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Kentucky | WellCare - WellCare of Kentucky
Over-the-Counter (OTC) Items Benefit Get up to $120 in FREE over-the-counter (OTC) items each year! That’s $10 each month! Para solicitar este documento en español o para escuchar la traducción, llame al Servicio al Cliente al 1-877-389-9457 (TTY/TDD: 1-877-247-6272). It’s EASY to get your items. Just follow these steps: 1 Choose what you and your family need. 2 Call Member Services with your order. 3The toll-free phone number is 1-877-389-9457 (TTY/TDD: 1-877-247-6272). 4Or visit our website at kentucky.wellcare.com, log into the member portal and place your order. That’s it! Your order will be mailed to your home at NO CHARGE to you! For more information, call 1-877-389-9457 (TTY/TDD: 1-877-247-6272). Item Generic Comparable ALLERGY PREVENTION AND TREATMENT 1 Loratadine 10mg Tablets 2 Cetirizine 10mg Tablets 3 Diphenhydramine 25mg Capsules 137 Chlorpheniramine 4mg Allergy Tablets ANALGESICS/ANTIPYRETICS 4 Aspirin 325mg Tablets 5 Aspirin Enteric Coated 81mg Tablets 6 Enteric Coated Aspirin 325mg Tablets 7 Acetaminophen 325mg Tablets 8 Acetaminophen 500mg Tablets 9 Pre-Menstrual Relief Tablets 136 Pain Relief PM ANTACIDS AND ACID REDUCERS 10 Gas Relief 80mg Tablets 11 12 Omeprazole 20mg Calcium Carbonate 500mg Tablets –Amount is for each head of household, not each family member. –If you do not use your $10 in a month, it does not carry over to the next month. –Items, quantities and prices may change depending on availability. OTC Items Benefit | 1 Brand Description Qty Cost Claritin® Zyrtec® Benadryl® Chlor-Trimeton Tablets 10 14 24 24 $5.00 $7.00 $4.00 $3.00 Bayer® Aspirin Bayer EC® Aspirin (Adult Regimen) Ecotrin® Tablets Tylenol® Regular Strength Tablets Tylenol® Extra Strength Caplets Midol® Tylenol PM 100 $3.00 120 $5.00 60 $4.00 100 $6.00 50 $5.00 24 24 $7.00 $3.00 100 $8.00 14 150 $10.00 $4.00 Mylanta® Gas 80mg Tablets Prilosec® Tums® Tablets –Brand items may be supplied in place of generic items. –The brand names of the OTC items listed are trademarks of their respective owners. OTC Items Benefit | 2 Item Generic Comparable 13 Ranitidine HCL 75mg Tablets 14 Famotidine 10mg Tablets 15 Gas Relief (Extra Strength) Tablets ANTI-ARTHRITICS 16 Acetaminophen 650mg Tablets Glucosamine 1500mg/Chondroitin 1200mg ANTICANDIALS (YEAST) Clotrimazole Vaginal 1% Cream—1 18 Application ANTIDIARRHEALS AND LAXATIVES 20 Docusate Sodium 100mg Capsules 21 Adult Glycerin Suppositories 22 Bisacodyl 10mg Suppositories 23 Bisacodyl 5mg Tablets 24 Loperamide 2mg Capsules 25 Antinausea Liquid 17 26 Bismuth Subsalicylate 262mg Tablets Brand Description Qty Cost 30 18 30 $8.00 $6.00 $5.00 50 $6.00 60 $9.00 Gyne-Lotrimin® 6oz $8.00 Colace® Softgels Fleet® Adult Suppositories Dulcolax® Suppositories Dulcolax® Tablets Imodium® Caplets Emetrol® Pepto-Bismol® Chewable Tablets 60 50 12 25 12 4oz $8.00 $4.00 $6.00 $5.00 $5.00 $7.00 30 $4.00 Dramamine® Motion Sickness 12 $4.00 Benadryl® Cream 1oz $4.00 Bengay® 1.25oz $3.00 Neosporin® Ointment Lotrimin® AF 0.5oz 0.5oz $5.00 $6.00 Zantac® Tablets Pepcid® Gas-X® Extra Strength Tylenol® Arthritis Pain Tablets Glucosamine/Chondroitin DS® MOTION SICKNESS MEDICATION 28 Dimenhydrinate 50mg Tablets TOPICAL OINTMENTS AND CREAMS 29 Diphenhydramine Anti-Itch Cream Menthol 10%/Methyl Salicylate 15% 30 Cream 31 Triple Antibiotic Ointment 32 Clotrimazole 1% Cream OTC Items Benefit | 3 OTC Items Benefit | 4 Item Generic Comparable Brand Description Qty Cost Tolnaftate 1% Cream Tinactin® Cream Hydrocortisone 1% Maximum Strength 35 Cortaid® Cream Cream 134 Capsaicin Cream Zostrix Cream 135 Benzoyl Peroxide Cream 10% Clearasil 10% Cream COLD, FLU, DECONGESTANT AND SINUS REMEDIES Oxymetazoline Hydrochloride 0.05% 36 Afrin® Nasal Spray Solution 37 Saline Nasal Spray Ocean® Nasal Spray 38 Throat Lozenges—Assorted Flavors Halls® Cough Drops 39 Guaifenesin 100mg/5ml Robitussin® Syrup Robitussin® Sugar-Free 40 Guaifenesin 100mg/5ml—Sugar-Free Syrup 41 Vicks Vaporub® Vicks Vaporub® Acetaminophen 325mg/ 42 Dextromethorphan 10mg/Phenylephrine DayQuil® Caplets 5mg Tablets Acetaminophen 325mg/ 43 Dextromethorphan 15mg/Doxylamine NyQuil® Caplets 6.25mg Tablets ASA 325mg/Sodium Bicarbonate 44 Alka-Seltzer® 1916mg/Citric Acid 1000mg Tablets 45 Guaifenesin 600mg Tablets Mucinex® Guaifenesin 600mg/Dextromethorphan 46 Mucinex-DM® 30mg Tablets COLD, FLU, DECONGESTANT AND SINUS REMEDIES 47 Phenylephrine HCL 10mg Tablets Sudafed® PE Tylenol® Sinus and 48 APAP Sinus Congestion Congestion Tablets 0.5oz $6.00 0.5oz $4.00 1 1 $6.00 $6.00 1oz $5.00 1.5oz 30 4oz $3.00 $2.00 $5.00 4oz $5.00 3.53oz $6.00 20 $6.00 12 $4.00 20 $5.00 30 $9.00 30 $10.00 18 $4.00 24 $5.00 33 OTC Items Benefit | 5 OTC Items Benefit | 6 Item Generic Comparable DENTAL/DENTURE CARE 49 Benzocaine 20% Oral Anesthetic 50 Denture Adhesive Cream 51 Toothbrush 52 Fluoride Toothpaste 53 Waxed Dental Floss EAR CARE 54 Ear Syringe 55 Carbamide Peroxide (6.5%) Solution EYE CARE Polyvinyl Alcohol 0.5%/Povidone 0.6% 56 Lubricant Eye Drops 57 Tetrahydrozoline HCl 0.05% FIBER SUPPLEMENTS 58 Psyllium Husk, Approximately 0.52g FIRST AID/MEDICAL SUPPLIES 59 Athletic Bandage 60 Adhesive Tape—1/2 Inch x 5 Yards 61 Alcohol Swabs 62 Bandages—Assorted 63 Butterfly Closures 64 Cotton Balls 65 Cotton Swabs 66 Ice Bag Stretch Gauze Bandage—2 Inches x 5 67 Yards 68 Oral Thermometer 69 