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2015
Over-the-Counter (OTC) Catalog
Get the OTC items you need.
What is Easy Choice’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 a couple of 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 at 1-877-483-9563, TTY 711, Monday-Friday, 6:30 a.m.–8:00 p.m. Pacific.
2. Visit us at www.easychoicehealthplan.com. Log in using your member ID number and date of birth. You can find your member ID number on your Easy Choice member ID card.
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
• In-home testing and monitoring • Hormone replacement
• 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. You cannot order them from us, and if you buy these items at a store, we can’t repay you for them. 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
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 items you want. We’ll send them to your home and deduct the amount from your monthly benefit.
OUR CATALOG ITEMS
ID# GENERIC DESCRIPTION QTY AMT ID# BRAND NAME QTY AMT
ACNE TREATMENT
1241389 Benzoyl Peroxide Gel 10% 45gm $3.50 N/A Benzoyl Peroxide Gel 10% N/A N/A ALLERGY
1498302 Cold & Allergy PE Tablets 24ct $3.50 N/A Cold & Allergy PE Tablets N/A N/A 2152874 Diphenhydramine 25mg Capsules 100ct $4.50 2118297 Benadryl® Allergy Softgels Dye Free 24ct $6.50 3595196 Nasal Spray 1oz $6.50 1200021 Afrin® Nasal Spray Original 0.5oz $7.50 4242327 Loratadine 10mg Tablet 30ct $4.00 N/A Loratadine 10mg Tablet N/A N/A 4257457 Loratadine 10mg Tablets 100ct $12.00 N/A Loratadine 10mg Tablets N/A N/A 4264792 Saline Nasal Spray 1.5oz $3.50 4764163 Ocean® Nasal Spray 1.5oz $4.50 4595054 Cetirizine 10mg Tablets 30ct $11.50 4014296 Zyrtec® OTC Adult 10mg 24-Hour Tab 5ct $9.00 7850068 Sinus & Allergy PE Tablets 24ct $3.50 N/A Sinus & Allergy PE Tablets N/A N/A
N/A Afrin® Nasal Spray Sinus 0.5oz N/A 2155083 Afrin® Nasal Spray Sinus 0.5oz $7.50 N/A Allegra® OTC 180mg Tablets 24-Hour 15ct N/A 4330601 Allegra® OTC 180mg Tablets 24-Hour 15ct $19.00 N/A Allegra® OTC 60mg Tablets 12-Hour 12ct N/A 4330668 Allegra® OTC 60Mg Tablets 12-Hour 12ct $13.50 * = Quantities and brands may vary depending upon availability.
† = Dual-purpose items
ANTACID / ACID REDUCERS
2804144 Antacid (Antigas) 80mg Tablets 100ct $4.00 N/A Antacid (Antigas) 80mg Tablets N/A N/A 2163913 Antacid Assorted Tablet 150ct $3.50 1336700 Tums® Tablets Regular Assorted Fruit 150ct $6.50 2311934 Antacid Chewable Extra Strength 96ct $3.50 1469030 Tums® Extra Strength Tablets Assorted 96ct $6.50 2164309 Antacid Liquid DS 12oz $4.50 N/A Antacid Liquid DS N/A N/A 3203700 Antacid Regular Strength Liquid 12oz $4.50 N/A Antacid Regular Strength Liquid N/A N/A 9900148 Effervescent Pain Relief Tablets 36ct $5.00 1189422 Alka-Seltzer® Original 24ct $5.00 4288551 Famotidine 10mg Tablet 70ct $11.00 N/A Famotidine 10mg Tablet N/A N/A
4305173 Famotidine Tablet 10mg 30ct $6.00 3434321 Pepcid® AC Tablets Original Strength 30ct $13.50 2967776 Gas Relief Softgel Extra Strength 30ct $6.00 2435568 Gas-X Extra Strength Softgels 10ct $3.50
2164325 Milk of Magnesia 12oz $4.00 N/A Milk of Magnesia N/A N/A 1006741 Pink Bismuth Liquid 8oz $3.50 1099829 Pepto-Bismol® Liquid Original 8oz $5.50 2236560 Pink Bismuth Tablet - Chewable 30ct $3.50 2189959 Pepto-Bismol® Caplets Original 40ct $9.50 4938775 Ranitidine 75mg Tablet 30ct $5.00 2508752 Zantac® 75mg Tablets 30ct $13.00
N/A Alka-Seltzer® Tablets Original 12ct N/A 1292697 Alka-Seltzer® Tablets Original 12ct $3.50 N/A Gas-X® Chew Tab Peppermint 36ct N/A 1196120 Gas-X® Chew Tab Peppermint 36ct $7.50 N/A Gas-X® Extra Strength Cherry Crème 18ct N/A 1696657 Gas-X® Extra Strength Cherry Crème 18ct $6.00 N/A Nexium® 24-Hour Heartburn Relief
20mg 14ct N/A 4949434
Nexium® 24-Hour Heartburn Relief
20mg 14ct $15.00 N/A Prevacid® OTC 24-Hour Capsules 14ct N/A 4228979 Prevacid® OTC 24-Hour Capsules 14ct $16.50 N/A Prilosec® OTC 20mg Tab 14ct N/A 3508264 Prilosec® OTC 20mg Tab 14ct $17.00
