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OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS Your 2018 catalog INT_18_57481 09112017

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Page 1: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS

Your 2018 catalog

INT_18_57481 09112017

ATTENTION If you speak English language assistance services free of charge are available to you Call 1-800-668-3813 (TTY 711) 8 am ndash 8 pm Monday ndash Friday and 8 am ndash 6 pm on Saturday ATENCIOacuteN Si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-800-668-3813 注意如果您使用繁體中文您可以 免費獲得語言援助服務 請致電1-800-668-3813 (TTY 711) All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including Cigna Health and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc Cigna HealthCare of Georgia Inc Cigna HealthCare of Arizona Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Tennessee Inc HealthSpring of Alabama Inc HealthSpring of Florida Inc Bravo Health Mid Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2017 Cigna

YOUR OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS

Choose from the list of covered medications and products in this catalog

Check your Cigna-HealthSpring Evidence of Coverage to see your monthly OTC allowance

2

1

Call to order 1-866-851-1579 (TTY 711) Monday ndash Friday 8 am ndash 9 pm EST

3

Ask us to double-check your mailing address We want to make sure you get your items 4

SAVE MONEY AND TIME You can get over-the-counter items sent right to your door ndash with FREE delivery

3

QAamp Common questions about

Q What can I order

A You can order from the list of covered items in this catalog Covered items may include

OTC medications bull Aspirin bull Acetaminophen bull Vitamins

bull Cold and flu medicine

Health-related products bull Nicotine patches bull Disposable underpads bull Compression socks

bull Nasal strips

Q How much is my quarterly allowance

A The dollar value of your quarterly allowance depends on your plan Check your Cigna-HealthSpring Evidence of Coverage to see your quarterly OTC allowance

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

your OTC benefit

Q When can I spend my quarterly allowance

A Your allowance goes into your account quarterly on January 1 April 1 July 1 and October 1 You can

bull Spend your full quarterly allowance as soon as it is in your account

bull Save up your allowances to order higher priced items later in the year

bull Order once a month up to 12 times a year

Unused balances roll forward each quarter However balances do not carry over to the next year

Q Who can get items through my OTC benefit

A You can order items that help you with a medical need every month you are a Cigna-HealthSpring customer Cigna-HealthSpring prohibits the purchase of OTC items for family members or friends

Q How do I get my order

A The cost of your order must be less than or equal to the account balance for items to ship OTC medications are only available for home delivery Covered items are sent to you free of delivery charge Please allow two weeks for home delivery

4

20

20

20

BRAND EQUIVALENT INDEX Please use the index below for ease in locating available OTC items

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

21st Century Glucosamine Chondroitin 3M Tape Tape Paper Surgical

- 1 in x 10 yd 3M Tape Tape Paper Surgical

- 2 in x 10 yd 3M Tape Tape Silk Surgical

- 1 in x 10 yd 3M Tape Tape Silk Surgical

- 2 in x 10 yd 3M Tape Tape Transparent

Surgical - 1 in x 10 yd 3M Tape Tape Transparent

Surgical - 2 in x 10 yd AampD A amp D Ointment Abreva Abreva Ace Ankle Support Ace Elastic Bandage - 2 in x 45 yd Ace Elastic Bandage - 3 in x 5 yd Ace Elastic Bandage - 4 in x 5 yd Ace Elastic Bandage - 6 in x 5 yd Advil Ibuprofen Afrin Nasal Decongestant

Spray - 12 Hour After Bite Relief After Bite Relief Aleve Naproxen AmLactin Ammonium Lactate Alka-Seltzer Effervescent Pain Reliever Anbesol Oral Pain Relief Antiseptic Towelettes

Antiseptic Towelettes

Arthritis Gloves Arthritis Gloves Small Arthritis Gloves Arthritis Gloves Medium Arthritis Gloves Arthritis Gloves Large Aspercreme Lidocaine Patch Attends Bladder Control Shaped

Pad Moderate Absorbency

10 Attends Bladder Control Shaped Pad18 Heavy Absorbency

Attends Bladder Control Shaped Pad 19 Maximum Absorbency

Attends Disposable Underwear 19 Medium

Attends Disposable Underwear 19 Large

Attends Disposable Underwear 19 X-Large

Attends Underpad Disposable 19 - 23rdquo x 24rdquo

Attends Underpad Disposable 19 - 23rdquo x 36rdquo

Attends Underpad Disposable15 - 30rdquo x 30rdquo 23 Bacitracin Bacitracin Ointment 17 Band-Aid Adhesive Bandages

17 Bath Mat Bath Mat Non-Skid Non-Skid

17 Bausch amp Lomb Eye Wash Solution 18 Bayer Aspirin 21 Bayer Aspirin Low Dose 12 Chewables

Benadryl Diphenhist (Antihistamine) 17 Benadryl Diphenhydramine HCL 22 (Antihistamine)

Benadryl Diphenhydramine HCL Zinc 22 Acetate Anti-itch Cream 13 Bengay Pain Relieving Muscle Rub 15 Benrsquos Insect Repellant Spray (Deet) 17 Biofreeze Fast Freeze Pain Relief Spray

23 Bonine Meclizine HCL Antiemetic

23 Braun Thermometer Digital Ear

23 Breathe Right Nasal Strips Small Medium

22 Breathe Right Nasal Strips Medium Large

20 Caltrate Calcium + Vitamin D Caltrate-D Calcium Carbonate Tablets

17

17

17

16

21

21

12

12

22

5

20

20

20

20

20

14

18 18 21 19 22 22 10 10

24

24

18 19

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Capzasin Capsaicin Carex Bath Tub Safety Rail Carex Cushion Foam Ring Carex Cushion Lumbar Carpal Tunnel Carpal Tunnel Brace Small Brace Carpal Tunnel Carpal Tunnel Brace Medium Brace Carpal Tunnel Carpal Tunnel Brace Large Brace Centrum Daily Multiple Vitamin

Tablets with Minerals Centrum SIlver Senior Multivitamin Cepacol Sore Throat Lozenges Cepacol Sore Throat Lozenges Cherry Chlor-Trimeton Chlorpheniramine Maleate

(Antihistamine) Chloraseptic Sore Throat Spray Cherry CholesTrak Home Access

Cholesterol Test Citrucel Methylcellulose Fiber Therapy Claritin Loratadine (Generic Claritin) Clean and Clear Acne Gel 10

Benzoyl Peroxide Colace Docusate Sodium

Stool Softener Colgate Rechargeable Toothbrush Colgate Toothbrush Colgate

Adult Soft Commit Nicotine Lozenges Compound W Wart Remover (liquid) Conair Water Jet Conair Water Jet Replacement Tips Coppertone Sunscreen Lotion SPF 30 Coricidin HBP Cough amp Cold for High

Blood Pressure Cortaid Hydrocortisone 1 Cream Cotton Balls Cotton Balls Curad Alcohol Pads

21 Curad Rib Belt - Female 17 (one size fits most)

17 17

Curad

Curad

Rib Belt - Male (one size fits most) First Aid Kit

23 DHEA DHEA

23 Depends Attends Discreet Menrsquos Guard Depends Attends Discreet Menrsquos Shield

23 Depends Attends Discreet Womenrsquos Maximum

10 Bladder Control Pad

11 Depends Attends Discreet

Womenrsquos Moderate 13 13

Depends Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

12 Depends Attends Discreet Womenrsquos Ultimate Bladder Control Pad

13 11

Depends Attends Discreet Womenrsquos Ultrathin Pad

Dr Scholls Callus Remover Pads 14 Dr Scholls Corn Remover Pads 12 Dr Scholls Diabetic Sock Black Medium 22 Dr Scholls Diabetic Sock Black Large

14 Dr Scholls Dr Scholls

Diabetic Sock White Medium Diabetic Sock White Large

15 Dramamine Dramamine Chewables 15

Dramamine Orange Driminate Antiemetic

23 Drive Medical Adjustable Transfer Bench 25 Drive Medical Cushion Gel Foam Seat 16 Drive Medical Quad Cane Small Base 16 Drive Medical Quad Cane Large Base 25 12

Dulcolax

Ecotrin

Bisacodyl Enteric Coated Laxative Aspirin Enteric Coated

14 Ecotrin Aspirin Low Dose 17 Efferdent Denture Cleaning Tablets 17 Essential Bath Bench with Back

20

20

20

19

19

16

16

16

16

21

21

17

17

6

20

20

20

20

18 18 14

21 21 15 17

25 19 25

13

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Essential Bath Bench without Back Excedrin Migraine Relief Feosol Ferrous Gluconate

(Iron Supplement) Feosol Ferrous Sulfate Fibercon Polycarbophil Fiber Tablets First Aid Only First Aid Kit 75 pieces Fixodent Fixodent Fleet Glycerin Suppository Fleet Hemorrhoidal Suppository Fruit of the Earth Aloe Vera Cream Futuro Back Support Elastic Futuro Back Support Elastic

with Lumbar Futuro Compression Knee High

Socks Womenrsquos Black Small Futuro Compression Knee

High Socks Womenrsquos Black Medium

Futuro Compression Knee High Socks Womenrsquos Black Large

Futuro Compression Knee High Socks Womenrsquos Nude Small

Futuro Compression Knee High Socks Womenrsquos Nude Medium

Futuro Compression Knee High Socks Womenrsquos Nude Large

Futuro Elbow Support Futuro Knee Support Elastic Small Futuro Knee Suppor t Elastic

Small with Stays Futuro Knee Suppor t

Elastic Medium Futuro Knee Suppor t Elastic

Medium with Stays Futuro Knee Support Elastic Large Futuro Knee Suppor t Elastic

Large with Stays Futuro Night Wrist Support

Smart Glove Futuro Wrist Splint

17 Futuro Wrist Support 22 Gold Bond Medicated Foot Powder 10 Gold Bond Moisturizing Body

Lotion with Aloe 10 14 18

Gyne-Lotrimin Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

15 HALLS Cough Drops Cherry 14 HealthSmart Finger Pulse Oximeter 19 Herpecin-L Herpecin-L Lip Balm 25 23 23

Hip Protector Hip Protector Hip Protector

Hip Protector Small Hip Protector Medium Hip Protector Large

23 Hip Protectorw Hip Protector X-Large

23 Hydrogen Peroxide Hydrogen Peroxide Hylandrsquos Ear Pain Relief Ear Drops

23 Hylandrsquos Leg Cramps Pain

Relief Caplets

23 Imodium A-D Loperamide HCL

Anti-Diarrheal

24 Isopropyl Isopropyl Alcohol

Wintergreen Lactaid Lactase Capsules 14

24 Lamisil AT Terbinafine HCL Antifungal Cream

15

24 24 24

24

24

Lantiseptic Lotrimin AF

Lotrimin AF

Ludens

Maalox

Barrier Cream Clotrimazole Antifungal Athletersquos Foot Cream Medicated Antifungal Foot Powder Spray Cough Drops Sugar Free Cherry Antacid Anti-Gas Liquid

20 14

15

12

13

24 Metamucil Natural Vegetable Laxative 24 Micatin Miconazole Nitrate 2

Antifungal Cream 24 Monistat 1 Tioconazole 1-Day Treatment

Vaginal Cream (with applicator) 25 Monistat 3 Micanozole 3-Day Treatment

12

11

15

24

24

24

24

18

16

10

7

14

18

14 15

13

13

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Murine Murine

Mucinex DM

NasalCrom

Ear Wax Removal Drops Ear Wax Removal System with Rubber Bulb Mucus Relief DM Expectorantamp Cough Suppressant Cromolyn Sodium(Allergy Nasal Spray)

16 16

12

12

Omron

One A Day

One A Day

Orajel

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo) One DailyMenrsquos Multivitamin One Daily Womenrsquos Multivitamin Orajel Pain Relief

11

11

11

15 Nature Made Nature Made Nature Made

Magnesium Oxide Niacin Stress Formula

10 11 11

Oral B Oral-B

Rechargeable Toothbrush Interdental Flossups 15

Tablets with Zinc Pepcid Famotidine Acid Reducer 13 Naturersquos Bounty Coenzyme Q-1 10 Pepsodent Toothpaste - Pepsodent 16 Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty

Folic Acid Iron Magnesium Melatonin

10 10 10 10

Pepto-Bismol Pepto-Bismol Phillipsrsquo

Bismatrol Chewable Tablets Pink Bismuth Milk of Magnesia

14 14 14

Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Neosporin Neosporin

Vitamin B-6 Vitamin D Fish Oil Tablets Neosporin Plus Triple Antibiotic Ointment

11 11 10 18 19

Povidone

Preparation H Prevail Prevail

Povidone Iodine Solution Antiseptic Hemorrhoidal Ointment Adult Briefs Medium Adult Briefs Large

18

19 19 20

Nexcare

Nexcare

Nicoderm

HotCold Pack1 small amp 1 large Thermometer Digital 60 seconds Nicotine Patch Step 1

18

19

23

Prevail Prilosec OTC ProCheck

Purell

Adult Briefs X-Large Omeprazole Acid Reducer Thermometer Flexible Tip Digital 10 seconds Hand Sanitizer

20 13 19

22 Nicoderm Nicoderm Nicorette Nix

Nicotine Patch Step 2 Nicotine Patch Step 3 Nicorelief Gum Permethrin Lice Treatment

23 23 23 22

Q-Tips Quick-Lock Reach

Cotton Tipped Swabs Raised Toilet Seat Reach Waxed Dental Floss Mint

16 18 15

Nova

Ocean Omron

Omron

Folding CaneErgonomic Handle Nasal Spray Saline Desktop Automatic Blood Pressure Monitor Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

18

13 11

11

Refresh PM Releev Renu MultipurposeSolution Reveal

Rid

Artificial Tears Ointment Releev Cold Sore Treatment Multi-Purpose Contact Lens Solution EZ Detect Colon Cancer Test Kit Lice Treatment Shampoo

16 15 16

11

22 Omron

Omron

Desktop Blood Pressure Monitor Replacement Cuff Wrist Blood Pressure Monitor

11

11

Robitussin Robitussin

Cough Syrup Expectorant Guaifenesin Cough Expectorant

12 12

8

12 16 16 10 10

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Robitussin Diabetic Tussin DM Salonpas Pain Relief Patches Senokot- S Senna Plus Stool