Flexible Tip Thermometer OTC Items Benefit | 7 Brand Description Qty Cost 0.5oz 2.4oz 1 6.4oz 1 $5.00 $4.00 $2.00 $3.00 $2.00 Ear Syringe 3oz Debrox® Ear Wax Removal 0.5oz $4.00 $7.00 Murine® Tears 0.5oz $5.00 Visine® Drops 0.5oz $4.00 Metamucil® 90 $9.00 Ace® Bandage Adhesive Tape Alcohol Swabs Band-Aids® Butterfly® Closures Cotton Balls Q-Tips® Cotton Swabs Ice Bag Johnson & Johnson® Gauze Oral Thermometer Flexible Tip Thermometer 1 1 100 30 10 100 200 1 $3.00 $2.00 $3.00 $2.00 $2.00 $2.00 $3.00 $5.00 1 $2.00 1 $6.00 1 $10.00 Anbesol® Fixodent® Toothbrush Colgate® Waxed Dental Floss OTC Items Benefit | 8 Item 70 Generic Comparable Thermometer Probe Covers 71 Menthol 5% Patches FIRST AID/MEDICAL SUPPLIES 72 Corn and Callus Remover 73 Salicylic Acid (17% w/w) Liquid HEMORRHOIDAL PREPARATIONS Mineral Oil 46.6%/Pramoxine HCL 1%/ 74 Zinc Oxide 12.5% Mineral Oil 14%/Petrolatum 71.9%/ 75 Phenylephrine 0.25%/Shark Oil 3% Cream 76 Witch Hazel 50% Pads HEADACHE RELIEF Acetaminophen 250mg/Aspirin 250mg/ 78 Caffeine 65mg Tablets Acetaminophen 500mg/ 79 Diphenhydramine Citrate 38mg Tablets ANTI-INFLAMMATORY 80 Ibuprofen 200mg FC Tablets 81 Naproxen Sodium 220mg Caplets 82 Ibuprofen 200mg Liquid Gel Caps PEDICULICIDES Lice Treatment Maximum Strength 83 Shampoo 84 Lice Comb OTC Items Benefit | 9 Brand Description Qty Cost 30 $3.00 5 $6.00 0.33oz $5.00 0.31oz $7.00 0.7oz $4.00 Preparation H® Ointment 2oz $8.00 Tucks® Medicated Pads 100 $8.00 Excedrin® Migraine 24 $4.00 Excedrin® PM Tablets 50 $6.00 Advil® Tablets Aleve® Caplets Advil® Liquid Gel Caps 50 50 20 $5.00 $6.00 $5.00 4oz $10.00 1 $5.00 Thermometer Probe Cover Icy Hot® Patches—Large Dr. Scholl’s® Corn and Callus Remover Compound W® Wart Remover Tucks® Hemorrhoidal Ointment Rid® Extra Strength Shampoo Lice Comb OTC Items Benefit | 10 Item Generic Comparable SLEEPING AIDS 85 Diphenhydramine 25mg Capsules VITAMINS AND MINERALS 86 B-Complex/B-12 Vitamins 87 Adult Multi-Vitamin Tablets 88 89 90 Prenatal Vitamins Vitamin C 500mg Tablets Vitamin E 400 IU Caplets 91 Vitamin A 10,000 IU Caplets 92 Elemental Iron 65mg Tablets 93 Folic Acid 500mcg Tablets 94 Magnesium 250mg Tablets 95 Zinc 50mg Tablets 96 Synthetic Vitamin B-1 100mg Tablets VITAMINS AND MINERALS 97 Synthetic B-12 500mcg Tablets 98 Synthetic Vitamin B-6 100mg Tablets Calcium Carbonate 600mg/Vitamin D 99 400 IU Tablets 100 Calcium Carbonate 600mg Tablets CHILDREN’S PRODUCTS 101 Orajel Baby Brand Description Qty Cost Unisom® Sleep Tablets 16 $5.00 B-Complex/B-12 Vitamins Centrum® Multi-Vitamin Tablets Stuart Prenatal® Vitamins Vitamin C 500mg Tablets Vitamin E 400 IU Caplets Vitamin A 10,000 IU Caplets Feosol® Folic Acid 400mcg Tablets Magnesium 250mg