ANTACID / ACID REDUCERS
N/A Rolaids® Extra Strength Chewable
Tablets Fruit 96ct N/A 4864161
Rolaids® Extra Strength Chewable
Tablets Fruit 96ct $6.00 N/A Rolaids® Regular Strength Chewable
Tablets Mint 150ct N/A 4864211
Rolaids® Regular Strength Chewable
Tablets Mint 150ct $6.00 N/A Tagamet® HB OTC 200mg Tablets 6ct N/A 4810545 Tagamet® HB OTC 200mg Tablets 6ct $3.50 N/A Tums® Extra Strength Smoothies Tab
Assorted Fruit 60ct N/A 3710092
Tums® Extra Strength Smoothies Tab
Assorted Fruit 60ct $6.50 N/A Zantac® 75mg Tablets 10ct N/A 2415958 Zantac® 75mg Tablets 10ct $6.50 N/A Zegerid OTC 20mg 14ct N/A 4269395 Zegerid OTC 20mg 14ct $15.00
ANTI-DIARRHEAL
4081907 Anti-Diarrheal Caplet 24ct $5.50 N/A Anti-Diarrheal Caplet N/A N/A 1363068 Anti-Diarrheal Caplet 12ct $3.50 N/A Anti-Diarrheal Caplet N/A N/A N/A Imodium® A-D Liquid Cool Mint 4oz N/A 3638244 Imodium® A-D Liquid Cool Mint 4oz $7.50 N/A Kaopectate® Liquid Regular Flavor 8oz N/A 4605168 Kaopectate® Liquid Regular Flavor 8oz $6.00
ANTI-FUNGAL
4081683 Athletes Antifungal Foot Cream 0.5oz $10.50 2856060 Lamisil® AT Athletes Foot Cream 12gm $12.00 3397718 Clotrimazole 1%
Cream 1oz $4.50 1887819 Lotrimin® AF Cream 24gm $14.50 3508470 Miconazole Nitrate Cream 2% 30gm $6.50 N/A Miconazole Nitrate Cream 2% N/A N/A
2534121 Tolnaftate 1% Cream 1oz $5.50 N/A Tolnaftate 1% Cream N/A N/A 1026525 Tolnaftate 1% Powder 1.5oz $4.00 N/A Tolnaftate 1% Powder N/A N/A N/A Fungi Nail Tincture 30ml N/A 1147065 Fungi Nail Tincture 30ml $14.50 N/A Lamisil® Defense Spray Powder 4.6oz N/A 3704459 Lamisil® Defense Spray Powder 4.6oz $8.50 N/A Lotrimin® AF Liquid
Spray 4.6oz N/A 4889614
Lotrimin® AF Liquid
ANTI-FUNGAL
N/A Lotrimin® AF Powder Spray 4.6oz N/A 3636883 Lotrimin® AF Powder Spray 4.6oz $9.00 N/A Mycocide NS
Antimicrobial Sol 1oz N/A 1119841
Mycocide NS
Antimicrobial Sol 1oz $16.00 ANTI-ITCH
9900662 Calamine Lotion 6oz $4.00 4829941 Caladryl® Lotion 6oz $7.00 2372134 Diphenhydramine Cream 2% 1oz $4.50 2529717
Benadryl® Extra Strength Itch
Stopping 2% Cream
1oz $6.00 1021872 Hydrocortisone 1%
Anti-Itch Cream 1oz $4.50 4995825
Cortaid® Anti-Itch Maximum Strength Cream 1% 1oz $7.00 N/A Benadryl® Regular Strength Itch Relief 1% Cream
1oz N/A 2529709
Benadryl® Regular Strength Itch Relief 1% Cream 1oz $5.50 N/A Cortizone-10 Intensive Healing Formula Anti-Itch Crème 1oz N/A 4029112 Cortizone-10 Intensive Healing Formula Anti-Itch Crème 1oz $6.50 N/A Gold Bond® Medicated Maximum Strength Cream 1oz N/A 1984046 Gold Bond® Medicated Maximum Strength Cream 1oz $5.00 N/A Psoriasin Ointment 4oz N/A 4424255 Psoriasin Ointment 4oz $11.50
ANTISEPTIC OINTMENTS / CREAMS
2149250 Bacitracin Zinc Ointment 1oz $6.00 N/A Bacitracin Zinc Ointment N/A N/A 4762878 Triple Antibiotic
Ointment 1oz $7.50 1026434
Neosporin® Original
Antibiotic Ointment 1oz $10.00 N/A Bactine® Liquid 4oz N/A 1028760 Bactine® Liquid 4oz $5.50 N/A Neosporin® Plus Maximum Strength Ointment 0.5oz N/A 4451555 Neosporin® Plus Maximum Strength Ointment 0.5oz $7.00 N/A Neosporin® Plus Maximum Strength Ointment 1oz N/A 1203504 Neosporin® Plus Maximum Strength Ointment 1oz $11.50
COLD / COUGH / FLU REMEDIES 4807822 All Night Cold
Original Liquid 8oz $5.50 4410890 Vicks NyQuil® Liquid 8oz $10.00 9900163 Effervescent Cold Relief Tablets 20ct $5.50 4235339 Alka-Seltzer® Plus Cold Effervescent Tablet Original 20ct $6.50 9900000 Medicated Chest
Rub 3.53oz $4.00 2972362 Vicks® VapoRub 3.53oz $10.50 4371688 Mucus Relief DM Tablet 30ct $4.00 3592367 Mucinex® DM Extended Release Tablets 20ct $15.00 4371647 Mucus Relief Tablets 60ct $5.00 3459377 Mucinex® Extended
Release Tablets 20ct $14.50 3653219 Sudogest PE Tab
10mg 36ct $6.00 N/A
Sudogest PE Tab
10mg N/A N/A
3695129 Tussin DM Sugar Free
Liquid Clear 4oz $4.00 4485868
Robitussin® DM Sugar Free Peak Cold Cough/Congestion
4oz $7.00 3454915 Tussin Form 8oz $5.00 N/A Tussin Form N/A N/A 3706827 Tussin Form CF 8oz $5.00 4485769