Softener Plus Laxative Shower Mat Shower Mat Non-Skid Sominex Sleep Tablets Sudafed PE Sudogest PE

(Nasal amp Sinus Decongestant) Sunbeam Heating Pad 12 in x 15 in Super Poligrip Polident Denture Cream Tek Pro Toothbrush Tek Pro

Straight Soft Therafirm Compression Knee High

Socks Menrsquos Black Medium Therafirm Compression Knee High

Socks Menrsquos Black Large Therafirm Compression Knee High

Socks Menrsquos White Medium Therafirm Compression Knee High

Socks Menrsquos White Large Thermacare Thermacare Knee amp Elbow Thermacare Thermacare Lower

Back amp Hip Thermacare Thermacare Menstrual Relief Thermometer Thermometer

Talking Ear and Forehead Tinactin Tolnaftate Antifungal Cream Toilet Safety Rails Toilet Safety Rails Tucks Pre-moist Hemorrhoid Pads Tums Antacid Chewables Tylenol Acetaminophen Tylenol Multi-Symptom Cold Formula Tylenol Arthritis Arthritis Pain Reliever Tylenol Extra Acetaminophen Strength Tylenol PM Pain Reliever

PM - Extra Strength Vicks Humidifier

Ultra-Sonic Cool Mist Vicks Personal Steam Inhaler

12 Vicks NyQuil All-Nite ColdFlu 22 Visine Artificial Tears Drops 14 Visine Redness Relief Eye Drops

18 22 13

Vitafusion Vitafusion Vitafusion Vitafusion

Biotin Gummy Calcium + Vitamin D Gummy Vitamin B-Complex Gummy Vitamin C Gummy

21 15

Vitafusion

Vitamin A

Vitafusion Fiber WeightManagement Vitamin A

16

23

Vitamin B-Complex Vitamin B-1

Vitamin B-Complex

Vitamin B-1

23 Vitamin B-6 Vitamin B-6 Vitamin B-12 Vitamin B-12

23 Vitamin C Vitamin C

23

22 22

Vitamin D Vitamin E Soft Gels Zantac Zantac

Vitamin D Vitamin E Soft Gels

Ranitidine Acid Reducer Simethicone

22 18 Zyrtec

Anti-Gas Chewables All-Day Allergy Tablets (Cetrizine HCL)

15 19 19 13 21 12 21 21

22

18

13

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

11

11

25

11

11

11

11

11

11

11

11

13

13

9

12

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 2: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

ATTENTION If you speak English language assistance services free of charge are available to you Call 1-800-668-3813 (TTY 711) 8 am ndash 8 pm Monday ndash Friday and 8 am ndash 6 pm on Saturday ATENCIOacuteN Si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-800-668-3813 注意如果您使用繁體中文您可以 免費獲得語言援助服務 請致電1-800-668-3813 (TTY 711) All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including Cigna Health and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc Cigna HealthCare of Georgia Inc Cigna HealthCare of Arizona Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Tennessee Inc HealthSpring of Alabama Inc HealthSpring of Florida Inc Bravo Health Mid Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2017 Cigna

YOUR OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS

Choose from the list of covered medications and products in this catalog

Check your Cigna-HealthSpring Evidence of Coverage to see your monthly OTC allowance

2

1

Call to order 1-866-851-1579 (TTY 711) Monday ndash Friday 8 am ndash 9 pm EST

3

Ask us to double-check your mailing address We want to make sure you get your items 4

SAVE MONEY AND TIME You can get over-the-counter items sent right to your door ndash with FREE delivery

3

QAamp Common questions about

Q What can I order

A You can order from the list of covered items in this catalog Covered items may include

OTC medications bull Aspirin bull Acetaminophen bull Vitamins

bull Cold and flu medicine

Health-related products bull Nicotine patches bull Disposable underpads bull Compression socks

bull Nasal strips

Q How much is my quarterly allowance

A The dollar value of your quarterly allowance depends on your plan Check your Cigna-HealthSpring Evidence of Coverage to see your quarterly OTC allowance

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

your OTC benefit

Q When can I spend my quarterly allowance

A Your allowance goes into your account quarterly on January 1 April 1 July 1 and October 1 You can

bull Spend your full quarterly allowance as soon as it is in your account

bull Save up your allowances to order higher priced items later in the year

bull Order once a month up to 12 times a year

Unused balances roll forward each quarter However balances do not carry over to the next year

Q Who can get items through my OTC benefit

A You can order items that help you with a medical need every month you are a Cigna-HealthSpring customer Cigna-HealthSpring prohibits the purchase of OTC items for family members or friends

Q How do I get my order

A The cost of your order must be less than or equal to the account balance for items to ship OTC medications are only available for home delivery Covered items are sent to you free of delivery charge Please allow two weeks for home delivery

4

20

20

20

BRAND EQUIVALENT INDEX Please use the index below for ease in locating available OTC items

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

21st Century Glucosamine Chondroitin 3M Tape Tape Paper Surgical

- 1 in x 10 yd 3M Tape Tape Paper Surgical

- 2 in x 10 yd 3M Tape Tape Silk Surgical

- 1 in x 10 yd 3M Tape Tape Silk Surgical

- 2 in x 10 yd 3M Tape Tape Transparent

Surgical - 1 in x 10 yd 3M Tape Tape Transparent

Surgical - 2 in x 10 yd AampD A amp D Ointment Abreva Abreva Ace Ankle Support Ace Elastic Bandage - 2 in x 45 yd Ace Elastic Bandage - 3 in x 5 yd Ace Elastic Bandage - 4 in x 5 yd Ace Elastic Bandage - 6 in x 5 yd Advil Ibuprofen Afrin Nasal Decongestant

Spray - 12 Hour After Bite Relief After Bite Relief Aleve Naproxen AmLactin Ammonium Lactate Alka-Seltzer Effervescent Pain Reliever Anbesol Oral Pain Relief Antiseptic Towelettes

Antiseptic Towelettes

Arthritis Gloves Arthritis Gloves Small Arthritis Gloves Arthritis Gloves Medium Arthritis Gloves Arthritis Gloves Large Aspercreme Lidocaine Patch Attends Bladder Control Shaped

Pad Moderate Absorbency

10 Attends Bladder Control Shaped Pad18 Heavy Absorbency

Attends Bladder Control Shaped Pad 19 Maximum Absorbency

Attends Disposable Underwear 19 Medium

Attends Disposable Underwear 19 Large

Attends Disposable Underwear 19 X-Large

Attends Underpad Disposable 19 - 23rdquo x 24rdquo

Attends Underpad Disposable 19 - 23rdquo x 36rdquo

Attends Underpad Disposable15 - 30rdquo x 30rdquo 23 Bacitracin Bacitracin Ointment 17 Band-Aid Adhesive Bandages

17 Bath Mat Bath Mat Non-Skid Non-Skid

17 Bausch amp Lomb Eye Wash Solution 18 Bayer Aspirin 21 Bayer Aspirin Low Dose 12 Chewables

Benadryl Diphenhist (Antihistamine) 17 Benadryl Diphenhydramine HCL 22 (Antihistamine)

Benadryl Diphenhydramine HCL Zinc 22 Acetate Anti-itch Cream 13 Bengay Pain Relieving Muscle Rub 15 Benrsquos Insect Repellant Spray (Deet) 17 Biofreeze Fast Freeze Pain Relief Spray

23 Bonine Meclizine HCL Antiemetic

23 Braun Thermometer Digital Ear

23 Breathe Right Nasal Strips Small Medium

22 Breathe Right Nasal Strips Medium Large

20 Caltrate Calcium + Vitamin D Caltrate-D Calcium Carbonate Tablets

17

17

17

16

21

21

12

12

22

5

20

20

20

20

20

14

18 18 21 19 22 22 10 10

24

24

18 19

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Capzasin Capsaicin Carex Bath Tub Safety Rail Carex Cushion Foam Ring Carex Cushion Lumbar Carpal Tunnel Carpal Tunnel Brace Small Brace Carpal Tunnel Carpal Tunnel Brace Medium Brace Carpal Tunnel Carpal Tunnel Brace Large Brace Centrum Daily Multiple Vitamin

Tablets with Minerals Centrum SIlver Senior Multivitamin Cepacol Sore Throat Lozenges Cepacol Sore Throat Lozenges Cherry Chlor-Trimeton Chlorpheniramine Maleate

(Antihistamine) Chloraseptic Sore Throat Spray Cherry CholesTrak Home Access

Cholesterol Test Citrucel Methylcellulose Fiber Therapy Claritin Loratadine (Generic Claritin) Clean and Clear Acne Gel 10

Benzoyl Peroxide Colace Docusate Sodium

Stool Softener Colgate Rechargeable Toothbrush Colgate Toothbrush Colgate

Adult Soft Commit Nicotine Lozenges Compound W Wart Remover (liquid) Conair Water Jet Conair Water Jet Replacement Tips Coppertone Sunscreen Lotion SPF 30 Coricidin HBP Cough amp Cold for High

Blood Pressure Cortaid Hydrocortisone 1 Cream Cotton Balls Cotton Balls Curad Alcohol Pads

21 Curad Rib Belt - Female 17 (one size fits most)

17 17

Curad

Curad

Rib Belt - Male (one size fits most) First Aid Kit

23 DHEA DHEA

23 Depends Attends Discreet Menrsquos Guard Depends Attends Discreet Menrsquos Shield

23 Depends Attends Discreet Womenrsquos Maximum

10 Bladder Control Pad

11 Depends Attends Discreet

Womenrsquos Moderate 13 13

Depends Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

12 Depends Attends Discreet Womenrsquos Ultimate Bladder Control Pad

13 11

Depends Attends Discreet Womenrsquos Ultrathin Pad

Dr Scholls Callus Remover Pads 14 Dr Scholls Corn Remover Pads 12 Dr Scholls Diabetic Sock Black Medium 22 Dr Scholls Diabetic Sock Black Large

14 Dr Scholls Dr Scholls

Diabetic Sock White Medium Diabetic Sock White Large

15 Dramamine Dramamine Chewables 15

Dramamine Orange Driminate Antiemetic

23 Drive Medical Adjustable Transfer Bench 25 Drive Medical Cushion Gel Foam Seat 16 Drive Medical Quad Cane Small Base 16 Drive Medical Quad Cane Large Base 25 12

Dulcolax

Ecotrin

Bisacodyl Enteric Coated Laxative Aspirin Enteric Coated

14 Ecotrin Aspirin Low Dose 17 Efferdent Denture Cleaning Tablets 17 Essential Bath Bench with Back

20

20

20

19

19

16

16

16

16

21

21

17

17

6

20

20

20

20

18 18 14

21 21 15 17

25 19 25

13

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Essential Bath Bench without Back Excedrin Migraine Relief Feosol Ferrous Gluconate

(Iron Supplement) Feosol Ferrous Sulfate Fibercon Polycarbophil Fiber Tablets First Aid Only First Aid Kit 75 pieces Fixodent Fixodent Fleet Glycerin Suppository Fleet Hemorrhoidal Suppository Fruit of the Earth Aloe Vera Cream Futuro Back Support Elastic Futuro Back Support Elastic

with Lumbar Futuro Compression Knee High

Socks Womenrsquos Black Small Futuro Compression Knee

High Socks Womenrsquos Black Medium

Futuro Compression Knee High Socks Womenrsquos Black Large

Futuro Compression Knee High Socks Womenrsquos Nude Small

Futuro Compression Knee High Socks Womenrsquos Nude Medium

Futuro Compression Knee High Socks Womenrsquos Nude Large

Futuro Elbow Support Futuro Knee Support Elastic Small Futuro Knee Suppor t Elastic

Small with Stays Futuro Knee Suppor t

Elastic Medium Futuro Knee Suppor t Elastic

Medium with Stays Futuro Knee Support Elastic Large Futuro Knee Suppor t Elastic

Large with Stays Futuro Night Wrist Support

Smart Glove Futuro Wrist Splint

17 Futuro Wrist Support 22 Gold Bond Medicated Foot Powder 10 Gold Bond Moisturizing Body

Lotion with Aloe 10 14 18

Gyne-Lotrimin Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

15 HALLS Cough Drops Cherry 14 HealthSmart Finger Pulse Oximeter 19 Herpecin-L Herpecin-L Lip Balm 25 23 23

Hip Protector Hip Protector Hip Protector

Hip Protector Small Hip Protector Medium Hip Protector Large

23 Hip Protectorw Hip Protector X-Large

23 Hydrogen Peroxide Hydrogen Peroxide Hylandrsquos Ear Pain Relief Ear Drops

23 Hylandrsquos Leg Cramps Pain

Relief Caplets

23 Imodium A-D Loperamide HCL

Anti-Diarrheal

24 Isopropyl Isopropyl Alcohol

Wintergreen Lactaid Lactase Capsules 14

24 Lamisil AT Terbinafine HCL Antifungal Cream

15

24 24 24

24

24

Lantiseptic Lotrimin AF

Lotrimin AF

Ludens

Maalox

Barrier Cream Clotrimazole Antifungal Athletersquos Foot Cream Medicated Antifungal Foot Powder Spray Cough Drops Sugar Free Cherry Antacid Anti-Gas Liquid

20 14

15

12

13

24 Metamucil Natural Vegetable Laxative 24 Micatin Miconazole Nitrate 2

Antifungal Cream 24 Monistat 1 Tioconazole 1-Day Treatment

Vaginal Cream (with applicator) 25 Monistat 3 Micanozole 3-Day Treatment

12

11

15

24

24

24

24

18

16

10

7

14

18

14 15

13

13

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Murine Murine

Mucinex DM

NasalCrom

Ear Wax Removal Drops Ear Wax Removal System with Rubber Bulb Mucus Relief DM Expectorantamp Cough Suppressant Cromolyn Sodium(Allergy Nasal Spray)

16 16

12

12

Omron

One A Day

One A Day

Orajel

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo) One DailyMenrsquos Multivitamin One Daily Womenrsquos Multivitamin Orajel Pain Relief

11

11

11

15 Nature Made Nature Made Nature Made

Magnesium Oxide Niacin Stress Formula

10 11 11

Oral B Oral-B

Rechargeable Toothbrush Interdental Flossups 15

Tablets with Zinc Pepcid Famotidine Acid Reducer 13 Naturersquos Bounty Coenzyme Q-1 10 Pepsodent Toothpaste - Pepsodent 16 Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty

Folic Acid Iron Magnesium Melatonin

10 10 10 10

Pepto-Bismol Pepto-Bismol Phillipsrsquo

Bismatrol Chewable Tablets Pink Bismuth Milk of Magnesia

14 14 14

Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Neosporin Neosporin

Vitamin B-6 Vitamin D Fish Oil Tablets Neosporin Plus Triple Antibiotic Ointment

11 11 10 18 19

Povidone

Preparation H Prevail Prevail

Povidone Iodine Solution Antiseptic Hemorrhoidal Ointment Adult Briefs Medium Adult Briefs Large

18

19 19 20

Nexcare

Nexcare

Nicoderm

HotCold Pack1 small amp 1 large Thermometer Digital 60 seconds Nicotine Patch Step 1

18

19

23

Prevail Prilosec OTC ProCheck

Purell

Adult Briefs X-Large Omeprazole Acid Reducer Thermometer Flexible Tip Digital 10 seconds Hand Sanitizer

20 13 19

22 Nicoderm Nicoderm Nicorette Nix

Nicotine Patch Step 2 Nicotine Patch Step 3 Nicorelief Gum Permethrin Lice Treatment

23 23 23 22

Q-Tips Quick-Lock Reach

Cotton Tipped Swabs Raised Toilet Seat Reach Waxed Dental Floss Mint

16 18 15

Nova

Ocean Omron

Omron

Folding CaneErgonomic Handle Nasal Spray Saline Desktop Automatic Blood Pressure Monitor Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

18

13 11

11

Refresh PM Releev Renu MultipurposeSolution Reveal

Rid

Artificial Tears Ointment Releev Cold Sore Treatment Multi-Purpose Contact Lens Solution EZ Detect Colon Cancer Test Kit Lice Treatment Shampoo

16 15 16

11

22 Omron

Omron

Desktop Blood Pressure Monitor Replacement Cuff Wrist Blood Pressure Monitor

11

11

Robitussin Robitussin

Cough Syrup Expectorant Guaifenesin Cough Expectorant

12 12

8

12 16 16 10 10

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Robitussin Diabetic Tussin DM Salonpas Pain Relief Patches Senokot- S Senna Plus Stool

Softener Plus Laxative Shower Mat Shower Mat Non-Skid Sominex Sleep Tablets Sudafed PE Sudogest PE

(Nasal amp Sinus Decongestant) Sunbeam Heating Pad 12 in x 15 in Super Poligrip Polident Denture Cream Tek Pro Toothbrush Tek Pro

Straight Soft Therafirm Compression Knee High

Socks Menrsquos Black Medium Therafirm Compression Knee High

Socks Menrsquos Black Large Therafirm Compression Knee High

Socks Menrsquos White Medium Therafirm Compression Knee High

Socks Menrsquos White Large Thermacare Thermacare Knee amp Elbow Thermacare Thermacare Lower

Back amp Hip Thermacare Thermacare Menstrual Relief Thermometer Thermometer

Talking Ear and Forehead Tinactin Tolnaftate Antifungal Cream Toilet Safety Rails Toilet Safety Rails Tucks Pre-moist Hemorrhoid Pads Tums Antacid Chewables Tylenol Acetaminophen Tylenol Multi-Symptom Cold Formula Tylenol Arthritis Arthritis Pain Reliever Tylenol Extra Acetaminophen Strength Tylenol PM Pain Reliever

PM - Extra Strength Vicks Humidifier

Ultra-Sonic Cool Mist Vicks Personal Steam Inhaler

12 Vicks NyQuil All-Nite ColdFlu 22 Visine Artificial Tears Drops 14 Visine Redness Relief Eye Drops

18 22 13

Vitafusion Vitafusion Vitafusion Vitafusion

Biotin Gummy Calcium + Vitamin D Gummy Vitamin B-Complex Gummy Vitamin C Gummy

21 15

Vitafusion

Vitamin A

Vitafusion Fiber WeightManagement Vitamin A

16

23

Vitamin B-Complex Vitamin B-1

Vitamin B-Complex

Vitamin B-1

23 Vitamin B-6 Vitamin B-6 Vitamin B-12 Vitamin B-12

23 Vitamin C Vitamin C

23

22 22

Vitamin D Vitamin E Soft Gels Zantac Zantac

Vitamin D Vitamin E Soft Gels

Ranitidine Acid Reducer Simethicone

22 18 Zyrtec

Anti-Gas Chewables All-Day Allergy Tablets (Cetrizine HCL)

15 19 19 13 21 12 21 21

22

18

13

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

11

11

25

11

11

11

11

11

11

11

11

13

13

9

12

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 3: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

YOUR OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS

Choose from the list of covered medications and products in this catalog

Check your Cigna-HealthSpring Evidence of Coverage to see your monthly OTC allowance

2

1

Call to order 1-866-851-1579 (TTY 711) Monday ndash Friday 8 am ndash 9 pm EST

3

Ask us to double-check your mailing address We want to make sure you get your items 4

SAVE MONEY AND TIME You can get over-the-counter items sent right to your door ndash with FREE delivery

3

QAamp Common questions about

Q What can I order

A You can order from the list of covered items in this catalog Covered items may include

OTC medications bull Aspirin bull Acetaminophen bull Vitamins

bull Cold and flu medicine

Health-related products bull Nicotine patches bull Disposable underpads bull Compression socks

bull Nasal strips

Q How much is my quarterly allowance

A The dollar value of your quarterly allowance depends on your plan Check your Cigna-HealthSpring Evidence of Coverage to see your quarterly OTC allowance

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

your OTC benefit

Q When can I spend my quarterly allowance

A Your allowance goes into your account quarterly on January 1 April 1 July 1 and October 1 You can

bull Spend your full quarterly allowance as soon as it is in your account

bull Save up your allowances to order higher priced items later in the year

bull Order once a month up to 12 times a year

Unused balances roll forward each quarter However balances do not carry over to the next year

Q Who can get items through my OTC benefit

A You can order items that help you with a medical need every month you are a Cigna-HealthSpring customer Cigna-HealthSpring prohibits the purchase of OTC items for family members or friends

Q How do I get my order

A The cost of your order must be less than or equal to the account balance for items to ship OTC medications are only available for home delivery Covered items are sent to you free of delivery charge Please allow two weeks for home delivery

4

20

20

20

BRAND EQUIVALENT INDEX Please use the index below for ease in locating available OTC items

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

21st Century Glucosamine Chondroitin 3M Tape Tape Paper Surgical

- 1 in x 10 yd 3M Tape Tape Paper Surgical

- 2 in x 10 yd 3M Tape Tape Silk Surgical

- 1 in x 10 yd 3M Tape Tape Silk Surgical

- 2 in x 10 yd 3M Tape Tape Transparent

Surgical - 1 in x 10 yd 3M Tape Tape Transparent

Surgical - 2 in x 10 yd AampD A amp D Ointment Abreva Abreva Ace Ankle Support Ace Elastic Bandage - 2 in x 45 yd Ace Elastic Bandage - 3 in x 5 yd Ace Elastic Bandage - 4 in x 5 yd Ace Elastic Bandage - 6 in x 5 yd Advil Ibuprofen Afrin Nasal Decongestant

Spray - 12 Hour After Bite Relief After Bite Relief Aleve Naproxen AmLactin Ammonium Lactate Alka-Seltzer Effervescent Pain Reliever Anbesol Oral Pain Relief Antiseptic Towelettes

Antiseptic Towelettes

Arthritis Gloves Arthritis Gloves Small Arthritis Gloves Arthritis Gloves Medium Arthritis Gloves Arthritis Gloves Large Aspercreme Lidocaine Patch Attends Bladder Control Shaped

Pad Moderate Absorbency

10 Attends Bladder Control Shaped Pad18 Heavy Absorbency

Attends Bladder Control Shaped Pad 19 Maximum Absorbency

Attends Disposable Underwear 19 Medium

Attends Disposable Underwear 19 Large

Attends Disposable Underwear 19 X-Large

Attends Underpad Disposable 19 - 23rdquo x 24rdquo

Attends Underpad Disposable 19 - 23rdquo x 36rdquo

Attends Underpad Disposable15 - 30rdquo x 30rdquo 23 Bacitracin Bacitracin Ointment 17 Band-Aid Adhesive Bandages

17 Bath Mat Bath Mat Non-Skid Non-Skid

17 Bausch amp Lomb Eye Wash Solution 18 Bayer Aspirin 21 Bayer Aspirin Low Dose 12 Chewables

Benadryl Diphenhist (Antihistamine) 17 Benadryl Diphenhydramine HCL 22 (Antihistamine)

Benadryl Diphenhydramine HCL Zinc 22 Acetate Anti-itch Cream 13 Bengay Pain Relieving Muscle Rub 15 Benrsquos Insect Repellant Spray (Deet) 17 Biofreeze Fast Freeze Pain Relief Spray

23 Bonine Meclizine HCL Antiemetic

23 Braun Thermometer Digital Ear

23 Breathe Right Nasal Strips Small Medium

22 Breathe Right Nasal Strips Medium Large

20 Caltrate Calcium + Vitamin D Caltrate-D Calcium Carbonate Tablets

17

17

17

16

21

21

12

12

22

5

20

20

20

20

20

14

18 18 21 19 22 22 10 10

24

24

18 19

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Capzasin Capsaicin Carex Bath Tub Safety Rail Carex Cushion Foam Ring Carex Cushion Lumbar Carpal Tunnel Carpal Tunnel Brace Small Brace Carpal Tunnel Carpal Tunnel Brace Medium Brace Carpal Tunnel Carpal Tunnel Brace Large Brace Centrum Daily Multiple Vitamin

Tablets with Minerals Centrum SIlver Senior Multivitamin Cepacol Sore Throat Lozenges Cepacol Sore Throat Lozenges Cherry Chlor-Trimeton Chlorpheniramine Maleate

(Antihistamine) Chloraseptic Sore Throat Spray Cherry CholesTrak Home Access

Cholesterol Test Citrucel Methylcellulose Fiber Therapy Claritin Loratadine (Generic Claritin) Clean and Clear Acne Gel 10

Benzoyl Peroxide Colace Docusate Sodium

Stool Softener Colgate Rechargeable Toothbrush Colgate Toothbrush Colgate

Adult Soft Commit Nicotine Lozenges Compound W Wart Remover (liquid) Conair Water Jet Conair Water Jet Replacement Tips Coppertone Sunscreen Lotion SPF 30 Coricidin HBP Cough amp Cold for High

Blood Pressure Cortaid Hydrocortisone 1 Cream Cotton Balls Cotton Balls Curad Alcohol Pads

21 Curad Rib Belt - Female 17 (one size fits most)

17 17

Curad

Curad

Rib Belt - Male (one size fits most) First Aid Kit

23 DHEA DHEA

23 Depends Attends Discreet Menrsquos Guard Depends Attends Discreet Menrsquos Shield

23 Depends Attends Discreet Womenrsquos Maximum

10 Bladder Control Pad

11 Depends Attends Discreet

Womenrsquos Moderate 13 13

Depends Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

12 Depends Attends Discreet Womenrsquos Ultimate Bladder Control Pad

13 11

Depends Attends Discreet Womenrsquos Ultrathin Pad

Dr Scholls Callus Remover Pads 14 Dr Scholls Corn Remover Pads 12 Dr Scholls Diabetic Sock Black Medium 22 Dr Scholls Diabetic Sock Black Large

14 Dr Scholls Dr Scholls

Diabetic Sock White Medium Diabetic Sock White Large

15 Dramamine Dramamine Chewables 15

Dramamine Orange Driminate Antiemetic

23 Drive Medical Adjustable Transfer Bench 25 Drive Medical Cushion Gel Foam Seat 16 Drive Medical Quad Cane Small Base 16 Drive Medical Quad Cane Large Base 25 12

Dulcolax

Ecotrin

Bisacodyl Enteric Coated Laxative Aspirin Enteric Coated

14 Ecotrin Aspirin Low Dose 17 Efferdent Denture Cleaning Tablets 17 Essential Bath Bench with Back

20

20

20

19

19

16

16

16

16

21

21

17

17

6

20

20

20

20

18 18 14

21 21 15 17

25 19 25

13

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Essential Bath Bench without Back Excedrin Migraine Relief Feosol Ferrous Gluconate

(Iron Supplement) Feosol Ferrous Sulfate Fibercon Polycarbophil Fiber Tablets First Aid Only First Aid Kit 75 pieces Fixodent Fixodent Fleet Glycerin Suppository Fleet Hemorrhoidal Suppository Fruit of the Earth Aloe Vera Cream Futuro Back Support Elastic Futuro Back Support Elastic

with Lumbar Futuro Compression Knee High

Socks Womenrsquos Black Small Futuro Compression Knee

High Socks Womenrsquos Black Medium

Futuro Compression Knee High Socks Womenrsquos Black Large

Futuro Compression Knee High Socks Womenrsquos Nude Small

Futuro Compression Knee High Socks Womenrsquos Nude Medium

Futuro Compression Knee High Socks Womenrsquos Nude Large

Futuro Elbow Support Futuro Knee Support Elastic Small Futuro Knee Suppor t Elastic

Small with Stays Futuro Knee Suppor t

Elastic Medium Futuro Knee Suppor t Elastic

Medium with Stays Futuro Knee Support Elastic Large Futuro Knee Suppor t Elastic

Large with Stays Futuro Night Wrist Support

Smart Glove Futuro Wrist Splint

17 Futuro Wrist Support 22 Gold Bond Medicated Foot Powder 10 Gold Bond Moisturizing Body

Lotion with Aloe 10 14 18

Gyne-Lotrimin Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

15 HALLS Cough Drops Cherry 14 HealthSmart Finger Pulse Oximeter 19 Herpecin-L Herpecin-L Lip Balm 25 23 23

Hip Protector Hip Protector Hip Protector

Hip Protector Small Hip Protector Medium Hip Protector Large

23 Hip Protectorw Hip Protector X-Large

23 Hydrogen Peroxide Hydrogen Peroxide Hylandrsquos Ear Pain Relief Ear Drops

23 Hylandrsquos Leg Cramps Pain

Relief Caplets

23 Imodium A-D Loperamide HCL

Anti-Diarrheal

24 Isopropyl Isopropyl Alcohol

Wintergreen Lactaid Lactase Capsules 14

24 Lamisil AT Terbinafine HCL Antifungal Cream

15

24 24 24

24

24

Lantiseptic Lotrimin AF

Lotrimin AF

Ludens

Maalox

Barrier Cream Clotrimazole Antifungal Athletersquos Foot Cream Medicated Antifungal Foot Powder Spray Cough Drops Sugar Free Cherry Antacid Anti-Gas Liquid