Tablets Zinc 50mg Tablets Vitamin B-1 100mg Tablets 100 $6.00 100 $9.00 100 100 100 $10.00 $4.00 $7.00 100 $4.00 100 100 100 100 100 $7.00 $5.00 $3.00 $5.00 $4.00 100 $6.00 100 $5.00 Caltrate® 600 + D 60 $6.00 Caltrate® 600 60 $5.00 Orajel® Baby 0.33oz 1.4oz gel 1oz 0.5oz $6.00 Vitamin B-12 500mcg Tablets Vitamin B-6 100mg Tablets 102 Tooth and Gum Cleanser Tooth and Gum Cleanser 103 Diaper Rash Ointment 104 Salicylic Acid 17% w/v 0.5oz Liquid Balmex® Ointment Duofilm® OTC Items Benefit | 11 OTC Items Benefit | 12 $6.00 $3.00 $7.00 Item Generic Comparable 105 Gas Relief Drops 106 Baby Poly Vitamin Drops 50ml 107 Children’s Chewable Multi-Vitamins 108 Children’s Ibuprofen Suspension 100mg 109 110 111 Junior Strength Pain Ibuprofen Chewable Tablets 100mg Junior Strength Pain Relief Apap Chewable Tablets 160mg Acetaminophen Children’s Elixir 160mg/5ml 112 Acetaminophen Chewable Tablets 113 Children’s Cold and Allergy Elixir 5ml 114 Infant Ibuprofen Oral Suspension 50mg 115 Acetaminophen Children’s Elixir 30ml 116 Childen’s Glycerin Suppositories Diphenhydramine Liquid 5ml—Alcohol Free OTHER ITEMS 120 Condoms 121 Pill Box 122 Throat Lozenges 123 Hand Sanitizer Wipes 124 Feminine Hygiene Wipes 117 OTC Items Benefit | 13 Brand Description Qty Cost Mylicon® drops Poli-Vi-Sol® Drops Flintstones® MultiVitamins Motrin® Suspension for Children 1oz 50ml $10.00 $7.00 100 $7.00 4oz $6.00 Motrin® Jr. Strength 24 $5.00 Tylenol® Jr. Strength 24 $5.00 Tylenol® Children’s Elixir 4oz $5.00 30 $5.00 4oz $5.00 1 $7.00 1oz $5.00 25 $2.00 Benadryl® Elixir 4oz $4.00 Condoms Pill Box Chloraseptic® Hand Sanitizer Wipes Feminine Hygiene Wipes 3 1 18 24 12 $2.00 $2.00 $2.00 $4.00 $2.00 Tylenol® Children’s Chewable Tablets Dimetapp® Cold and Flu Elixir Motrin® Infant Drops Dye Free Tylenol® Infant Drops Children’s Glycerin Suppositories OTC Items Benefit | 14 Item 125 Generic Comparable Premium Medium Baby Diapers 126 Premium Large Baby Diapers 127 Premium Extra Large Baby Diapers 128 SPF 30 Sunblock 129 Preference Facial Tissue OTHER ITEMS 130 Pregnancy Test 131 Fever Strip Thermometer 132 Premium Baby Wipes 133 Premium Antibacterial Hand Soap 138 Dry Skin Therapy Moisturizing Cream OTC Items Benefit | 15 Brand Description Premium Medium Baby Diapers Premium Large Baby Diapers Premium Extra Large Baby Diapers SPF 30 Sunblock Preference Facial Tissue Pregnancy Test Fever Strip Thermometer Pampers Baby Wipes Soft Soap Antibacterial Soap Eucerin Cream Qty Cost 18 $8.00 16 $8.00 14 $8.00 1 1 $6.00 $2.00 1 1 1 pkg $8.00 $3.00 $3.00 1 $3.00 1 $8.00 OTC Items Benefit | 16 KY017502_CAD_OTC_ENG State Approved 01062012 WC012012218 P.O. Box 43800 Louisville, KY 40253 ©WellCare 2011 KY_12_11 43095