Robitussin® Peak Cold Max Multi-Symptom Liquid
4oz $8.50 1759349 Tussin Form DM 8oz $5.00 4427639
Robitussin® DM Peak Cold Cough/ Congestion 4oz $7.00 N/A Alka-Seltzer® Plus Cold Formula Effervescent Tablets Original 36ct N/A 4240206 Alka-Seltzer® Plus Cold Formula Effervescent Tablets Original 36ct $10.00 N/A Chloraseptic® Sore Throat Spray Menthol
6oz N/A 1041318
Chloraseptic® Sore Throat Spray Menthol
6oz $6.50 N/A Contac® Cold/Flu Day/Night Caplet 28ct N/A 4595310 Contac® Cold/Flu Day/Night Caplet 28ct $8.50 N/A
Coricidin® HBP Chest Congestion & Cough Liqui-Gels
20ct N/A 3383619
Coricidin® HBP Chest Congestion & Cough Liqui-Gels
COLD / COUGH / FLU REMEDIES N/A Coricidin® HBP Maximum Strength Flu Tablets 20ct N/A 2947067 Coricidin® HBP Maximum Strength Flu Tablets 20ct $7.50 N/A Mucinex® DM Maximum Strength Tablets 14ct N/A 3989977 Mucinex® DM Maximum Strength Tablets 14ct $16.50 N/A Vicks DayQuil®
Liquid Capsules 24ct N/A 4420766
Vicks DayQuil®
Liquid Capsules 24ct $11.50 N/A Vicks NyQuil® Liquid
Capsules 24ct N/A 4410767
Vicks NyQuil® Liquid
Capsules 24ct $11.50 N/A Vicks® VapoRub 1.76oz N/A 2972354 Vicks® VapoRub 1.76oz $6.00 N/A Vicks® VapoRub 6oz N/A 1274505 Vicks® VapoRub 6oz $15.50
EAR CARE N/A Debrox® Drops
Earwax Removal Aid 0.5oz N/A 4811857
Debrox® Drops
Earwax Removal Aid 0.5oz $7.00 EYE CARE
1287648 Artificial Tears 0.5oz $8.00 N/A Artificial Tears N/A N/A 2260040 Eye Drops 0.5oz $2.50 1133156 Visine® Original Eye Drops 0.5oz $6.00
N/A
Bausch & Lomb® Soothe Hydration Lubricant Eye Drops
15ml N/A 4449708
Bausch & Lomb® Soothe Hydration Lubricant Eye Drops
15ml $12.00 N/A Clear Eyes® Itchy Eye Relief Drops 0.5oz N/A 3599412 Clear Eyes® Itchy Eye Relief Drops 0.5oz $5.00 N/A Refresh Liquigel® 0.5oz N/A 3286267 Refresh Liquigel® 0.5oz $12.50 N/A Thera® Tears Sterilid
Lid Scrub 1.62oz N/A 3804671
Thera® Tears Sterilid
Lid Scrub 1.62oz $19.00 N/A Visine® A Drops 0.5oz N/A 3952991 Visine® A Drops 0.5oz $7.50
FIBER SUPPLEMENTS
9900364 Fiber Laxative Caplets 100ct $10.50 N/A Fiber Laxative Caplets N/A N/A 2566214 Fiberlax Tablets 90ct $7.00 1559285 FiberCon® Tablet 90ct $16.00 2567832 Natural Fiber Powder 13oz $9.50 N/A Natural Fiber Powder N/A N/A
N/A Metamucil® Capsules 100ct N/A 4590543 Metamucil® Capsules 100ct $19.50 N/A Metamucil® Fiber
Wafers Cinnamon 24ct N/A 4408878
Metamucil® Fiber
FIRST AID SUPPLIES 1047281 Adhesive Fabric
Strips Assorted 30ct $3.50 1204890
BAND-AID® Flexible
Fabric Assorted Sizes 30ct $4.00 3342177 Adhesive Pads
Non-Stick Large 3in X 4in** 10ct $3.50 N/A
Adhesive Pads
Non-Stick Large 3in X 4in** N/A N/A 2256915 Adhesive Sheer Strips Assorted 60ct $2.50 1675024 BAND-AID® Comfort-Flex Sheer Assorted 60ct $3.50 9900077 Adhesive Tape
1/2in X 5yd** 1ea $2.50 N/A
Adhesive Tape
1/2in X 5yd** N/A N/A 2256865 Adhesive Waterproof
Tape 1/2in X 10yd** 1ea $3.00 1174028
Johnson & Johnson Tape Waterproof 1/2in X 10yd**
1ea $5.00 4763371 Alcohol Prep Pads** 100ct $3.00 1237551 BD Alcohol Swabs** 100ct $3.50 3260080 Cotton Balls 300ct $4.00 N/A Cotton Balls N/A N/A 9280058 Cotton Swabs 300ct $4.50 N/A Cotton Swabs N/A N/A
1332113 Hydrogen Peroxide
3% 16oz $3.50 N/A
Hydrogen Peroxide
3% N/A N/A
4756862 Sterile Pads 3in X 3in** 25ct $4.00 1134436 Johnson & Johnson Gauze 4in X 4in Pad** 25ct $8.50 4535811 Thermometer Digital Flexible Tip 1ea $8.00 N/A Thermometer Digital Flexible Tip N/A N/A
N/A ACE™ Bandage Velcro
2in 1ea N/A 1669886
ACE™ Bandage Velcro
2in 1ea $5.00
N/A ACE™ Bandage Velcro 3in 1ea N/A 1669878 ACE™ Bandage Velcro 3in 1ea $8.00 N/A ACE™ Cold Compress Reusable 1ea N/A 1363159 ACE™ Cold Compress Reusable 1ea $7.00 N/A ACE™ Elastic Bandage
3in 1ea N/A 1002054
ACE™ Elastic Bandage
3in 1ea $8.00
N/A BD Basic
Thermometer Digitial 1ea N/A 4543138
BD Basic
Thermometer Digitial 1ea $5.00 N/A Ice Bag 9in 1ea N/A 1009349 Ice Bag 9in 1ea $9.50 N/A
Lanacane®
Antibacterial First Aid Spray Maximum Strength
3.5oz N/A 4562286
Lanacane®