20 14

15

12

13

24 Metamucil Natural Vegetable Laxative 24 Micatin Miconazole Nitrate 2

Antifungal Cream 24 Monistat 1 Tioconazole 1-Day Treatment

Vaginal Cream (with applicator) 25 Monistat 3 Micanozole 3-Day Treatment

12

11

15

24

24

24

24

18

16

10

7

14

18

14 15

13

13

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Murine Murine

Mucinex DM

NasalCrom

Ear Wax Removal Drops Ear Wax Removal System with Rubber Bulb Mucus Relief DM Expectorantamp Cough Suppressant Cromolyn Sodium(Allergy Nasal Spray)

16 16

12

12

Omron

One A Day

One A Day

Orajel

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo) One DailyMenrsquos Multivitamin One Daily Womenrsquos Multivitamin Orajel Pain Relief

11

11

11

15 Nature Made Nature Made Nature Made

Magnesium Oxide Niacin Stress Formula

10 11 11

Oral B Oral-B

Rechargeable Toothbrush Interdental Flossups 15

Tablets with Zinc Pepcid Famotidine Acid Reducer 13 Naturersquos Bounty Coenzyme Q-1 10 Pepsodent Toothpaste - Pepsodent 16 Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty

Folic Acid Iron Magnesium Melatonin

10 10 10 10

Pepto-Bismol Pepto-Bismol Phillipsrsquo

Bismatrol Chewable Tablets Pink Bismuth Milk of Magnesia

14 14 14

Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Neosporin Neosporin

Vitamin B-6 Vitamin D Fish Oil Tablets Neosporin Plus Triple Antibiotic Ointment

11 11 10 18 19

Povidone

Preparation H Prevail Prevail

Povidone Iodine Solution Antiseptic Hemorrhoidal Ointment Adult Briefs Medium Adult Briefs Large

18

19 19 20

Nexcare

Nexcare

Nicoderm

HotCold Pack1 small amp 1 large Thermometer Digital 60 seconds Nicotine Patch Step 1

18

19

23

Prevail Prilosec OTC ProCheck

Purell

Adult Briefs X-Large Omeprazole Acid Reducer Thermometer Flexible Tip Digital 10 seconds Hand Sanitizer

20 13 19

22 Nicoderm Nicoderm Nicorette Nix

Nicotine Patch Step 2 Nicotine Patch Step 3 Nicorelief Gum Permethrin Lice Treatment

23 23 23 22

Q-Tips Quick-Lock Reach

Cotton Tipped Swabs Raised Toilet Seat Reach Waxed Dental Floss Mint

16 18 15

Nova

Ocean Omron

Omron

Folding CaneErgonomic Handle Nasal Spray Saline Desktop Automatic Blood Pressure Monitor Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

18

13 11

11

Refresh PM Releev Renu MultipurposeSolution Reveal

Rid

Artificial Tears Ointment Releev Cold Sore Treatment Multi-Purpose Contact Lens Solution EZ Detect Colon Cancer Test Kit Lice Treatment Shampoo

16 15 16

11

22 Omron

Omron

Desktop Blood Pressure Monitor Replacement Cuff Wrist Blood Pressure Monitor

11

11

Robitussin Robitussin

Cough Syrup Expectorant Guaifenesin Cough Expectorant

12 12

8

12 16 16 10 10

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Robitussin Diabetic Tussin DM Salonpas Pain Relief Patches Senokot- S Senna Plus Stool

Softener Plus Laxative Shower Mat Shower Mat Non-Skid Sominex Sleep Tablets Sudafed PE Sudogest PE

(Nasal amp Sinus Decongestant) Sunbeam Heating Pad 12 in x 15 in Super Poligrip Polident Denture Cream Tek Pro Toothbrush Tek Pro

Straight Soft Therafirm Compression Knee High

Socks Menrsquos Black Medium Therafirm Compression Knee High

Socks Menrsquos Black Large Therafirm Compression Knee High

Socks Menrsquos White Medium Therafirm Compression Knee High

Socks Menrsquos White Large Thermacare Thermacare Knee amp Elbow Thermacare Thermacare Lower

Back amp Hip Thermacare Thermacare Menstrual Relief Thermometer Thermometer

Talking Ear and Forehead Tinactin Tolnaftate Antifungal Cream Toilet Safety Rails Toilet Safety Rails Tucks Pre-moist Hemorrhoid Pads Tums Antacid Chewables Tylenol Acetaminophen Tylenol Multi-Symptom Cold Formula Tylenol Arthritis Arthritis Pain Reliever Tylenol Extra Acetaminophen Strength Tylenol PM Pain Reliever

PM - Extra Strength Vicks Humidifier

Ultra-Sonic Cool Mist Vicks Personal Steam Inhaler

12 Vicks NyQuil All-Nite ColdFlu 22 Visine Artificial Tears Drops 14 Visine Redness Relief Eye Drops

18 22 13

Vitafusion Vitafusion Vitafusion Vitafusion

Biotin Gummy Calcium + Vitamin D Gummy Vitamin B-Complex Gummy Vitamin C Gummy

21 15

Vitafusion

Vitamin A

Vitafusion Fiber WeightManagement Vitamin A

16

23

Vitamin B-Complex Vitamin B-1

Vitamin B-Complex

Vitamin B-1

23 Vitamin B-6 Vitamin B-6 Vitamin B-12 Vitamin B-12

23 Vitamin C Vitamin C

23

22 22

Vitamin D Vitamin E Soft Gels Zantac Zantac

Vitamin D Vitamin E Soft Gels

Ranitidine Acid Reducer Simethicone

22 18 Zyrtec

Anti-Gas Chewables All-Day Allergy Tablets (Cetrizine HCL)

15 19 19 13 21 12 21 21

22

18

13

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

11

11

25

11

11

11

11

11

11

11

11

13

13

9

12

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 4: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

QAamp Common questions about

Q What can I order

A You can order from the list of covered items in this catalog Covered items may include

OTC medications bull Aspirin bull Acetaminophen bull Vitamins

bull Cold and flu medicine

Health-related products bull Nicotine patches bull Disposable underpads bull Compression socks

bull Nasal strips

Q How much is my quarterly allowance

A The dollar value of your quarterly allowance depends on your plan Check your Cigna-HealthSpring Evidence of Coverage to see your quarterly OTC allowance

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

your OTC benefit

Q When can I spend my quarterly allowance

A Your allowance goes into your account quarterly on January 1 April 1 July 1 and October 1 You can

bull Spend your full quarterly allowance as soon as it is in your account

bull Save up your allowances to order higher priced items later in the year

bull Order once a month up to 12 times a year

Unused balances roll forward each quarter However balances do not carry over to the next year

Q Who can get items through my OTC benefit

A You can order items that help you with a medical need every month you are a Cigna-HealthSpring customer Cigna-HealthSpring prohibits the purchase of OTC items for family members or friends

Q How do I get my order

A The cost of your order must be less than or equal to the account balance for items to ship OTC medications are only available for home delivery Covered items are sent to you free of delivery charge Please allow two weeks for home delivery

4

20

20

20

BRAND EQUIVALENT INDEX Please use the index below for ease in locating available OTC items

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

21st Century Glucosamine Chondroitin 3M Tape Tape Paper Surgical

- 1 in x 10 yd 3M Tape Tape Paper Surgical

- 2 in x 10 yd 3M Tape Tape Silk Surgical

- 1 in x 10 yd 3M Tape Tape Silk Surgical

- 2 in x 10 yd 3M Tape Tape Transparent

Surgical - 1 in x 10 yd 3M Tape Tape Transparent

Surgical - 2 in x 10 yd AampD A amp D Ointment Abreva Abreva Ace Ankle Support Ace Elastic Bandage - 2 in x 45 yd Ace Elastic Bandage - 3 in x 5 yd Ace Elastic Bandage - 4 in x 5 yd Ace Elastic Bandage - 6 in x 5 yd Advil Ibuprofen Afrin Nasal Decongestant

Spray - 12 Hour After Bite Relief After Bite Relief Aleve Naproxen AmLactin Ammonium Lactate Alka-Seltzer Effervescent Pain Reliever Anbesol Oral Pain Relief Antiseptic Towelettes

Antiseptic Towelettes

Arthritis Gloves Arthritis Gloves Small Arthritis Gloves Arthritis Gloves Medium Arthritis Gloves Arthritis Gloves Large Aspercreme Lidocaine Patch Attends Bladder Control Shaped

Pad Moderate Absorbency

10 Attends Bladder Control Shaped Pad18 Heavy Absorbency

Attends Bladder Control Shaped Pad 19 Maximum Absorbency

Attends Disposable Underwear 19 Medium

Attends Disposable Underwear 19 Large

Attends Disposable Underwear 19 X-Large

Attends Underpad Disposable 19 - 23rdquo x 24rdquo

Attends Underpad Disposable 19 - 23rdquo x 36rdquo

Attends Underpad Disposable15 - 30rdquo x 30rdquo 23 Bacitracin Bacitracin Ointment 17 Band-Aid Adhesive Bandages

17 Bath Mat Bath Mat Non-Skid Non-Skid

17 Bausch amp Lomb Eye Wash Solution 18 Bayer Aspirin 21 Bayer Aspirin Low Dose 12 Chewables

Benadryl Diphenhist (Antihistamine) 17 Benadryl Diphenhydramine HCL 22 (Antihistamine)

Benadryl Diphenhydramine HCL Zinc 22 Acetate Anti-itch Cream 13 Bengay Pain Relieving Muscle Rub 15 Benrsquos Insect Repellant Spray (Deet) 17 Biofreeze Fast Freeze Pain Relief Spray

23 Bonine Meclizine HCL Antiemetic

23 Braun Thermometer Digital Ear

23 Breathe Right Nasal Strips Small Medium

22 Breathe Right Nasal Strips Medium Large

20 Caltrate Calcium + Vitamin D Caltrate-D Calcium Carbonate Tablets

17

17

17

16

21

21

12

12

22

5

20

20

20

20

20

14

18 18 21 19 22 22 10 10

24

24

18 19

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Capzasin Capsaicin Carex Bath Tub Safety Rail Carex Cushion Foam Ring Carex Cushion Lumbar Carpal Tunnel Carpal Tunnel Brace Small Brace Carpal Tunnel Carpal Tunnel Brace Medium Brace Carpal Tunnel Carpal Tunnel Brace Large Brace Centrum Daily Multiple Vitamin

Tablets with Minerals Centrum SIlver Senior Multivitamin Cepacol Sore Throat Lozenges Cepacol Sore Throat Lozenges Cherry Chlor-Trimeton Chlorpheniramine Maleate

(Antihistamine) Chloraseptic Sore Throat Spray Cherry CholesTrak Home Access

Cholesterol Test Citrucel Methylcellulose Fiber Therapy Claritin Loratadine (Generic Claritin) Clean and Clear Acne Gel 10

Benzoyl Peroxide Colace Docusate Sodium

Stool Softener Colgate Rechargeable Toothbrush Colgate Toothbrush Colgate

Adult Soft Commit Nicotine Lozenges Compound W Wart Remover (liquid) Conair Water Jet Conair Water Jet Replacement Tips Coppertone Sunscreen Lotion SPF 30 Coricidin HBP Cough amp Cold for High

Blood Pressure Cortaid Hydrocortisone 1 Cream Cotton Balls Cotton Balls Curad Alcohol Pads

21 Curad Rib Belt - Female 17 (one size fits most)

17 17

Curad

Curad

Rib Belt - Male (one size fits most) First Aid Kit

23 DHEA DHEA

23 Depends Attends Discreet Menrsquos Guard Depends Attends Discreet Menrsquos Shield

23 Depends Attends Discreet Womenrsquos Maximum

10 Bladder Control Pad

11 Depends Attends Discreet

Womenrsquos Moderate 13 13

Depends Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

12 Depends Attends Discreet Womenrsquos Ultimate Bladder Control Pad

13 11

Depends Attends Discreet Womenrsquos Ultrathin Pad

Dr Scholls Callus Remover Pads 14 Dr Scholls Corn Remover Pads 12 Dr Scholls Diabetic Sock Black Medium 22 Dr Scholls Diabetic Sock Black Large

14 Dr Scholls Dr Scholls

Diabetic Sock White Medium Diabetic Sock White Large

15 Dramamine Dramamine Chewables 15

Dramamine Orange Driminate Antiemetic

23 Drive Medical Adjustable Transfer Bench 25 Drive Medical Cushion Gel Foam Seat 16 Drive Medical Quad Cane Small Base 16 Drive Medical Quad Cane Large Base 25 12

Dulcolax

Ecotrin

Bisacodyl Enteric Coated Laxative Aspirin Enteric Coated

14 Ecotrin Aspirin Low Dose 17 Efferdent Denture Cleaning Tablets 17 Essential Bath Bench with Back

20

20

20

19

19

16

16

16

16

21

21

17

17

6

20

20

20

20

18 18 14

21 21 15 17

25 19 25

13

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Essential Bath Bench without Back Excedrin Migraine Relief Feosol Ferrous Gluconate

(Iron Supplement) Feosol Ferrous Sulfate Fibercon Polycarbophil Fiber Tablets First Aid Only First Aid Kit 75 pieces Fixodent Fixodent Fleet Glycerin Suppository Fleet Hemorrhoidal Suppository Fruit of the Earth Aloe Vera Cream Futuro Back Support Elastic Futuro Back Support Elastic

with Lumbar Futuro Compression Knee High

Socks Womenrsquos Black Small Futuro Compression Knee

High Socks Womenrsquos Black Medium

Futuro Compression Knee High Socks Womenrsquos Black Large

Futuro Compression Knee High Socks Womenrsquos Nude Small

Futuro Compression Knee High Socks Womenrsquos Nude Medium

Futuro Compression Knee High Socks Womenrsquos Nude Large

Futuro Elbow Support Futuro Knee Support Elastic Small Futuro Knee Suppor t Elastic

