Over-the-Counter Health and Wellness

Over-the-Counter Health and Wellness Product Catalog

Effective November 2020

M1390_2107

Florida

Over-the-counter health and wellness product catalog

Receive products by mail

AmeriHealth Caritas Florida has an Over-the-Counter (OTC) Expanded Benefit that allows members to receive OTC products by mail. Your OTC items must be ordered through PerformRxSM. Your orders from PerformRx will then be mailed directly to you by United Medco Pharmaceuticals.

Your allowance

Your allowance for OTC health and wellness items is $25 per month, per household. One order per month is permitted. Any unused monthly allowance does not carry over. Keep this catalog somewhere accessible. It will help you know what health and wellness products you can order.

How to order

Call PerformRx Pharmacy Member Services at 1-855-371-3963, Monday ? Friday, 8:30 a.m. ? 6 p.m. Eastern time.

Questions? We can help.

For general benefit questions, call AmeriHealth Caritas Florida Member Services at 1-855-355-9800 (TTY 1-855-358-5856).

Orders will be shipped to your home at no extra charge to you. Please allow five to seven business days for your order to be shipped. Some brand name items are listed for reference only. You may receive the generic version. Items, quantities, sizes, and values may change depending on availability. Item cost may change from year to year. Please consult with your primary care provider (PCP) before using any overthe-counter (OTC) product. This product list is subject to change. OTC items may only be requested for the plan enrollee. It is prohibited to request OTC items for family members and friends.

Florida

2

AmeriHealth Caritas Florida OTC Product Catalog

Item #

1 2 280

3 4 5 6 7 8 459

9 10 12 13 14

15

16 17 18 19 231 279 290 20 21 22

23 24 25 26

26 27

170 167 168 169

Description

Qty

Formulary or catalog

price

Brand comparable

ALLERGY PREVENTION AND TREATMENT

Allergy relief, cetirizine, 10 mg tablets

30

$10 Zyrtec?

Allergy relief, loratadine, 10 mg tablets

30

$7

Claritin?

NasoflowTM Allergy Relief

60 sprays $24 Flonase?, Claritin?

ANALGESICS/ANTIPYRETICS

Acetaminophen, 325 mg tablets

100

$4

Tylenol? 325 mg Regular Strength Tablets

Acetaminophen, 500 mg tablets

100

$5

Tylenol? 500 mg Extra Strength Tablets

Aspirin, 325 mg tablets

100

$3

Bayer? Aspirin 325 mg

Aspirin, 81 mg chewable

36

$3

Bayer? Aspirin 81 mg Chewable

Aspirin, enteric coated, 81 mg tablets

120

$5

Bayer? EC Aspirin 81 mg Adult Regimen

Aspirin, enteric coated, 325 mg tablets

100

$4

Ecotrin? Tablets

EQL menstrual relief caplet

40

$5

Equaline? Vitamin

ANTACIDS AND ACID REDUCERS

Acid reducer, famotidine, 10 mg tablets

30

$6

Pepcid? AC Tab

Acid reducer, omeprazole, 20 mg

14

$14 Prilosec?

Antacid tablets

150

$5

Tums? Tablets

Effervescent tablets

36

$6

Alka-Seltzer?

Gas relief caplet extra-strength

30

$4

Gas-X? Extra Strength

ANTICANDIAL (YEAST INFECTION) TREATMENTS

Miconazole vaginal suppository, three day

1

$15 Monistat? Vaginal Suppository 3-Day

ANTIDIARRHEAL AND LAXATIVES

Adult glycerin suppositories

25

$3 Fleet? Adult Suppositories

Anti-diarrheal caplets

12

$4

Imodium? AD

Anti-nausea liquid

4 oz

$7

Emetrol?

Bisacodyl, 5 mg tablets

25

$4

Dulcolax? Tablets

Enema, mineral oil

4.5 oz

$4

Fleet? Mineral Oil

Enema, saline laxative

4.5 oz

$2

Fleet? Enema

Stomach relief flavored liquid

8 oz

$6

Pepto-Bismol?