Antibacterial First Aid Spray Maximum Strength
FIRST AID SUPPLIES
N/A Johnson & Johnson First Aid Kit 140 Items 1ea N/A 4476826 Johnson & Johnson First Aid Kit 140 Items 1ea $13.50 N/A New-Skin® Liquid
Bandage 1oz N/A 2167104
New-Skin® Liquid
Bandage 1oz $6.00 N/A Nexcare™ Comfort
Strip 3/4in 35ct N/A 3483625
Nexcare™ Comfort
Strip 3/4in 35ct $3.00 N/A Purell® Hand Sanitizer 8oz N/A 3659315 Purell® Hand Sanitizer 8oz $4.00 N/A Vaseline® Petroleum Jelly 13oz N/A 1217694 Vaseline® Petroleum Jelly 13oz $6.00 N/A Vicks® Comfortflex
Thermometer 1ea N/A 2867786
Vicks® Comfortflex
Thermometer 1ea $15.50 FOOT CARE
N/A Dr. Scholl’s® Callous
Remover One Step 1ea N/A 2314151
Dr. Scholl’s® Callous
Remover One Step 1ea $5.50 N/A
Dr. Scholl’s® Corn Remover Extra Thick Pads
1ea N/A 1085018
Dr. Scholl’s® Corn Remover Extra Thick Pads
1ea $3.50 N/A Dr. Scholl’s® Corn
Cushion Regular 9ct N/A 1038108
Dr. Scholl’s® Corn
Cushion Regular 9ct $3.50
ID# GENERIC DESCRIPTION PACK CONTAINS AMT
HOME CARE KITS 999621
Cough Peak Max Multi-Symptom Cold And Fever Combo
Pack Contains: Robitussin® Peak CF Max Multi-Symptom Cold 4oz, BD Basic Oral Thermometer, Acetaminophen 325mg Tablets 100ct $
18.00 999244 Ear Eye And Nose Combo Pack Contains: Eye Drops 0.5oz, Mack’s® Wax Away
Removal System, Saline Nasal Spray 1.5oz $12.00 999826 First Aid Essentials
Pack Contains: Hydrogen Peroxide 16oz, Triple Antibiotic Ointment 1oz, BAND-AID® Flexible
Fabric Strips 30ct $
15.00 999027 Hemorrhoid Care Combo Pack Contains: Tucks® Pads 40ct, Hemorrhoidal
Cream 1.8oz $11.50
999115 Oral Care Combo Pack Contains: Crest® Toothpaste 3.6oz, Dental Floss 100yds, Toothbrush Full Head, Soft $7.50 999053 Pain Relief Combo Pack Contains: Arthritis Pain Reliever Caplets 50ct, Icy Hot® Pain Relieving Cream 1.25oz $12.00
HEMORRHOIDAL CARE 4362869 Antiseptic Cleansing
Pads 100ct $6.00 1101237 Tucks® Medicated Pads 100ct $10.00 9913268 Hemorrhoidal Cream 1.8oz $5.50 3621521 Preparation H® Cream
Maximum Strength 0.9oz $9.50 1633445 Hemorrhoidal Suppositories 12ct $5.00 1156850 Preparation H® Suppositories 24ct $17.50
N/A Preparation H®
Ointment 2oz N/A 1156835
Preparation H®
Ointment 2oz $15.50 N/A Tucks® Medicated Pads 40ct N/A 1101229 Tucks® Medicated Pads 40ct $6.50
INCONTINENCE
N/A A&D® Ointment 4oz N/A 1219070 A&D® Ointment 4oz $6.00 N/A Balmex Clear Protection Ointment 3.5oz N/A 3545092 Balmex Clear Protection Ointment 3.5oz $6.00 N/A
Balmex Diaper Rash Cream With Zinc Oxide
4oz N/A 2320794
Balmex Diaper Rash Cream With Zinc Oxide
4oz $5.50 N/A Desitin® Ointment 2oz N/A 1171875 Desitin® Ointment 2oz $5.50 N/A Fitted Briefs Extra
Large (Diapers) 15ct N/A 4740585
Fitted Briefs Extra
Large (Diapers) 15ct $15.00 N/A Fitted Briefs Large (Diapers) 18ct N/A 4740536 Fitted Briefs Large (Diapers) 18ct $15.00 N/A Fitted Briefs
Medium (Diapers) 16ct N/A 4740551
Fitted Briefs Medium (Diapers) 16ct $15.00 N/A Perfit Protective Underwear Extra Large 14ct N/A 4157053 Perfit Protective Underwear Extra Large 14ct $15.00 N/A Perfit Protective
Underwear Large 18ct N/A 4157012
Perfit Protective Underwear Large 18ct $15.00 N/A Perfit Protective Underwear Medium 20ct N/A 4157004 Perfit Protective Underwear Medium 20ct $15.00 N/A Prevail® Bladder Control Pads, Moderate 20ct N/A 3012762 Prevail® Bladder Control Pads, Moderate 20ct $15.00 N/A Prevail® Underpad
(Bed Liners) 30in X 36in 25ct N/A 4742458
Prevail® Underpad
INCONTINENCE N/A Surecare Protective Underwear Extra Large 14ct N/A 4494621 Surecare Protective Underwear Extra Large 14ct $20.00 N/A Surecare Protective
Underwear Large 18ct N/A 4438008
Surecare Protective Underwear Large 18ct $20.00 N/A Surecare Protective Underwear Medium 18ct N/A 4763892 Surecare Protective Underwear Medium 18ct $20.00 LACTOSE INTOLERANT
N/A Lactaid® Caplets 120ct N/A 4418844 Lactaid® Caplets 120ct $18.50 N/A Lactaid® Fast Act
Caplets 32ct N/A 3637964
Lactaid® Fast Act
Caplets 32ct $11.00 LAXATIVES