Small with Stays Futuro Knee Suppor t

Elastic Medium Futuro Knee Suppor t Elastic

Medium with Stays Futuro Knee Support Elastic Large Futuro Knee Suppor t Elastic

Large with Stays Futuro Night Wrist Support

Smart Glove Futuro Wrist Splint

17 Futuro Wrist Support 22 Gold Bond Medicated Foot Powder 10 Gold Bond Moisturizing Body

Lotion with Aloe 10 14 18

Gyne-Lotrimin Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

15 HALLS Cough Drops Cherry 14 HealthSmart Finger Pulse Oximeter 19 Herpecin-L Herpecin-L Lip Balm 25 23 23

Hip Protector Hip Protector Hip Protector

Hip Protector Small Hip Protector Medium Hip Protector Large

23 Hip Protectorw Hip Protector X-Large

23 Hydrogen Peroxide Hydrogen Peroxide Hylandrsquos Ear Pain Relief Ear Drops

23 Hylandrsquos Leg Cramps Pain

Relief Caplets

23 Imodium A-D Loperamide HCL

Anti-Diarrheal

24 Isopropyl Isopropyl Alcohol

Wintergreen Lactaid Lactase Capsules 14

24 Lamisil AT Terbinafine HCL Antifungal Cream

15

24 24 24

24

24

Lantiseptic Lotrimin AF

Lotrimin AF

Ludens

Maalox

Barrier Cream Clotrimazole Antifungal Athletersquos Foot Cream Medicated Antifungal Foot Powder Spray Cough Drops Sugar Free Cherry Antacid Anti-Gas Liquid

20 14

15

12

13

24 Metamucil Natural Vegetable Laxative 24 Micatin Miconazole Nitrate 2

Antifungal Cream 24 Monistat 1 Tioconazole 1-Day Treatment

Vaginal Cream (with applicator) 25 Monistat 3 Micanozole 3-Day Treatment

12

11

15

24

24

24

24

18

16

10

7

14

18

14 15

13

13

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Murine Murine

Mucinex DM

NasalCrom

Ear Wax Removal Drops Ear Wax Removal System with Rubber Bulb Mucus Relief DM Expectorantamp Cough Suppressant Cromolyn Sodium(Allergy Nasal Spray)

16 16

12

12

Omron

One A Day

One A Day

Orajel

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo) One DailyMenrsquos Multivitamin One Daily Womenrsquos Multivitamin Orajel Pain Relief

11

11

11

15 Nature Made Nature Made Nature Made

Magnesium Oxide Niacin Stress Formula

10 11 11

Oral B Oral-B

Rechargeable Toothbrush Interdental Flossups 15

Tablets with Zinc Pepcid Famotidine Acid Reducer 13 Naturersquos Bounty Coenzyme Q-1 10 Pepsodent Toothpaste - Pepsodent 16 Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty

Folic Acid Iron Magnesium Melatonin

10 10 10 10

Pepto-Bismol Pepto-Bismol Phillipsrsquo

Bismatrol Chewable Tablets Pink Bismuth Milk of Magnesia

14 14 14

Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Neosporin Neosporin

Vitamin B-6 Vitamin D Fish Oil Tablets Neosporin Plus Triple Antibiotic Ointment

11 11 10 18 19

Povidone

Preparation H Prevail Prevail

Povidone Iodine Solution Antiseptic Hemorrhoidal Ointment Adult Briefs Medium Adult Briefs Large

18

19 19 20

Nexcare

Nexcare

Nicoderm

HotCold Pack1 small amp 1 large Thermometer Digital 60 seconds Nicotine Patch Step 1

18

19

23

Prevail Prilosec OTC ProCheck

Purell

Adult Briefs X-Large Omeprazole Acid Reducer Thermometer Flexible Tip Digital 10 seconds Hand Sanitizer

20 13 19

22 Nicoderm Nicoderm Nicorette Nix

Nicotine Patch Step 2 Nicotine Patch Step 3 Nicorelief Gum Permethrin Lice Treatment

23 23 23 22

Q-Tips Quick-Lock Reach

Cotton Tipped Swabs Raised Toilet Seat Reach Waxed Dental Floss Mint

16 18 15

Nova

Ocean Omron

Omron

Folding CaneErgonomic Handle Nasal Spray Saline Desktop Automatic Blood Pressure Monitor Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

18

13 11

11

Refresh PM Releev Renu MultipurposeSolution Reveal

Rid

Artificial Tears Ointment Releev Cold Sore Treatment Multi-Purpose Contact Lens Solution EZ Detect Colon Cancer Test Kit Lice Treatment Shampoo

16 15 16

11

22 Omron

Omron

Desktop Blood Pressure Monitor Replacement Cuff Wrist Blood Pressure Monitor

11

11

Robitussin Robitussin

Cough Syrup Expectorant Guaifenesin Cough Expectorant

12 12

8

12 16 16 10 10

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Robitussin Diabetic Tussin DM Salonpas Pain Relief Patches Senokot- S Senna Plus Stool

Softener Plus Laxative Shower Mat Shower Mat Non-Skid Sominex Sleep Tablets Sudafed PE Sudogest PE

(Nasal amp Sinus Decongestant) Sunbeam Heating Pad 12 in x 15 in Super Poligrip Polident Denture Cream Tek Pro Toothbrush Tek Pro

Straight Soft Therafirm Compression Knee High

Socks Menrsquos Black Medium Therafirm Compression Knee High

Socks Menrsquos Black Large Therafirm Compression Knee High

Socks Menrsquos White Medium Therafirm Compression Knee High

Socks Menrsquos White Large Thermacare Thermacare Knee amp Elbow Thermacare Thermacare Lower

Back amp Hip Thermacare Thermacare Menstrual Relief Thermometer Thermometer

Talking Ear and Forehead Tinactin Tolnaftate Antifungal Cream Toilet Safety Rails Toilet Safety Rails Tucks Pre-moist Hemorrhoid Pads Tums Antacid Chewables Tylenol Acetaminophen Tylenol Multi-Symptom Cold Formula Tylenol Arthritis Arthritis Pain Reliever Tylenol Extra Acetaminophen Strength Tylenol PM Pain Reliever

PM - Extra Strength Vicks Humidifier

Ultra-Sonic Cool Mist Vicks Personal Steam Inhaler

12 Vicks NyQuil All-Nite ColdFlu 22 Visine Artificial Tears Drops 14 Visine Redness Relief Eye Drops

18 22 13

Vitafusion Vitafusion Vitafusion Vitafusion

Biotin Gummy Calcium + Vitamin D Gummy Vitamin B-Complex Gummy Vitamin C Gummy

21 15

Vitafusion

Vitamin A

Vitafusion Fiber WeightManagement Vitamin A

16

23

Vitamin B-Complex Vitamin B-1

Vitamin B-Complex

Vitamin B-1

23 Vitamin B-6 Vitamin B-6 Vitamin B-12 Vitamin B-12

23 Vitamin C Vitamin C

23

22 22

Vitamin D Vitamin E Soft Gels Zantac Zantac

Vitamin D Vitamin E Soft Gels

Ranitidine Acid Reducer Simethicone

22 18 Zyrtec

Anti-Gas Chewables All-Day Allergy Tablets (Cetrizine HCL)

15 19 19 13 21 12 21 21

22

18

13

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

11

11

25

11

11

11

11

11

11

11

11

13

13

9

12

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 5: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

20

20

20

BRAND EQUIVALENT INDEX Please use the index below for ease in locating available OTC items

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

21st Century Glucosamine Chondroitin 3M Tape Tape Paper Surgical

- 1 in x 10 yd 3M Tape Tape Paper Surgical

- 2 in x 10 yd 3M Tape Tape Silk Surgical

- 1 in x 10 yd 3M Tape Tape Silk Surgical

- 2 in x 10 yd 3M Tape Tape Transparent

Surgical - 1 in x 10 yd 3M Tape Tape Transparent

Surgical - 2 in x 10 yd AampD A amp D Ointment Abreva Abreva Ace Ankle Support Ace Elastic Bandage - 2 in x 45 yd Ace Elastic Bandage - 3 in x 5 yd Ace Elastic Bandage - 4 in x 5 yd Ace Elastic Bandage - 6 in x 5 yd Advil Ibuprofen Afrin Nasal Decongestant

Spray - 12 Hour After Bite Relief After Bite Relief Aleve Naproxen AmLactin Ammonium Lactate Alka-Seltzer Effervescent Pain Reliever Anbesol Oral Pain Relief Antiseptic Towelettes

Antiseptic Towelettes

Arthritis Gloves Arthritis Gloves Small Arthritis Gloves Arthritis Gloves Medium Arthritis Gloves Arthritis Gloves Large Aspercreme Lidocaine Patch Attends Bladder Control Shaped

Pad Moderate Absorbency

10 Attends Bladder Control Shaped Pad18 Heavy Absorbency

Attends Bladder Control Shaped Pad 19 Maximum Absorbency

Attends Disposable Underwear 19 Medium

Attends Disposable Underwear 19 Large

Attends Disposable Underwear 19 X-Large

Attends Underpad Disposable 19 - 23rdquo x 24rdquo

Attends Underpad Disposable 19 - 23rdquo x 36rdquo

Attends Underpad Disposable15 - 30rdquo x 30rdquo 23 Bacitracin Bacitracin Ointment 17 Band-Aid Adhesive Bandages

17 Bath Mat Bath Mat Non-Skid Non-Skid

17 Bausch amp Lomb Eye Wash Solution 18 Bayer Aspirin 21 Bayer Aspirin Low Dose 12 Chewables

Benadryl Diphenhist (Antihistamine) 17 Benadryl Diphenhydramine HCL 22 (Antihistamine)

Benadryl Diphenhydramine HCL Zinc 22 Acetate Anti-itch Cream 13 Bengay Pain Relieving Muscle Rub 15 Benrsquos Insect Repellant Spray (Deet) 17 Biofreeze Fast Freeze Pain Relief Spray

23 Bonine Meclizine HCL Antiemetic

23 Braun Thermometer Digital Ear

23 Breathe Right Nasal Strips Small Medium

22 Breathe Right Nasal Strips Medium Large

20 Caltrate Calcium + Vitamin D Caltrate-D Calcium Carbonate Tablets

17

17

17

16

21

21

12

12

22

5

20

20

20

20

20

14

18 18 21 19 22 22 10 10

24

24

18 19

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Capzasin Capsaicin Carex Bath Tub Safety Rail Carex Cushion Foam Ring Carex Cushion Lumbar Carpal Tunnel Carpal Tunnel Brace Small Brace Carpal Tunnel Carpal Tunnel Brace Medium Brace Carpal Tunnel Carpal Tunnel Brace Large Brace Centrum Daily Multiple Vitamin

Tablets with Minerals Centrum SIlver Senior Multivitamin Cepacol Sore Throat Lozenges Cepacol Sore Throat Lozenges Cherry Chlor-Trimeton Chlorpheniramine Maleate

(Antihistamine) Chloraseptic Sore Throat Spray Cherry CholesTrak Home Access

Cholesterol Test Citrucel Methylcellulose Fiber Therapy Claritin Loratadine (Generic Claritin) Clean and Clear Acne Gel 10

Benzoyl Peroxide Colace Docusate Sodium

Stool Softener Colgate Rechargeable Toothbrush Colgate Toothbrush Colgate

Adult Soft Commit Nicotine Lozenges Compound W Wart Remover (liquid) Conair Water Jet Conair Water Jet Replacement Tips Coppertone Sunscreen Lotion SPF 30 Coricidin HBP Cough amp Cold for High

Blood Pressure Cortaid Hydrocortisone 1 Cream Cotton Balls Cotton Balls Curad Alcohol Pads

21 Curad Rib Belt - Female 17 (one size fits most)

17 17

Curad

Curad

Rib Belt - Male (one size fits most) First Aid Kit

23 DHEA DHEA

23 Depends Attends Discreet Menrsquos Guard Depends Attends Discreet Menrsquos Shield

23 Depends Attends Discreet Womenrsquos Maximum

10 Bladder Control Pad

11 Depends Attends Discreet

Womenrsquos Moderate 13 13

Depends Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

12 Depends Attends Discreet Womenrsquos Ultimate Bladder Control Pad

13 11

Depends Attends Discreet Womenrsquos Ultrathin Pad

Dr Scholls Callus Remover Pads 14 Dr Scholls Corn Remover Pads 12 Dr Scholls Diabetic Sock Black Medium 22 Dr Scholls Diabetic Sock Black Large

14 Dr Scholls Dr Scholls

Diabetic Sock White Medium Diabetic Sock White Large

15 Dramamine Dramamine Chewables 15

Dramamine Orange Driminate Antiemetic

23 Drive Medical Adjustable Transfer Bench 25 Drive Medical Cushion Gel Foam Seat 16 Drive Medical Quad Cane Small Base 16 Drive Medical Quad Cane Large Base 25 12

Dulcolax

Ecotrin

Bisacodyl Enteric Coated Laxative Aspirin Enteric Coated

14 Ecotrin Aspirin Low Dose 17 Efferdent Denture Cleaning Tablets 17 Essential Bath Bench with Back

20

20

20

19

19

16

16

16

16

21

21

17

17

6

20

20

20

20

18 18 14

21 21 15 17

25 19 25

13

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Essential Bath Bench without Back Excedrin Migraine Relief Feosol Ferrous Gluconate

(Iron Supplement) Feosol Ferrous Sulfate Fibercon Polycarbophil Fiber Tablets First Aid Only First Aid Kit 75 pieces Fixodent Fixodent Fleet Glycerin Suppository Fleet Hemorrhoidal Suppository Fruit of the Earth Aloe Vera Cream Futuro Back Support Elastic Futuro Back Support Elastic

with Lumbar Futuro Compression Knee High

Socks Womenrsquos Black Small Futuro Compression Knee

High Socks Womenrsquos Black Medium

Futuro Compression Knee High Socks Womenrsquos Black Large

Futuro Compression Knee High Socks Womenrsquos Nude Small

Futuro Compression Knee High Socks Womenrsquos Nude Medium

Futuro Compression Knee High Socks Womenrsquos Nude Large

Futuro Elbow Support Futuro Knee Support Elastic Small Futuro Knee Suppor t Elastic