Laxative bisacodyl, 10 mg suppositories

12

$5

Dulcolax? Suppositories

Stomach relief flavored tablets

30

$4

Pepto?Bismol? Tablets

Stool softener softgel

100

$6

Colace? Softgels

ANTI-INFLAMMATORY

Ibuprofen, 200 mg liquid gel caps

20

$5

Advil? Liquid Gel Caps

Ibuprofen, 200 mg tablets

50

$6

Advil? Tablets

Naproxen sodium, 220 mg caplets

50

$8

Aleve? Caplets

Advil, 200 mg liquid gel caps

20

$8

Advil? Liquid Gel Caps

ARTHRITIS MEDICINE

Arthritis pain relief tablets

24

$5

Tylenol? Arthritis Pain Relief Tablets

Hot/cold patches

5

$6

Icy Hot? Patches

BLADDER CONTROL ITEMS

Adult bladder control pads

28

$9

Depend? Adult Bladder Control Pads

Adult protective disposable briefs, S/M

20

$18 Depend? Adult Protective Briefs S/M

Adult protective disposable briefs, L

20

$18 Depend? Adult Protective Briefs LG

Adult protective disposable briefs, XL

20

$20 Depend? Adult Protective Briefs XL

3

AmeriHealth Caritas Florida OTC Product Catalog

Item #

200

198 28 30 32 33 34 35 31 270 36 195 37 38 39 40 41 42 45 46 47 48 49 50 51 52 212 213 214 217 218 299 308 381 400

420

421 442

Description

Qty

Formulary or catalog

price

Disposable bed underpads

5

$6

CHILDREN'S PRODUCTS

Vitamin A and D ointment

1 oz

$3

Acetaminophen, 80 mg chew tabs

30

$5

Acetaminophen junior-strength chew tab, 160 mg 24

$7

Children's chewable multivitamins

100

$8

Children's ibuprofen suspension, 100 mg

4 oz

$10

Children's acetaminophen liquid

4 oz

$5

Children's cold and allergy liquid

4 oz

$5

Children's glycerin suppositories

12

$4

Children's saline drops

30 ml

$8

Children's toothbrush

1

$2

Children's toothpaste

3 oz

$3

Diaper rash ointment

1 oz

$3

Diphenhydramine liquid

4 oz

$4

Duofilm

0.3 oz

$9

Gas relief drops

1 oz

$10

Ibuprofen infants drops

0.5 oz

$8

Junior-strength ibuprofen chew tabs, 100 mg

24

$7

Premium preemie to 6 lbs diapers

20

$9

Premium up to 12 lbs diapers, S

24

$10

Premium 12 ? 20 lbs diapers, M

20

$10

Premium 20 ? 30 lbs diapers, L

18

$10

Premium 30 ? 38 lbs diapers, XL

16

$10

Premium 38+ lbs diapers, XXL

14

$10

Premium baby wipes

80

$5

Tooth and gum cleanser

1

$6

2T ? 3T pull-up diapers

17

$12

3T ? 4T pull-up diapers

15

$12

4T ? 5T pull-up diapers

13

$12

Baby shampoo tear-free

15 oz

$3

Children's conditioning shampoo

8 oz

$3

Baby nail clippers

1

$1

Baby wipes, travel size

10

$1

Baby lotion

3.5 oz

$5

Multivitamin gummies, child

60

$10

Calcium 250 mg + vitamin D3 500 IU, child gum-

30

$10

my

Vitamin C, child gummy, 250 mg

60

$10

Sunscreen lotion, babies, SPF 50

8 oz

$9

Brand comparable

Prevail? Disposable Bed Underpads

A&D? Ointment Tylenol? 80 mg Chew Tabs Tylenol? Jr. Strength Chews Flintstones? Chewable Multi-Vitamins Motrin? Children's Suspension Tylenol? Children's Liquid Dimetapp? Cold and Allergy Elixir Fleet? Children's Glycerin Suppositories Little Remedies? Children's Saline Drop GUM? Toothbrush Colgate? Children's Toothpaste Desitin? Ointment Benadryl? Elixir Duofilm? Mylicon? drops Motrin? Infant Drops Motrin? Jr. Strength Tablets Pampers? Preemi to 6lbs Pampers? Up to 12 lbs Diapers SM Pampers? 12-20 lbs Diapers MED Pampers? 20-30 lbs Diapers L Pampers? 30-38 lbs Diapers XL Pampers? 38+ lbs Diapers XXL Pampers? Baby Wipes Orajel? Tooth and Gum Cleanser Pull-Ups? 2T-3T Pull-Ups? 3T-4T Pull-Ups? 4T-5T J&J? Baby Shampoo Tear-Free J&J? Children's Conditioning Shampoo Safety 1st? Baby Nail Clipper Pampers? Baby Wipes, Travel J&J? Baby Lotion Little Critters? Gummies Little Critters? Calc+Vit D Child Gummy