2362390 Bisacodyl 5mg Tablet 100ct $7.00 N/A Bisacodyl 5mg Tablet N/A N/A 2362408 Bisacodyl 5mg Tablet 25ct $4.00 3323664 Dulcolax® Tablets 5mg 25ct $8.00 4222527 Clearlax Powder 4.1oz $5.50 3919909 MiraLAX® Pwd 7 doses 4.1oz $8.50 4222535 Clearlax Powder 8.3oz $13.50 3919917 MiraLAX® Powder 8.3oz $15.00
1553338 Magnesium Citrate
Cherry 10oz $3.00 N/A
Magnesium Citrate
Cherry N/A N/A
1163260 Magnesium Citrate
Lemon 10oz $3.00 N/A
Magnesium Citrate
Lemon N/A N/A
3550779
Natural Laxative Plus Stool Softener Tablets
60ct $5.00 N/A
Natural Laxative Plus Stool Softener Tablets
N/A N/A 3580743 Senna Tablet 100ct $6.00 1003565 Senokot®-S Tablet 30ct $21.00
1470475 Stool Softener
Softgels 100ct $4.50 N/A
Stool Softener
Softgels N/A N/A N/A Ex-Lax® Pieces Regular Strength 24ct N/A 4064515 Ex-Lax® Pieces Regular Strength 24ct $6.00 N/A Ex-Lax® Tablets Regular Strength 30ct N/A 2617033 Ex-Lax® Tablets Regular Strength 30ct $7.50 N/A Fleet Enema Adult 4.5oz N/A 1098011 Fleet Enema Adult 4.5oz $4.00 N/A Fleet Glycerin
Suppository 24ct N/A 1025972
Fleet Glycerin
LICE TREATMENT
N/A Nix® Control Spray Pump 5oz N/A 2879807 Nix® Control Spray Pump 5oz $8.00 N/A Nix® Lice Treatment Creme Rinse Single 2oz N/A 1827625 Nix® Lice Treatment Creme Rinse Single 2oz $14.00 N/A Nix® Lice Treatment
Creme Rinse
2oz x
2oz N/A 1827617
Nix® Lice Treatment Creme Rinse
2oz x
2oz $23.00 LOZENGES
4562393 Cough Drops Black Cherry Sugar Free 25ct $2.00 N/A Cough Drops Black Cherry Sugar Free N/A N/A 4348082 Cough Drops Cherry 30ct $2.00 2970994 Halls® Mentho-Lyptus Drops Cherry 30ct $3.00
4348199 Cough Drops Honey
Lemon 30ct $2.00 2971000
Halls® Cough Drop
Honey Lemon 30ct $3.00 N/A Cepacol® Maximum Strength Lozenge Honey Lemon 16ct N/A 4972725 Cepacol® Maximum Strength Lozenge Honey Lemon 16ct $4.00 N/A Halls® Defense Vitamin C Drops Sugar Free Assorted Citrus
25ct N/A 3662343
Halls® Defense Vitamin C Drops Sugar Free Assorted Citrus
25ct $3.00
N/A
Halls® Defense Zinc Drops Harvest Cherry
25ct N/A 2971125
Halls® Defense Zinc Drops Harvest Cherry 25ct $3.00 MISCELLANEOUS CARE**† N/A Lumiscope Self-Taking Blood Pressure Kit With Stethoscope
1ea N/A 2158566
Lumiscope Self-Taking Blood Pressure Kit With Stethoscope
1ea $17.50 MOTION SICKNESS
1200336 Motion Sickness Tab 12ct $2.50 4583258 Dramamine® 50mg 12ct $5.50 N/A Bonine® Tablets 8ct N/A 4489688 Bonine® Tablets 8ct $4.50
ORAL CARE
9900441 Dental Floss 100yd 1ea $2.50 N/A Dental Floss 100yd N/A N/A 9900440 Dental Floss Mint Waxed 100yd 1ea $2.50 N/A Dental Floss Mint Waxed 100yd N/A N/A 1123272 Toothbrush Full Head Soft 1ea $1.50 N/A Toothbrush Full Head Soft N/A N/A
ORAL CARE
N/A Anbesol® Gel Regular
Strength Cool Mint 0.33oz N/A 3031879
Anbesol® Gel Regular
Strength Cool Mint 0.33oz $7.00 N/A Anbesol® Liquid Regular Strength Cool Mint 0.41oz N/A 3677994 Anbesol® Liquid Regular Strength Cool Mint 0.41oz $7.00 N/A Colgate® Toothpaste
Regular Super 8.2oz N/A 1236058
Colgate® Toothpaste
Regular Super 8.2oz $5.00 N/A Efferdent® Denture
Cleanser Tablets 40ct N/A 1359454
Efferdent® Denture Cleanser Tablets 40ct $4.00 N/A Fixodent® Denture Adhesive Cream Original 2.5oz N/A 1179100 Fixodent® Denture Adhesive Cream Original 2.5oz $7.00 N/A Fixodent® Fresh 2.5oz N/A 1831072 Fixodent® Fresh 2.5oz $7.00 N/A Orajel® Maximum
Strength Gel 0.25oz N/A 1033471
Orajel® Maximum
Strength Gel 0.25oz $7.00 N/A Orajel® Mouth Sore Gel 0.18oz N/A 1529403 Orajel® Mouth Sore Gel 0.18oz $6.50 N/A Polident® 3 Minute
Tablets 120ct N/A 4575304
Polident® 3 Minute
Tablets 120ct $10.00 N/A Polident® Overnight
Cleanser 120ct N/A 4575296 Polident® Overnight Cleanser 120ct $10.00 N/A Sea-Bond® Denture Adhesive Lowers Original 15ea N/A 1138809 Sea-Bond® Denture Adhesive Lowers Original 15ea $4.00 N/A Sea-Bond® Denture Adhesive Uppers Original 15ea N/A 1138932 Sea-Bond® Denture Adhesive Uppers Original 15ea $4.00 N/A Sensodyne® Toothpaste Original Flavor 4oz N/A 1089689 Sensodyne® Toothpaste Original Flavor 4oz $7.50 N/A Super Poligrip® Denture Adhesive Cream Zinc Free Formula