Small with Stays Futuro Knee Suppor t

Elastic Medium Futuro Knee Suppor t Elastic

Medium with Stays Futuro Knee Support Elastic Large Futuro Knee Suppor t Elastic

Large with Stays Futuro Night Wrist Support

Smart Glove Futuro Wrist Splint

17 Futuro Wrist Support 22 Gold Bond Medicated Foot Powder 10 Gold Bond Moisturizing Body

Lotion with Aloe 10 14 18

Gyne-Lotrimin Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

15 HALLS Cough Drops Cherry 14 HealthSmart Finger Pulse Oximeter 19 Herpecin-L Herpecin-L Lip Balm 25 23 23

Hip Protector Hip Protector Hip Protector

Hip Protector Small Hip Protector Medium Hip Protector Large

23 Hip Protectorw Hip Protector X-Large

23 Hydrogen Peroxide Hydrogen Peroxide Hylandrsquos Ear Pain Relief Ear Drops

23 Hylandrsquos Leg Cramps Pain

Relief Caplets

23 Imodium A-D Loperamide HCL

Anti-Diarrheal

24 Isopropyl Isopropyl Alcohol

Wintergreen Lactaid Lactase Capsules 14

24 Lamisil AT Terbinafine HCL Antifungal Cream

15

24 24 24

24

24

Lantiseptic Lotrimin AF

Lotrimin AF

Ludens

Maalox

Barrier Cream Clotrimazole Antifungal Athletersquos Foot Cream Medicated Antifungal Foot Powder Spray Cough Drops Sugar Free Cherry Antacid Anti-Gas Liquid

20 14

15

12

13

24 Metamucil Natural Vegetable Laxative 24 Micatin Miconazole Nitrate 2

Antifungal Cream 24 Monistat 1 Tioconazole 1-Day Treatment

Vaginal Cream (with applicator) 25 Monistat 3 Micanozole 3-Day Treatment

12

11

15

24

24

24

24

18

16

10

7

14

18

14 15

13

13

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Murine Murine

Mucinex DM

NasalCrom

Ear Wax Removal Drops Ear Wax Removal System with Rubber Bulb Mucus Relief DM Expectorantamp Cough Suppressant Cromolyn Sodium(Allergy Nasal Spray)

16 16

12

12

Omron

One A Day

One A Day

Orajel

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo) One DailyMenrsquos Multivitamin One Daily Womenrsquos Multivitamin Orajel Pain Relief

11

11

11

15 Nature Made Nature Made Nature Made

Magnesium Oxide Niacin Stress Formula

10 11 11

Oral B Oral-B

Rechargeable Toothbrush Interdental Flossups 15

Tablets with Zinc Pepcid Famotidine Acid Reducer 13 Naturersquos Bounty Coenzyme Q-1 10 Pepsodent Toothpaste - Pepsodent 16 Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty

Folic Acid Iron Magnesium Melatonin

10 10 10 10

Pepto-Bismol Pepto-Bismol Phillipsrsquo

Bismatrol Chewable Tablets Pink Bismuth Milk of Magnesia

14 14 14

Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Neosporin Neosporin

Vitamin B-6 Vitamin D Fish Oil Tablets Neosporin Plus Triple Antibiotic Ointment

11 11 10 18 19

Povidone

Preparation H Prevail Prevail

Povidone Iodine Solution Antiseptic Hemorrhoidal Ointment Adult Briefs Medium Adult Briefs Large

18

19 19 20

Nexcare

Nexcare

Nicoderm

HotCold Pack1 small amp 1 large Thermometer Digital 60 seconds Nicotine Patch Step 1

18

19

23

Prevail Prilosec OTC ProCheck

Purell

Adult Briefs X-Large Omeprazole Acid Reducer Thermometer Flexible Tip Digital 10 seconds Hand Sanitizer

20 13 19

22 Nicoderm Nicoderm Nicorette Nix

Nicotine Patch Step 2 Nicotine Patch Step 3 Nicorelief Gum Permethrin Lice Treatment

23 23 23 22

Q-Tips Quick-Lock Reach

Cotton Tipped Swabs Raised Toilet Seat Reach Waxed Dental Floss Mint

16 18 15

Nova

Ocean Omron

Omron

Folding CaneErgonomic Handle Nasal Spray Saline Desktop Automatic Blood Pressure Monitor Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

18

13 11

11

Refresh PM Releev Renu MultipurposeSolution Reveal

Rid

Artificial Tears Ointment Releev Cold Sore Treatment Multi-Purpose Contact Lens Solution EZ Detect Colon Cancer Test Kit Lice Treatment Shampoo

16 15 16

11

22 Omron

Omron

Desktop Blood Pressure Monitor Replacement Cuff Wrist Blood Pressure Monitor

11

11

Robitussin Robitussin

Cough Syrup Expectorant Guaifenesin Cough Expectorant

12 12

8

12 16 16 10 10

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Robitussin Diabetic Tussin DM Salonpas Pain Relief Patches Senokot- S Senna Plus Stool

Softener Plus Laxative Shower Mat Shower Mat Non-Skid Sominex Sleep Tablets Sudafed PE Sudogest PE

(Nasal amp Sinus Decongestant) Sunbeam Heating Pad 12 in x 15 in Super Poligrip Polident Denture Cream Tek Pro Toothbrush Tek Pro

Straight Soft Therafirm Compression Knee High

Socks Menrsquos Black Medium Therafirm Compression Knee High

Socks Menrsquos Black Large Therafirm Compression Knee High

Socks Menrsquos White Medium Therafirm Compression Knee High

Socks Menrsquos White Large Thermacare Thermacare Knee amp Elbow Thermacare Thermacare Lower

Back amp Hip Thermacare Thermacare Menstrual Relief Thermometer Thermometer

Talking Ear and Forehead Tinactin Tolnaftate Antifungal Cream Toilet Safety Rails Toilet Safety Rails Tucks Pre-moist Hemorrhoid Pads Tums Antacid Chewables Tylenol Acetaminophen Tylenol Multi-Symptom Cold Formula Tylenol Arthritis Arthritis Pain Reliever Tylenol Extra Acetaminophen Strength Tylenol PM Pain Reliever

PM - Extra Strength Vicks Humidifier

Ultra-Sonic Cool Mist Vicks Personal Steam Inhaler

12 Vicks NyQuil All-Nite ColdFlu 22 Visine Artificial Tears Drops 14 Visine Redness Relief Eye Drops

18 22 13

Vitafusion Vitafusion Vitafusion Vitafusion

Biotin Gummy Calcium + Vitamin D Gummy Vitamin B-Complex Gummy Vitamin C Gummy

21 15

Vitafusion

Vitamin A

Vitafusion Fiber WeightManagement Vitamin A

16

23

Vitamin B-Complex Vitamin B-1

Vitamin B-Complex

Vitamin B-1

23 Vitamin B-6 Vitamin B-6 Vitamin B-12 Vitamin B-12

23 Vitamin C Vitamin C

23

22 22

Vitamin D Vitamin E Soft Gels Zantac Zantac

Vitamin D Vitamin E Soft Gels

Ranitidine Acid Reducer Simethicone

22 18 Zyrtec

Anti-Gas Chewables All-Day Allergy Tablets (Cetrizine HCL)

15 19 19 13 21 12 21 21

22

18

13

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

11

11

25

11

11

11

11

11

11

11

11

13

13

9

12

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 6: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

24

24

18 19

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Capzasin Capsaicin Carex Bath Tub Safety Rail Carex Cushion Foam Ring Carex Cushion Lumbar Carpal Tunnel Carpal Tunnel Brace Small Brace Carpal Tunnel Carpal Tunnel Brace Medium Brace Carpal Tunnel Carpal Tunnel Brace Large Brace Centrum Daily Multiple Vitamin

Tablets with Minerals Centrum SIlver Senior Multivitamin Cepacol Sore Throat Lozenges Cepacol Sore Throat Lozenges Cherry Chlor-Trimeton Chlorpheniramine Maleate

(Antihistamine) Chloraseptic Sore Throat Spray Cherry CholesTrak Home Access

Cholesterol Test Citrucel Methylcellulose Fiber Therapy Claritin Loratadine (Generic Claritin) Clean and Clear Acne Gel 10

Benzoyl Peroxide Colace Docusate Sodium

Stool Softener Colgate Rechargeable Toothbrush Colgate Toothbrush Colgate

Adult Soft Commit Nicotine Lozenges Compound W Wart Remover (liquid) Conair Water Jet Conair Water Jet Replacement Tips Coppertone Sunscreen Lotion SPF 30 Coricidin HBP Cough amp Cold for High

Blood Pressure Cortaid Hydrocortisone 1 Cream Cotton Balls Cotton Balls Curad Alcohol Pads

21 Curad Rib Belt - Female 17 (one size fits most)

17 17

Curad

Curad

Rib Belt - Male (one size fits most) First Aid Kit

23 DHEA DHEA

23 Depends Attends Discreet Menrsquos Guard Depends Attends Discreet Menrsquos Shield

23 Depends Attends Discreet Womenrsquos Maximum

10 Bladder Control Pad

11 Depends Attends Discreet

Womenrsquos Moderate 13 13

Depends Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

12 Depends Attends Discreet Womenrsquos Ultimate Bladder Control Pad

13 11

Depends Attends Discreet Womenrsquos Ultrathin Pad

Dr Scholls Callus Remover Pads 14 Dr Scholls Corn Remover Pads 12 Dr Scholls Diabetic Sock Black Medium 22 Dr Scholls Diabetic Sock Black Large

14 Dr Scholls Dr Scholls

Diabetic Sock White Medium Diabetic Sock White Large

15 Dramamine Dramamine Chewables 15

Dramamine Orange Driminate Antiemetic

23 Drive Medical Adjustable Transfer Bench 25 Drive Medical Cushion Gel Foam Seat 16 Drive Medical Quad Cane Small Base 16 Drive Medical Quad Cane Large Base 25 12

Dulcolax

Ecotrin

Bisacodyl Enteric Coated Laxative Aspirin Enteric Coated

14 Ecotrin Aspirin Low Dose 17 Efferdent Denture Cleaning Tablets 17 Essential Bath Bench with Back

20

20

20

19

19

16

16

16

16

21

21

17

17

6

20

20

20

20

18 18 14

21 21 15 17

25 19 25

13

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Essential Bath Bench without Back Excedrin Migraine Relief Feosol Ferrous Gluconate

(Iron Supplement) Feosol Ferrous Sulfate Fibercon Polycarbophil Fiber Tablets First Aid Only First Aid Kit 75 pieces Fixodent Fixodent Fleet Glycerin Suppository Fleet Hemorrhoidal Suppository Fruit of the Earth Aloe Vera Cream Futuro Back Support Elastic Futuro Back Support Elastic

with Lumbar Futuro Compression Knee High

Socks Womenrsquos Black Small Futuro Compression Knee

High Socks Womenrsquos Black Medium

Futuro Compression Knee High Socks Womenrsquos Black Large

Futuro Compression Knee High Socks Womenrsquos Nude Small

Futuro Compression Knee High Socks Womenrsquos Nude Medium

Futuro Compression Knee High Socks Womenrsquos Nude Large

Futuro Elbow Support Futuro Knee Support Elastic Small Futuro Knee Suppor t Elastic

Small with Stays Futuro Knee Suppor t

Elastic Medium Futuro Knee Suppor t Elastic

Medium with Stays Futuro Knee Support Elastic Large Futuro Knee Suppor t Elastic

Large with Stays Futuro Night Wrist Support

Smart Glove Futuro Wrist Splint

17 Futuro Wrist Support 22 Gold Bond Medicated Foot Powder 10 Gold Bond Moisturizing Body

Lotion with Aloe 10 14 18

Gyne-Lotrimin Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

15 HALLS Cough Drops Cherry 14 HealthSmart Finger Pulse Oximeter 19 Herpecin-L Herpecin-L Lip Balm 25 23 23

Hip Protector Hip Protector Hip Protector

Hip Protector Small Hip Protector Medium Hip Protector Large

23 Hip Protectorw Hip Protector X-Large

23 Hydrogen Peroxide Hydrogen Peroxide Hylandrsquos Ear Pain Relief Ear Drops

23 Hylandrsquos Leg Cramps Pain

Relief Caplets

23 Imodium A-D Loperamide HCL

Anti-Diarrheal

24 Isopropyl Isopropyl Alcohol

Wintergreen Lactaid Lactase Capsules 14

24 Lamisil AT Terbinafine HCL Antifungal Cream

15

24 24 24

24

24

Lantiseptic Lotrimin AF

Lotrimin AF

Ludens

Maalox

Barrier Cream Clotrimazole Antifungal Athletersquos Foot Cream Medicated Antifungal Foot Powder Spray Cough Drops Sugar Free Cherry Antacid Anti-Gas Liquid

20 14

15

12

13

24 Metamucil Natural Vegetable Laxative 24 Micatin Miconazole Nitrate 2

Antifungal Cream 24 Monistat 1 Tioconazole 1-Day Treatment

Vaginal Cream (with applicator) 25 Monistat 3 Micanozole 3-Day Treatment

12

11

15

24

24

24

24

18

16

10

7

14

18

14 15

13

13

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Murine Murine

Mucinex DM

NasalCrom

Ear Wax Removal Drops Ear Wax Removal System with Rubber Bulb Mucus Relief DM Expectorantamp Cough Suppressant Cromolyn Sodium(Allergy Nasal Spray)

16 16

12

12

Omron

One A Day

One A Day

Orajel

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo) One DailyMenrsquos Multivitamin One Daily Womenrsquos Multivitamin Orajel Pain Relief

11

11

11

15 Nature Made Nature Made Nature Made

Magnesium Oxide Niacin Stress Formula

10 11 11

Oral B Oral-B

Rechargeable Toothbrush Interdental Flossups 15

Tablets with Zinc Pepcid Famotidine Acid Reducer 13 Naturersquos Bounty Coenzyme Q-1 10 Pepsodent Toothpaste - Pepsodent 16 Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty

Folic Acid Iron Magnesium Melatonin

10 10 10 10

Pepto-Bismol Pepto-Bismol Phillipsrsquo

Bismatrol Chewable Tablets Pink Bismuth Milk of Magnesia

14 14 14

Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Neosporin Neosporin

Vitamin B-6 Vitamin D Fish Oil Tablets Neosporin Plus Triple Antibiotic Ointment

11 11 10 18 19

Povidone

Preparation H Prevail Prevail

Povidone Iodine Solution Antiseptic Hemorrhoidal Ointment Adult Briefs Medium Adult Briefs Large

18

19 19 20

Nexcare

Nexcare

Nicoderm

HotCold Pack1 small amp 1 large Thermometer Digital 60 seconds Nicotine Patch Step 1

18

19

23

Prevail Prilosec OTC ProCheck

Purell

Adult Briefs X-Large Omeprazole Acid Reducer Thermometer Flexible Tip Digital 10 seconds Hand Sanitizer

20 13 19

22 Nicoderm Nicoderm Nicorette Nix

Nicotine Patch Step 2 Nicotine Patch Step 3 Nicorelief Gum Permethrin Lice Treatment

23 23 23 22

Q-Tips Quick-Lock Reach

Cotton Tipped Swabs Raised Toilet Seat Reach Waxed Dental Floss Mint

16 18 15

Nova

Ocean Omron

Omron

Folding CaneErgonomic Handle Nasal Spray Saline Desktop Automatic Blood Pressure Monitor Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

18

13 11

11

Refresh PM Releev Renu MultipurposeSolution Reveal

Rid

Artificial Tears Ointment Releev Cold Sore Treatment Multi-Purpose Contact Lens Solution EZ Detect Colon Cancer Test Kit Lice Treatment Shampoo

16 15 16

11

22 Omron

Omron

Desktop Blood Pressure Monitor Replacement Cuff Wrist Blood Pressure Monitor

11

11

Robitussin Robitussin

Cough Syrup Expectorant Guaifenesin Cough Expectorant

12 12

8

12 16 16 10 10

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Robitussin Diabetic Tussin DM Salonpas Pain Relief Patches Senokot- S Senna Plus Stool

Softener Plus Laxative Shower Mat Shower Mat Non-Skid Sominex Sleep Tablets Sudafed PE Sudogest PE

(Nasal amp Sinus Decongestant) Sunbeam Heating Pad 12 in x 15 in Super Poligrip Polident Denture Cream Tek Pro Toothbrush Tek Pro

Straight Soft Therafirm Compression Knee High

Socks Menrsquos Black Medium Therafirm Compression Knee High

Socks Menrsquos Black Large Therafirm Compression Knee High

Socks Menrsquos White Medium Therafirm Compression Knee High

Socks Menrsquos White Large Thermacare Thermacare Knee amp Elbow Thermacare Thermacare Lower

Back amp Hip Thermacare Thermacare Menstrual Relief Thermometer Thermometer

Talking Ear and Forehead Tinactin Tolnaftate Antifungal Cream Toilet Safety Rails Toilet Safety Rails Tucks Pre-moist Hemorrhoid Pads Tums Antacid Chewables Tylenol Acetaminophen Tylenol Multi-Symptom Cold Formula Tylenol Arthritis Arthritis Pain Reliever Tylenol Extra Acetaminophen Strength Tylenol PM Pain Reliever

PM - Extra Strength Vicks Humidifier

Ultra-Sonic Cool Mist Vicks Personal Steam Inhaler

12 Vicks NyQuil All-Nite ColdFlu 22 Visine Artificial Tears Drops 14 Visine Redness Relief Eye Drops

18 22 13

Vitafusion Vitafusion Vitafusion Vitafusion

Biotin Gummy Calcium + Vitamin D Gummy Vitamin B-Complex Gummy Vitamin C Gummy

21 15

Vitafusion

Vitamin A

Vitafusion Fiber WeightManagement Vitamin A

16

23

Vitamin B-Complex Vitamin B-1

Vitamin B-Complex

Vitamin B-1

23 Vitamin B-6 Vitamin B-6 Vitamin B-12 Vitamin B-12

23 Vitamin C Vitamin C

23

22 22

Vitamin D Vitamin E Soft Gels Zantac Zantac

Vitamin D Vitamin E Soft Gels

Ranitidine Acid Reducer Simethicone

22 18 Zyrtec

Anti-Gas Chewables All-Day Allergy Tablets (Cetrizine HCL)

15 19 19 13 21 12 21 21

22

18

13

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

11

11

25

11

11

11

11

11

11

11

11

13

13

9

12

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 7: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

25 19 25

13

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Essential Bath Bench without Back Excedrin Migraine Relief Feosol Ferrous Gluconate

(Iron Supplement) Feosol Ferrous Sulfate Fibercon Polycarbophil Fiber Tablets First Aid Only First Aid Kit 75 pieces Fixodent Fixodent Fleet Glycerin Suppository Fleet Hemorrhoidal Suppository Fruit of the Earth Aloe Vera Cream Futuro Back Support Elastic Futuro Back Support Elastic

with Lumbar Futuro Compression Knee High

Socks Womenrsquos Black Small Futuro Compression Knee

High Socks Womenrsquos Black Medium

Futuro Compression Knee High Socks Womenrsquos Black Large

Futuro Compression Knee High Socks Womenrsquos Nude Small

Futuro Compression Knee High Socks Womenrsquos Nude Medium

Futuro Compression Knee High Socks Womenrsquos Nude Large

Futuro Elbow Support Futuro Knee Support Elastic Small Futuro Knee Suppor t Elastic

Small with Stays Futuro Knee Suppor t

Elastic Medium Futuro Knee Suppor t Elastic

Medium with Stays Futuro Knee Support Elastic Large Futuro Knee Suppor t Elastic

Large with Stays Futuro Night Wrist Support

Smart Glove Futuro Wrist Splint

17 Futuro Wrist Support 22 Gold Bond Medicated Foot Powder 10 Gold Bond Moisturizing Body

Lotion with Aloe 10 14 18

Gyne-Lotrimin Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

15 HALLS Cough Drops Cherry 14 HealthSmart Finger Pulse Oximeter 19 Herpecin-L Herpecin-L Lip Balm 25 23 23

Hip Protector Hip Protector Hip Protector

Hip Protector Small Hip Protector Medium Hip Protector Large

23 Hip Protectorw Hip Protector X-Large

23 Hydrogen Peroxide Hydrogen Peroxide Hylandrsquos Ear Pain Relief Ear Drops

23 Hylandrsquos Leg Cramps Pain

Relief Caplets

23 Imodium A-D Loperamide HCL

Anti-Diarrheal

24 Isopropyl Isopropyl Alcohol

Wintergreen Lactaid Lactase Capsules 14

24 Lamisil AT Terbinafine HCL Antifungal Cream

15

24 24 24

24

24

Lantiseptic Lotrimin AF

Lotrimin AF

Ludens

Maalox

Barrier Cream Clotrimazole Antifungal Athletersquos Foot Cream Medicated Antifungal Foot Powder Spray Cough Drops Sugar Free Cherry Antacid Anti-Gas Liquid

20 14

15

12

13

24 Metamucil Natural Vegetable Laxative 24 Micatin Miconazole Nitrate 2

Antifungal Cream 24 Monistat 1 Tioconazole 1-Day Treatment

Vaginal Cream (with applicator) 25 Monistat 3 Micanozole 3-Day Treatment

12

11

15

24

24

24

24

18

16

10

7

14

18

14 15

13

13

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Murine Murine

Mucinex DM

NasalCrom

Ear Wax Removal Drops Ear Wax Removal System with Rubber Bulb Mucus Relief DM Expectorantamp Cough Suppressant Cromolyn Sodium(Allergy Nasal Spray)

16 16

12

12

Omron

One A Day

One A Day

Orajel

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo) One DailyMenrsquos Multivitamin One Daily Womenrsquos Multivitamin Orajel Pain Relief

11

11

11

15 Nature Made Nature Made Nature Made

Magnesium Oxide Niacin Stress Formula

10 11 11

Oral B Oral-B

Rechargeable Toothbrush Interdental Flossups 15

Tablets with Zinc Pepcid Famotidine Acid Reducer 13 Naturersquos Bounty Coenzyme Q-1 10 Pepsodent Toothpaste - Pepsodent 16 Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty

Folic Acid Iron Magnesium Melatonin

10 10 10 10

Pepto-Bismol Pepto-Bismol Phillipsrsquo

Bismatrol Chewable Tablets Pink Bismuth Milk of Magnesia

14 14 14

Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Neosporin Neosporin

Vitamin B-6 Vitamin D Fish Oil Tablets Neosporin Plus Triple Antibiotic Ointment

11 11 10 18 19

Povidone

Preparation H Prevail Prevail

Povidone Iodine Solution Antiseptic Hemorrhoidal Ointment Adult Briefs Medium Adult Briefs Large

18

19 19 20

Nexcare

Nexcare

Nicoderm

HotCold Pack1 small amp 1 large Thermometer Digital 60 seconds Nicotine Patch Step 1

18

19

23

Prevail Prilosec OTC ProCheck

Purell

Adult Briefs X-Large Omeprazole Acid Reducer Thermometer Flexible Tip Digital 10 seconds Hand Sanitizer

20 13 19

22 Nicoderm Nicoderm Nicorette Nix

Nicotine Patch Step 2 Nicotine Patch Step 3 Nicorelief Gum Permethrin Lice Treatment

23 23 23 22

Q-Tips Quick-Lock Reach

Cotton Tipped Swabs Raised Toilet Seat Reach Waxed Dental Floss Mint

16 18 15

Nova

Ocean Omron

Omron

Folding CaneErgonomic Handle Nasal Spray Saline Desktop Automatic Blood Pressure Monitor Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

18

13 11

11

Refresh PM Releev Renu MultipurposeSolution Reveal

Rid

Artificial Tears Ointment Releev Cold Sore Treatment Multi-Purpose Contact Lens Solution EZ Detect Colon Cancer Test Kit Lice Treatment Shampoo

16 15 16

11

22 Omron

Omron

Desktop Blood Pressure Monitor Replacement Cuff Wrist Blood Pressure Monitor

11

11

Robitussin Robitussin

Cough Syrup Expectorant Guaifenesin Cough Expectorant

12 12

8

12 16 16 10 10

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Robitussin Diabetic Tussin DM Salonpas Pain Relief Patches Senokot- S Senna Plus Stool

Softener Plus Laxative Shower Mat Shower Mat Non-Skid Sominex Sleep Tablets Sudafed PE Sudogest PE

(Nasal amp Sinus Decongestant) Sunbeam Heating Pad 12 in x 15 in Super Poligrip Polident Denture Cream Tek Pro Toothbrush Tek Pro

Straight Soft Therafirm Compression Knee High

Socks Menrsquos Black Medium Therafirm Compression Knee High

Socks Menrsquos Black Large Therafirm Compression Knee High

Socks Menrsquos White Medium Therafirm Compression Knee High

Socks Menrsquos White Large Thermacare Thermacare Knee amp Elbow Thermacare Thermacare Lower

Back amp Hip Thermacare Thermacare Menstrual Relief Thermometer Thermometer

Talking Ear and Forehead Tinactin Tolnaftate Antifungal Cream Toilet Safety Rails Toilet Safety Rails Tucks Pre-moist Hemorrhoid Pads Tums Antacid Chewables Tylenol Acetaminophen Tylenol Multi-Symptom Cold Formula Tylenol Arthritis Arthritis Pain Reliever Tylenol Extra Acetaminophen Strength Tylenol PM Pain Reliever

PM - Extra Strength Vicks Humidifier

Ultra-Sonic Cool Mist Vicks Personal Steam Inhaler

12 Vicks NyQuil All-Nite ColdFlu 22 Visine Artificial Tears Drops 14 Visine Redness Relief Eye Drops

18 22 13

Vitafusion Vitafusion Vitafusion Vitafusion

Biotin Gummy Calcium + Vitamin D Gummy Vitamin B-Complex Gummy Vitamin C Gummy

21 15

Vitafusion

Vitamin A

Vitafusion Fiber WeightManagement Vitamin A

16

23

Vitamin B-Complex Vitamin B-1

Vitamin B-Complex

Vitamin B-1

23 Vitamin B-6 Vitamin B-6 Vitamin B-12 Vitamin B-12

23 Vitamin C Vitamin C

23

22 22

Vitamin D Vitamin E Soft Gels Zantac Zantac

Vitamin D Vitamin E Soft Gels

Ranitidine Acid Reducer Simethicone

22 18 Zyrtec

Anti-Gas Chewables All-Day Allergy Tablets (Cetrizine HCL)

15 19 19 13 21 12 21 21

22

18

13

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

11

11

25

11

11

11

11

11

11

11

11

13

13

9

12

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 8: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

BRAND EQUIVALENT INDEX

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Murine Murine

Mucinex DM

NasalCrom

Ear Wax Removal Drops Ear Wax Removal System with Rubber Bulb Mucus Relief DM Expectorantamp Cough Suppressant Cromolyn Sodium(Allergy Nasal Spray)

16 16

12

12

Omron

One A Day

One A Day

Orajel

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo) One DailyMenrsquos Multivitamin One Daily Womenrsquos Multivitamin Orajel Pain Relief

11

11

11

15 Nature Made Nature Made Nature Made

Magnesium Oxide Niacin Stress Formula

10 11 11

Oral B Oral-B

Rechargeable Toothbrush Interdental Flossups 15

Tablets with Zinc Pepcid Famotidine Acid Reducer 13 Naturersquos Bounty Coenzyme Q-1 10 Pepsodent Toothpaste - Pepsodent 16 Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty

Folic Acid Iron Magnesium Melatonin

10 10 10 10

Pepto-Bismol Pepto-Bismol Phillipsrsquo

Bismatrol Chewable Tablets Pink Bismuth Milk of Magnesia

14 14 14

Naturersquos Bounty Naturersquos Bounty Naturersquos Bounty Neosporin Neosporin

Vitamin B-6 Vitamin D Fish Oil Tablets Neosporin Plus Triple Antibiotic Ointment

11 11 10 18 19

Povidone

Preparation H Prevail Prevail

Povidone Iodine Solution Antiseptic Hemorrhoidal Ointment Adult Briefs Medium Adult Briefs Large

18

19 19 20

Nexcare

Nexcare

Nicoderm

HotCold Pack1 small amp 1 large Thermometer Digital 60 seconds Nicotine Patch Step 1

