Over-The-Counter Health & Wellness Products - Catalog And Order Form - 2015 Page 8
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11251
Adult Incontinence Underwear Small
Protection Plus Classic
22
$20.00
Protective Underwear
Small 20"-28"
254
Adult Incontinence Underwear X-Large
Protection Plus Classic
14
$20.00
Protective Underwear
X-Large 56"-68"
255
Adult Incontinence Underwear XX-Large
Protection Plus Classic
12
$20.00
Protective Underwear
XX-Large 68"-80"
243
Bladder control pads (regular)
Poise
Moderate Pads
20
$9.00
®
242
Blood Pressure Home Kit
Blood Pressure Home Kit
1
$17.00
(manual pump w/stethoscope)**
(manual pump
w/stethoscope
036
Cotton Swabs
Q-Tips
300
$4.75
®
224
Dental Floss
Dental Floss
1
$4.75
225
Denture Adhesive
Fixodent
42 gm
$6.00
®
039
Diaper Rash Cream
Desitin
Cream
120 gm
$6.00
®276
247
Digital Bathroom Scale**
Digital Bathroom Scale
1
$35.00
245
Digital Blood Pressure Monitor**
Digital Blood
1
$50.00
Pressure Monitor
118
Earwax removal drops
Debrox
Earwax
15 ml
$8.00
®
RemovalDrops
235
Effervsecent Denture Tabs
Efferdent
40
$5.25
®
244
Electric Heating Pad**
Electrical Heating Pad
1
$40.00
276
Eye Drop Cup with Guide
Eye Drop Cup with Guide
1
$6.00
219
Eye Drops – Redness Reliever
Visine
Original
15 ml
$5.00
®
114
Lubricant Eye Drops (Sterile)
Liquifilm Tears
15 ml
$6.00
®
048
Oral Thermometer
B-D
Oral Thermometer
1
$6.00
®
284
Toothbrush
Toothbrush
3
$5.75
285
Toothpaste
Toothpaste
2
$8.00
** For items noted above: limit one per plan year. Prior to purchase, the enrollee must have appropriate
conversations with the enrollee’s personal provider and the enrollee’s personal provider must orally
recommend the OTC item.
Skin Care
Product
Product name
Compare to
Package
Price
code
size
217
Allergy cream – itch and pain relief
Benadryl
Extra
30 gm
$5.00
®
Strength Cream
037
Calamine lotion
Caladryl
180 ml
$5.25
®
038
Clotrimazole Cream 1%
Lotrimin AF
15 gm
$6.00
®
004
Hydrocortisone Cream 1%
Cortizone 10
30 gm
$5.00
®
241
Medicated Callus Remover
Dr. Scholl’s
6
$5.00
®
286
Medicated Lip Balm
Chapstick
3
$5.00
®
106
Sunblock
Coppertone
120 ml
$7.00
®
277
Terbinafine Cream
Lamisil
AT
.53 oz.
$10.00
®
218
Tolnaftate 1% Antifungal
Tinactin
Cream
30 gm
$8.00
®
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