2.4oz N/A 4300133
Super Poligrip® Denture Adhesive Cream Zinc Free Formula
2.4oz $7.50 N/A Toothpaste Crest® Large 4.6oz N/A 1185313 Toothpaste Crest® Large 4.6oz $3.50
PAIN RELIEVERS 2525855 Acetaminophen 325mg Tablet 100ct $4.50 1296250 Tylenol® 325mg Tablets 100ct $11.00 2525871 Acetaminophen Extra Strength 500mg Tablet 100ct $5.00 1331958 Tylenol® Extra Strength 500mg Caplets 100ct $14.50 3956810 Acetaminophen Extra Strength Rapid Release Gels 500mg
100ct $7.50 N/A
Acetaminophen Extra Strength Rapid Release Gels 500mg
N/A N/A 2940625 Arthritis Pain Relief Caplet 50ct $7.50 N/A Arthritis Pain Relief Caplet N/A N/A 2749588 Aspirin 325mg Tablet 100ct $3.50 4212866 Bayer® 325mg Tablets 100ct $9.50
3998192 Aspirin Adult Enteric Coated 81mg 120ct $3.50 4212809
Bayer® Adult 81mg Enteric Coated Low Dose Aspirin
120ct $10.00 1498807 Aspirin Child Chew 81mg 36ct $2.00 1366830 Bayer® Child Chew Aspirin Low Dose 36ct $3.50 3679529 Aspirin Enteric Coated 325mg Tablet 125ct $4.00 4810636
Ecotrin® 325mg Regular Strength Tablets 125ct $9.00 2164226 Headache Relief Added Strength Tablet 100ct $5.50 N/A Headache Relief Added Strength Tablet N/A N/A 2291243 Ibuprofen 200mg
Caplet 100ct $6.00 1110543 Advil® 200mg Caplet 100ct $14.50 1783547 Ibuprofen 200mg
Caplet 50ct $3.00 1110568
Advil® 200mg
Caplets 50ct $9.00 3035771 Ibuprofen 200mg Tablet 100ct $6.00 1330505 Advil® 200mg Tablets 100ct $14.50 4086849 Ibuprofen Child Susp
Berry 4oz $5.00 2488237
Advil® Child
Suspension Fruit 4oz $7.50 9914581 Migraine Relief
Caplet 24ct $4.00 N/A
Migraine Relief
Caplet N/A N/A
4596680 Naproxen Sodium Caplet 100ct $9.00 2190874 Aleve® 220mg Caplet 100ct $15.00 2163442 Non-Aspirin Child
Chewable 80mg Fruit 30ct $4.00 N/A
Non-Aspirin Child
PAIN RELIEVERS 4760310 Pain Reliever PM
Extra Strength Caplet 50ct $4.00 N/A
Pain Reliever PM
Extra Strength Caplet N/A N/A 7180078 Sleep Aid Tablets 16ct $3.50 N/A Sleep Aid Tablets N/A N/A
N/A Advil® 200mg Gel
Caplets 24ct N/A 2384238
Advil® 200mg Gel
Caplets 24ct $5.50 N/A Advil® 200mg Liqui-Gel 80ct N/A 2764959 Advil® 200mg Liqui-Gel 80ct $16.00 N/A Advil® 200mg Liqui-Gel 20ct N/A 2764934 Advil® 200mg Liqui-Gel 20ct $6.00 N/A Advil® 200mg
Migraine Liqui-Gels 20ct N/A 2947406
Advil® 200mg
Migraine Liqui-Gels 20ct $6.00 N/A Advil® 200mg Tablets 24ct N/A 1330471 Advil® 200mg Tablets 24ct $5.50 N/A Advil® 200mg Tablets
EZ Open 150ct N/A 3779477
Advil® 200mg Tablets
EZ Open 150ct $19.00 N/A Advil® PM Caplet 40ct N/A 3725611 Advil® PM Caplet 40ct $10.50 N/A Aleve® 220mg Arthritis Gelcaps Easy Open 40ct N/A 4212783 Aleve® 220mg Arthritis Gelcaps Easy Open 40ct $9.50 N/A Aleve® 220mg Caplets 50ct N/A 2190858 Aleve® 220mg Caplets 50ct $9.50 N/A Aleve® 220mg Caplets 24ct N/A 2190833 Aleve® 220mg Caplets 24ct $5.50 N/A Aleve® 220mg Liqu-Gels 40ct N/A 3807260 Aleve® 220mg Liqu-Gels 40ct $12.00 N/A Aleve® 220mg Tablets 24ct N/A 2190825 Aleve® 220mg Tablets 24ct $5.50 N/A Aleve® 220mg Tablets 100ct N/A 2190866 Aleve® 220mg Tablets 100ct $15.00 N/A Anacin® Tablets 100ct N/A 1156512 Anacin® Tablets 100ct $11.50 N/A Bayer® 325mg Tablets 200ct N/A 4212882 Bayer® 325mg Tablets 200ct $14.00 N/A BC® Arthritis Powder 24ct N/A 4849196 BC® Arthritis Powder 24ct $5.00 N/A BC® Headache Powder 24ct N/A 4849139 BC® Headache Powder 24ct $5.00 N/A Midol® Maximum Strength Menstrual Form Caplet 24ct N/A 2612778 Midol® Maximum Strength Menstrual Form Caplet 24ct $7.00 N/A Midol® Maximum Strength Menstrual Form Gelcap 24ct N/A 2715464 Midol® Maximum Strength Menstrual Form Gelcap 24ct $7.00 N/A Motrin® IB 200mg Caplet 100ct N/A 1752898 Motrin® IB 200mg Caplet 100ct $13.50 N/A Pamprin® Cramp Max Relief Caplet 16ct N/A 1027267 Pamprin® Cramp Max
Relief Caplet 16ct $4.50 N/A Pamprin® Multi-Symptom Caplets 20ct N/A 2364834 Pamprin® Multi-Symptom Caplets 20ct $5.00
