read the package labeling for specific instructions on how to take them, as well as any warnings or precautions you should consider when taking them.

Warning about herb-based products

Medicinal herbs, as any other medication, can have an effect on the body and should be carefully used. Not all herb-based products are medications. Always remember that terms such as "natural", "herbs" and "plant-based products" do not necessarily mean "safe." There is a notion that what is natural is safe and, for this reason, many medicinal herbs users do not realize that an herb-based remedy may be responsible for the symptoms they have felt and can interact with medications. Therefore, for your safety, you should always tell your doctor or pharmacist about all medications you are taking, especially vitamins, natural products or herbs.

How and where to send us your request for reimbursement

OTC items purchased during emergency circumstances may be eligible for reimbursement if, at the time of your claim, you have the quarterly balance for benefits available. Send us your request for payment, along with your bill and purchase receipts of any payments you have made. We recommend you make a copies of your bills and receipts for your records.

To make sure you are giving us all the information we need to make a decision, please fill out our Direct Member Reimbursement Form.

? You don't have to fill out the form, but it will help us process your information faster.

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? Download a copy of the form from our website () or call our Call Center and ask for a copy of the form. (Phone numbers for our Call Center are listed on the first page of this guide.)

Mail your payment request, together with any bills or receipts, and a written notification from your physician to this address:

Payment Request for OTC Drugs MCS Advantage, Inc. ? Pharmacy Department

PO BOX 191720 San Juan, PR 00919-1720

You may also call our plan to request a reimbursement or to learn where to send your request for us to pay our part of the cost of the OTC item you received. For details, go to Chapter 2, Section 1 and look for the section called, "Where to send a request that asks us to pay for our share of the cost for medical care or a drug you have received".

You must submit your OTC item claim to us within 7 days of the date you purchased the item.

Contact our Call Center if you have any questions (phone numbers for our Call Center are listed on the first page of this guide). You can also call if you want to give us more information about a request for payment you have already sent to us.

How do I use this OTC Items Guide?

This guide classifies OTC items by category, according to the most common symptoms they are used for. For example, items to treat cough and congestion are classified under the category Anticatarrhal drugs. If you know what your OTC item is used for, look for the category name in the Table of Contents. Then look for your OTC item under that category. You can also look for the name of some OTC items examples in the alphabetical Index at the end of this document.

MCS Classicare is a product subscribed by MCS Advantage, Inc. MCS Classicare is an HMO plan with a Medicare contract. MCS Classicare is an HMO plan with a Medicare contract and a contract with the Puerto Rico Medicaid program. Enrollment in MCS Classicare depends on contract renewal.

MCS Advantage, Inc. complies with the applicable Federal civil rights laws and does not discriminate on grounds of race, color, national origin, age, disability or sex.

MCS Advantage, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

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MCS Advantage, Inc.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1.866.627.8183 (TTY: 1.866.627.8182).

ATENCI?N: Si habla espa?ol, tiene a su disposici?n servicios gratuitos de asistencia ling??stica. Llame al 1.866.627.8183 (TTY: 1.866.627.8182).

TTY: 1.866.627.8182

1.866.627.8183

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Table of Contents

Antiacid.................................................................................................................... 6 Anti-catarrhal drugs ............................................................................................... 6 Anti-diarrhea agents............................................................................................... 7 Callous removers .................................................................................................... 7 Ear drops.................................................................................................................. 7 Eye drops ................................................................................................................. 7 Gas relief .................................................................................................................. 8 Hemorrhoids ........................................................................................................... 8 Hormone replacement .......................................................................................... 8 Items for Personal Use........................................................................................... 8 Lactose intolerance ................................................................................................ 8 Laxatives .................................................................................................................. 9 Migraine ................................................................................................................... 9 Nasal allergy agents................................................................................................ 9 Nasal decongestant ................................................................................................ 9 Nausea/dizziness ................................................................................................... 10 Pain and fever........................................................................................................10 Pain and inflammation ......................................................................................... 10 Scabies ................................................................................................................... 10 Topical analgesics/local ........................................................................................ 10 Topical antibiotics................................................................................................. 10 Topical antifungal ................................................................................................. 11 Topical antihistamines ......................................................................................... 11 Topical anti-inflammatory ................................................................................... 11 Urinary analgesics.................................................................................................11 Vitamins and minerals..........................................................................................12 Vitamins and minerals (continued) .................................................................... 13

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