Little Critters? Vit C Child Gummy Coppertone? Sunscreen for Babies SPF-50

4

AmeriHealth Caritas Florida OTC Product Catalog

Item #

53 54 211 55 56 174 230 57 58 59 60 61 62 63 64 65 66 67 402 433 449 450 451 458

68 69 70 71 72 73 74 75 76 313 314 315 318 332 333

77 78

Description

Qty

Formulary or catalog

price

Brand comparable

COLD/COUGH/FLU REMEDIES

APAP (acetaminophen) sinus congestion

24

$4

Tylenol? Sinus Congestion

Cough/throat drops

30

$3

Halls? Cough Drops

Sugar-free cough/throat drops

25

$3

Halls? Sugar-Free Cough Drops

Daytime cold/flu relief softgels

16

$5

DayQuil? Softgels

Daytime cold/flu relief liquid

4 oz

$5

DayQuil? Liquid

Daytime/nighttime cold/flu caplets

20

$5

Mucinex? Day/Night Caplets

Diphenhydramine, 25 mg capsules

24

$3

Benadryl?

Mucus relief DM tablets

30

$9

Mucinex? DM

Mucus relief tablets

30

$8

Mucinex?

Nasal decongestion spray

1 oz

$4

Afrin? Nasal Spray

Nasal decongestion PE tablets

36

$4

Sudafed PE? Tablets

Nighttime cold/flu relief softgels

16

$5

NyQuil? Caplets

Nighttime cold/flu relief liquid

4 oz

$7

NyQuil? Liquid

Saline nasal spray

1.5 oz

$3

Ocean? Nasal Spray

Sore throat spray

6 oz

$5

Chloraseptic? Sore Throat Spray

Tussin DM syrup SF

4 oz

$4

Robitussin? DM Syrup

Tussin syrup

4 oz

$4

Robitussin? Syrup

Vapor rub

3.53 oz

$5

Vicks? Vapor Rub

SinuCleanse neti pot

30 uses

$20 NasaFlo? Neti Pot

Green tea, multi flu/severe cold, honey lemon

6

$9

Thera-Flu?, Multi-Symp Severe Cold-Lemon

Child allergy elixir

4 oz

$5

Children's Benadryl?

Child cold/cough/sore throat

4 oz

$6

Children's Mucinex?

HBP cough cold

16

$6

Coricidin?

Acetaminophen PM, 500 mg

50

$3

Tylenol PM?

DENTAL AND DENTURE CARE

Dental tool kit

1

$5

GUM? Dental Tool Kit

Denture adhesive cream

2.4 oz

$5

Fixodent?

Denture cleaner

40

$4

Efferdent?

Fluoride toothpaste

6.4 oz

$4

Colgate?

Adult toothbrush, medium

1

$2

Colgate? Toothbrush

Dental floss

1

$2

Reach? Dental Floss

Mouthwash

4 oz

$3

Listerine?

Sensitive teeth toothpaste

4.3 oz

$5

Sensodyne?

Toothache relief liquid/gel

0.33 oz

$4

Anbesol? Liquid/Gel

Dental floss, waxed

55 yds

$1

Reach? Dental Floss, Waxed

Dental floss, mint waxed

55 yds

$1

Reach? Dental Floss, Mint Waxed

Denture brush

1

$1

GUM? Denture Brush

Toothpaste

0.85 oz

$1

Colgate? Toothpaste

Flosser, mechanical

1

$12 Power Flosser?

Water jet, battery operated

1

$23 Oral-B? Vitality Water Jet

EAR CARE

Ear syringe

1

$3

Apex?Ear Syringe

Earwax drops

0.5 oz

$7

Debrox? Ear Wax Drops

5

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