PAIN RELIEVERS N/A St. Joseph® Adult Aspirin 81mg Chew Tab 36ct N/A 4379871 St. Joseph® Adult Aspirin 81mg Chew Tab 36ct $3.50 N/A Tylenol® Extra Strength 500mg Caplets 24ct N/A 2331908 Tylenol® Extra Strength 500mg Caplets 24ct $5.00 SKIN CARE / SUNSCREEN
N/A Banana Boat® Sport Sunblock SPF 30 8oz N/A 4251906 Banana Boat® Sport Sunblock SPF 30 8oz $10.50 N/A
Banana Boat®
Ultramist Sport Clear SPF 50
6oz N/A 4799995
Banana Boat®
Ultramist Sport Clear SPF 50
6oz $12.00 SMOKING CESSATION
3666583 Nicotine Gum 2mg 50ct $25.00 N/A Nicotine Gum 2mg N/A N/A 3593225 Nicotine Gum 4mg 50ct $25.00 N/A Nicotine Gum 4mg N/A N/A 3733920 Nicotine Patch Step
1 21mg 7ct $24.50 N/A
Nicotine Patch Step
1 21mg N/A N/A
3734118 Nicotine Patch Step
2 14mg 7ct $24.50 N/A
Nicotine Patch Step
2 14mg N/A N/A
3734092 Nicotine Patch Step 3 7mg 7ct $24.50 N/A Nicotine Patch Step 3 7mg N/A N/A SUPPORT
N/A Futuro™ Ankle Support
Wrap Around Medium 1ea N/A 3936366
Futuro™ Ankle Support
Wrap Around Medium 1ea $10.50 N/A Futuro™ Ankle Support
Wrap Around Large 1ea N/A 3936374
Futuro™ Ankle Support
Wrap Around Large 1ea $10.50 N/A Futuro™ Knee Support Stabilizing Large 1ea N/A 3498516 Futuro™ Knee Support Stabilizing Large 1ea $15.50 N/A Futuro™ Knee Support
Stabilizing Medium 1ea N/A 3498508
Futuro™ Knee Support
Stabilizing Medium 1ea $15.50 N/A
Jobst® Women’s Sheer Knee High 8-15mmHg Medium Silky Beige
1ea N/A 2952414
Jobst® Women’s Sheer Knee High 8-15mmHg Medium Silky Beige
1ea $13.00
N/A
Jobst® Women’s Sheer Knee High 8-15mmHg Small Silky Beige
1ea N/A 2952406
Jobst® Women’s Sheer Knee High 8-15mmHg Small Silky Beige
TOPICAL 2987865 Muscle Rub Ultra
Strength 2oz $4.00 2308583
Bengay® Pain Relieving
Cream Ultra Strength 2oz $7.00 N/A Abreva® Cold Sore
Cream 2gm N/A 2986651
Abreva® Cold Sore
Cream 2gm $24.50 N/A Activon Ultra Strength Arthritis Topical Analgesic 2oz N/A 3878014 Activon Ultra Strength Arthritis Topical Analgesic 2oz $11.50 N/A Aspercreme® Heat
Pain Relieving Gel 2.5oz N/A 4020004
Aspercreme® Heat
Pain Relieving Gel 2.5oz $7.00 N/A Aspercreme® Pain
Relieving Rub 3oz N/A 1241249
Aspercreme® Pain
Relieving Rub 3oz $7.00 N/A
Bengay® Pain
Relieving Cream Ultra Strength
4oz N/A 2308591
Bengay® Pain
Relieving Cream Ultra Strength
4oz $10.00
N/A
Bengay® Ultra Strength Pain Relieving Patch Reg Size
5ct N/A 3577418
Bengay® Ultra Strength Pain Relieving Patch Reg Size
5ct $9.50 N/A Bengay® Vanishing
Scent Rub 2oz N/A 2308534
Bengay® Vanishing
Scent Rub 2oz $5.50 N/A
Capzasin Topical Analgesic Liquid No-Mess Applicator
1oz N/A 3934254
Capzasin Topical Analgesic Liquid No-Mess Applicator
1oz $10.00 N/A Icy Hot® Balm 3.5oz N/A 1021112 Icy Hot® Balm 3.5oz $7.00 N/A Icy Hot® Cream 1.25oz N/A 1141878 Icy Hot® Cream 1.25oz $5.00 N/A
Icy Hot® Medicated Patches Extra
Strength Large (Back)
5ct N/A 3485984
Icy Hot® Medicated Patches Extra
Strength Large (Back)
5ct $8.50 N/A Icy Hot® Patches Arm/Neck/Leg 5ct N/A 3011889 Icy Hot® Patches Arm/Neck/Leg 5ct $7.00 N/A Icy Hot® Sleeve Large Knee/Ankle/Elbow 3ct N/A 3549649 Icy Hot® Sleeve Large Knee/Ankle/Elbow 3ct $8.00 N/A Stopain® (Now Cryoderm™) SX 10% MSM Pain Relief Spray 4oz N/A 4878468 Stopain® (Now Cryoderm™) SX 10% MSM Pain Relief Spray 4oz $11.50
TOPICAL
N/A
ThermaCare® Heatwraps 8HR Lower Back & Hip
2ct N/A 3296340
ThermaCare® Heatwraps 8HR Lower Back & Hip
2ct $9.50 N/A ThermaCare® Heatwraps 8HR Neck/ Shoulder/Wrist 3ct N/A 3296365 ThermaCare® Heatwraps 8HR Neck/ Shoulder/Wrist 3ct $9.50 N/A ThermaCare® Heatwraps Menstrual 3ct N/A 4264628 ThermaCare® Heatwraps Menstrual 3ct $9.50 N/A
Zostrix High Potency Arthritis Pain Relief Cream
2oz N/A 2307304
Zostrix High Potency Arthritis Pain Relief Cream
2oz $22.00 N/A
Zostrix Original Strength Arthritis Pain Relief Cream
2oz N/A 3396918
Zostrix Original Strength Arthritis Pain Relief Cream
2oz $18.00 VAGINAL
2470433 Miconazole 7 Vaginal Cream 45gm $10.50 4725487
Monistat® 7 Cream With Disposable Applicator
1.59oz $13.50 3379666 Miconazole 7 Vaginal Suppositories 7ct $6.00 N/A Miconazole 7 Vaginal Suppositories N/A N/A
N/A Monistat® 3 Cream Prefilled Applicator 3ct 3ct N/A 4738936 Monistat® 3 Cream Prefilled Applicator 3ct 3ct $18.50 N/A Vagistat-3
Combination Pack 1ea N/A 4008520
Vagistat-3
Combination Pack 1ea $13.00 VITAMINS†
2200285 Calcium Carbonate 600mg + D Tablet 60ct $5.00 4604971 Caltrate® 600mg + D Tablet 60ct $10.50 1121797 Cerovite Senior
Tablet 60ct $6.00 N/A
Cerovite Senior
Tablet N/A N/A
3671534 Ferrous Sulfate
Tablets 325mg 100ct $6.00 N/A
Ferrous Sulfate
Tablets 325mg N/A N/A 2461689 Oyst-Cal + D 500mg 60ct $3.50 N/A Oyst-Cal + D 500mg N/A N/A 2204881 Prosight Tablet 60ct $8.50 N/A Prosight Tablet N/A N/A 3662608 Vitamin B-12 500mcg
Tablets 100ct $5.50 N/A
Vitamin B-12 500mcg
Tablets N/A N/A
VITAMINS†
1715473 Vitamin D Tab 400IU 100ct $5.00 N/A Vitamin D Tab 400IU N/A N/A 2162998 Vitamin E 400IU
Softgel 100ct $11.50 N/A
Vitamin E 400IU
Softgel N/A N/A 3123247 Windmill Vitamin A 10000IU Softgel 100ct $5.50 N/A Windmill Vitamin A 10000IU Softgel N/A N/A 3108404 Windmill Vitamin B Complex With Vitamin C + Iron 100ct $8.00 N/A Windmill Vitamin B Complex With Vitamin C + Iron N/A N/A 3123239 Windmill Calcium
Chewable 500mg Tab 60ct $6.50 N/A
Windmill Calcium
Chewable 500mg Tab N/A N/A 3069549 Windmill Folic Acid 400mcg Tabs 180ct $6.50 N/A Windmill Folic Acid 400mcg Tabs N/A N/A
N/A Centrum® Silver 50+
Ultra Men’s 100ct N/A 4163507
Centrum® Silver 50+
Ultra Men’s 100ct $15.50 N/A Centrum® Silver
Chewable 60ct N/A 3651502
Centrum® Silver
Chewable 60ct $16.50 N/A Centrum® Silver 50+ Ultra Women’s 100ct N/A 4967014 Centrum® Silver 50+ Ultra Women’s 100ct $15.50 N/A Ester-C 500mg
Tablets 60ct N/A 3915196
Ester-C 500mg
Tablets 60ct $8.50 N/A Ocuvite® Tablet 60ct N/A 1753490 Ocuvite® Tablet 60ct $11.50 N/A Viactiv® Calcium
Chew Carmel + D 60ct N/A 4898375
Viactiv® Calcium
Chew Carmel + D 60ct $10.00 N/A
Viactiv® Calcium Chew Milk Chocolate + D
60ct N/A 4898383
Viactiv® Calcium Chew Milk Chocolate + D 60ct $10.00 N/A Vitafusion™ B Complex Chew Energy 70ct N/A 4829388 Vitafusion™ B Complex Chew Energy 70ct $5.00 WART REMOVAL
N/A Compound W® Fast-Acting Liquid 0.31oz N/A 1156603 Compound W® Fast-Acting Liquid 0.31oz $9.50 N/A Compound W® Gel 0.25oz N/A 1047471 Compound W® Gel 0.25oz $9.50 N/A
Dr. Scholl’s® Clear Away One Step Wart Remover
1ea N/A 1963636
Dr. Scholl’s® Clear Away One Step Wart Remover
Easy Choice Health Plan allows for the submission of retail receipts for items purchased that follow the Centers for Medicare & Medicaid Services (CMS)
guidelines. Our catalog is representative of these types of items. Please refer to the catalog for the listings of items that are eligible for reimbursement and those that are not.
Receipt totals will be deducted from the member’s monthly benefit allowance for the month in which the purchase occurred. If the member’s monthly benefit allowance has been exhausted, the request for reimbursement will be denied. To have a receipt reimbursement form sent to you, call 1-877-483-9563, TTY 711,
Monday-Friday, 6:30 a.m.–8:00 p.m. Pacific. Or visit www.easychoicehealthplan.com to print the form.
Completed forms should be mailed to:
Drug Source PO. Box 1366.
Elk Grove Village, IL 60009-9917
Please allow 30 days from the date the receipt and form were received for payment. For a list of eligible items, please refer to this catalog.
If you’re ready to enroll or have enrollment questions, call 1-866-999-3945,
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. California: All Plans...1-866-999-3945
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.easychoicehealthplan.com.�
Nurse Advice Line ... 1-800-581-9952 (24 hours, 7 days a week) TTY for all of the above...1-800-735-2929�
on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. 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 Easy Choice for details.
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