18

19

23

Prevail Prilosec OTC ProCheck

Purell

Adult Briefs X-Large Omeprazole Acid Reducer Thermometer Flexible Tip Digital 10 seconds Hand Sanitizer

20 13 19

22 Nicoderm Nicoderm Nicorette Nix

Nicotine Patch Step 2 Nicotine Patch Step 3 Nicorelief Gum Permethrin Lice Treatment

23 23 23 22

Q-Tips Quick-Lock Reach

Cotton Tipped Swabs Raised Toilet Seat Reach Waxed Dental Floss Mint

16 18 15

Nova

Ocean Omron

Omron

Folding CaneErgonomic Handle Nasal Spray Saline Desktop Automatic Blood Pressure Monitor Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

18

13 11

11

Refresh PM Releev Renu MultipurposeSolution Reveal

Rid

Artificial Tears Ointment Releev Cold Sore Treatment Multi-Purpose Contact Lens Solution EZ Detect Colon Cancer Test Kit Lice Treatment Shampoo

16 15 16

11

22 Omron

Omron

Desktop Blood Pressure Monitor Replacement Cuff Wrist Blood Pressure Monitor

11

11

Robitussin Robitussin

Cough Syrup Expectorant Guaifenesin Cough Expectorant

12 12

8

12 16 16 10 10

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Robitussin Diabetic Tussin DM Salonpas Pain Relief Patches Senokot- S Senna Plus Stool

Softener Plus Laxative Shower Mat Shower Mat Non-Skid Sominex Sleep Tablets Sudafed PE Sudogest PE

(Nasal amp Sinus Decongestant) Sunbeam Heating Pad 12 in x 15 in Super Poligrip Polident Denture Cream Tek Pro Toothbrush Tek Pro

Straight Soft Therafirm Compression Knee High

Socks Menrsquos Black Medium Therafirm Compression Knee High

Socks Menrsquos Black Large Therafirm Compression Knee High

Socks Menrsquos White Medium Therafirm Compression Knee High

Socks Menrsquos White Large Thermacare Thermacare Knee amp Elbow Thermacare Thermacare Lower

Back amp Hip Thermacare Thermacare Menstrual Relief Thermometer Thermometer

Talking Ear and Forehead Tinactin Tolnaftate Antifungal Cream Toilet Safety Rails Toilet Safety Rails Tucks Pre-moist Hemorrhoid Pads Tums Antacid Chewables Tylenol Acetaminophen Tylenol Multi-Symptom Cold Formula Tylenol Arthritis Arthritis Pain Reliever Tylenol Extra Acetaminophen Strength Tylenol PM Pain Reliever

PM - Extra Strength Vicks Humidifier

Ultra-Sonic Cool Mist Vicks Personal Steam Inhaler

12 Vicks NyQuil All-Nite ColdFlu 22 Visine Artificial Tears Drops 14 Visine Redness Relief Eye Drops

18 22 13

Vitafusion Vitafusion Vitafusion Vitafusion

Biotin Gummy Calcium + Vitamin D Gummy Vitamin B-Complex Gummy Vitamin C Gummy

21 15

Vitafusion

Vitamin A

Vitafusion Fiber WeightManagement Vitamin A

16

23

Vitamin B-Complex Vitamin B-1

Vitamin B-Complex

Vitamin B-1

23 Vitamin B-6 Vitamin B-6 Vitamin B-12 Vitamin B-12

23 Vitamin C Vitamin C

23

22 22

Vitamin D Vitamin E Soft Gels Zantac Zantac

Vitamin D Vitamin E Soft Gels

Ranitidine Acid Reducer Simethicone

22 18 Zyrtec

Anti-Gas Chewables All-Day Allergy Tablets (Cetrizine HCL)

15 19 19 13 21 12 21 21

22

18

13

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

11

11

25

11

11

11

11

11

11

11

11

13

13

9

12

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 9: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

12 16 16 10 10

Brand Equivalent Catalog Item Page Brand

Equivalent Catalog Item Page

Robitussin Diabetic Tussin DM Salonpas Pain Relief Patches Senokot- S Senna Plus Stool

Softener Plus Laxative Shower Mat Shower Mat Non-Skid Sominex Sleep Tablets Sudafed PE Sudogest PE

(Nasal amp Sinus Decongestant) Sunbeam Heating Pad 12 in x 15 in Super Poligrip Polident Denture Cream Tek Pro Toothbrush Tek Pro

Straight Soft Therafirm Compression Knee High

Socks Menrsquos Black Medium Therafirm Compression Knee High

Socks Menrsquos Black Large Therafirm Compression Knee High

Socks Menrsquos White Medium Therafirm Compression Knee High

Socks Menrsquos White Large Thermacare Thermacare Knee amp Elbow Thermacare Thermacare Lower

Back amp Hip Thermacare Thermacare Menstrual Relief Thermometer Thermometer

Talking Ear and Forehead Tinactin Tolnaftate Antifungal Cream Toilet Safety Rails Toilet Safety Rails Tucks Pre-moist Hemorrhoid Pads Tums Antacid Chewables Tylenol Acetaminophen Tylenol Multi-Symptom Cold Formula Tylenol Arthritis Arthritis Pain Reliever Tylenol Extra Acetaminophen Strength Tylenol PM Pain Reliever

PM - Extra Strength Vicks Humidifier

Ultra-Sonic Cool Mist Vicks Personal Steam Inhaler

12 Vicks NyQuil All-Nite ColdFlu 22 Visine Artificial Tears Drops 14 Visine Redness Relief Eye Drops

18 22 13

Vitafusion Vitafusion Vitafusion Vitafusion

Biotin Gummy Calcium + Vitamin D Gummy Vitamin B-Complex Gummy Vitamin C Gummy

21 15

Vitafusion

Vitamin A

Vitafusion Fiber WeightManagement Vitamin A

16

23

Vitamin B-Complex Vitamin B-1

Vitamin B-Complex

Vitamin B-1

23 Vitamin B-6 Vitamin B-6 Vitamin B-12 Vitamin B-12

23 Vitamin C Vitamin C

23

22 22

Vitamin D Vitamin E Soft Gels Zantac Zantac

Vitamin D Vitamin E Soft Gels

Ranitidine Acid Reducer Simethicone

22 18 Zyrtec

Anti-Gas Chewables All-Day Allergy Tablets (Cetrizine HCL)

15 19 19 13 21 12 21 21

22

18

13

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

11

11

25

11

11

11

11

11

11

11

11

13

13

9

12

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 10: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

OTC MEDICATIONS AND PRODUCTS Before ordering any of the items below you should talk with your doctor

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Biotin Gummy 1820 Compare to Vitafusion Biotin Gummy Vitamins A registered trademark of Church amp Dwight Co Inc

$1200

Calcium + Vitamin D 1373 Compare to Caltratereg 600 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Calcium + Vitamin D Gummy

1823 Compare to Vitafusion Calcium + Vitamin D Gummy A registered trademark of Church amp Dwight Co Inc

$1400

Calcium Carbonate Tablets

1291 Compare to Caltrate-Dreg 600 + D Calcium Supplement 600 mg tablets 60 per bottle A registered trademark of Pfizer Consumer Healthcare

$500

Coenzyme Q-10 1829 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

Daily Multiple Vitamin Tablets with Minerals

1385 Compare to Centrumreg 100 tablets per bottle A registered trademark of Pfizer Consumer Healthcare

$700

Ferrous Gluconate (Iron Supplement)

1375 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$600

Ferrous Sulfate 1376 Compare to Feosolreg 325 mg tablets 100 per bottle A registered trademark of Meda Consumer Healthcare Inc

$500

Fish Oil Tablets 1741 Compare to Naturersquos Bountyreg 1000 mg tablets 60 per bottleA registered trademark of Naturersquos Bounty Inc

$1100

Folic Acid 1850 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Glucosamine Chondroitin

1003 Compare to 21st Century Glucosamine amp Chondroitin Original Formula 250-200 mg capsules 60 per bottle A registered trademark of 21st Century HealthCare Inc

$1100

Iron 1417 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$900

Leg Cramps Pain Relief Caplets

1869 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1400

Magnesium 1418 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$800

Magnesium Oxide 1377 Compare to Nature Madereg Strength 250mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$700

Melatonin 1879 Compare to Naturersquos BountyA registered trademark of Naturersquos Bounty Inc

$1200

10

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 11: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

Category Product Item Brand EquivalentDescription Cost

Vitamins amp Minerals

Niacin 1378 Compare to Nature Madereg Strength 100mgQuantity 100 tabs A registered trademark of Nature Made Nutritional Products

$500

One Daily Menrsquos Multi-Vitamin

1886 Compare to One A DayA registered trademark of Bayer AG

$1000

One Daily Womenrsquos Multi-Vitamin

1887 Compare to One A DayA registered trademark of Bayer AG

$1000

Senior Multivitamin 1392 Compare to Centrum SilverA registered trademark of Pfizer

$1000

Stress Formula Tablets with Zinc

1734 Compare to Nature Made Stress B Complex with Zinc A registered trademark of Pharmavite

$1400

Vitamin A 1379 Vitamin A 100 tablets per bottle $600 Vitamin B-Complex 1382 Vitamin B Complex 100 tablets per bottle $600 Vitamin B-Complex Gummy

1915 Compare to Vitafusion B-Complex Gummy VitaminsA registered trademark of Church amp Dwight Co Inc

$1200

Vitamin B-1 1016 Vitamin B-1 100 mg tablets 100 per bottle $600 Vitamin B-6 1380 Vitamin B-6 50 mg tablets 100 per bottle $600 Vitamin B-6 1388 Compare to Naturersquos Bounty A registered

trademark of Naturersquos Bounty Inc $800

Vitamin B-12 1381 Vitamin B-12 100 tablets per bottle $1000 Vitamin C 1017 Vitamin C 500 mg 100 tablets per bottle $600 Vitamin C Gummy 1916 Compare to Vitafusion Power C Gummy Vitamins

A registered trademark of Church amp Dwight Co Inc $1200

Vitamin D 1383 Vitamin D 100 tablets per bottle $500 Vitamin D 1390 Compare to Naturersquos Bounty

A registered trademark of Naturersquos Bounty Inc $1000

Vitamin E Soft Gels 1384 Vitamin E 100 tablets per bottle $800 In-Home Diagnostics

Desktop AutomaticBlood Pressure Monitor

1253 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$6000

Desktop Blood PressureMonitor Replacement Cuff

1504 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$1900

Desktop Talking Blood Pressure Monitor (87rdquo to 134rdquo)

1503 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$8000

EZ Detect Colon Cancer Test Kit

1416 Compare to Reveal Colon Disease Testreg A registered trademark of American Screening Corp

$1300

Finger Pulse Oximeter

1505 Compare to HealthSmartregA registered trademark of Briggs Healthcare

$5200

Home Access Cholesterol Test

1251 Compare to CholesTrakreg 1 pieceA registered trademark of AccuTech LLC

$3500

Wrist Blood Pressure Monitor

1501 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$4000

Wrist Talking Blood Pressure Monitor (9rdquo to 146rdquo)

1502 Compare to Omronreg A registered trademark of Omron Healthcare Inc

$5500

11

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 12: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

OTC MEDICATIONS AND PRODUCTS You can order the following items without having to talk with your doctor but we always recommend that you talk with your doctor before starting a new product regime

Category Product Item Brand EquivalentDescription Cost

Allergy All-Day Allergy TabletsCold Flu (Cetrizine HCL) Decongestant amp Sinus All-Nite ColdFlu

1090

1361

Compare to Zyrtecreg $700 10 mg tablets 14 per box A registered trademark of McNeil-PPC Inc Compare to Vicksreg NyQuilreg Cough $600 A registered trademark of Procter amp Gamble

ChlorpheniramineMaleate (Antihistamine)

1008 Compare to Chlor-Trimetonreg Allergy 4 mg tablets 100 per boxA registered trademark of Schering-Plough HealthCare Products Inc

$500

Cough amp Cold for High Blood Pressure

1166 Compare to Coricidin HBPA registered trademark of Bayer AG

$700

Cough Drops Cherry

1056 Compare to HALLSreg Quantity 30 lozenges A registered trademark of Mondelēz International

$600

Cough Drops Sugar Free Cherry

1182 Compare to Ludens Throat Drops Sugar Free Wild CherryA registered trademark of Prestige Brands

$600

Cough Syrup Expectorant

1054 Compare to Robitussinreg 4 oz per bottleA registered trademark of American Home Products Corporation

$500

Cromolyn Sodium(Allergy Nasal Spray)

1356 Compare to NasalCromreg 26 ml per bottleA registered trademark of McNeil-PPC Inc

$1400

Diabetic Tussin DM 1323 Compare to Robitussin DMA registered trademark of Pfizer

$1100

Diphenhist(Antihistamine)

1308 Compare to Benadrylreg 25 mg tablets 100 per box A registered trademark of Pfizer

$600

Diphenhydramine HCL (Antihistamine)

1009 Compare to Benadrylreg 25 mg 24 per packA registered trademark of Pfizer

$500

Guaifenesin Cough Expectorant

1180 Compare to Robitussinreg 200mg tablets 60 per bottle A registered trademark of American Home Products Corporation

$900

Loratadine (Generic Claritin)

1611 Compare to Claritinreg Allergy Relief 24hr 100 per bottle A registered trademark of Bayer

$2000

Mucus Relief DM Expectorant amp Cough Suppressant

1178 Compare to Mucinex DMA registered trademark of Reckitt Benckiser

$1200

Multi-Symptom Cold Formula

1357 Compare to Tylenolreg Cold Multi-Symptom 24 tablets per box A registered trademark of McNeil PPC Inc

$600

Nasal Decongestant Spray - 12 Hour

1091 Compare to Afrinreg 005 30 ml sprayA registered trademark of Schering-Plough HealthCare Products Inc

$500

12

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 13: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

Category Product Item Brand EquivalentDescription Cost

Allergy Cold Flu Decongestant amp Sinus (continued)

Nasal Spray Saline 1052 Compare to Oceanreg Premium Saline Nasal Spray 065 15 oz spray A registered trademark of Fleming Pharmaceuticals

$500

Personal Steam Inhaler 1792 Compare to Vicks Personal Steam InhalerA registered trademark of Procter amp Gamble

$5000

Sore Throat Lozenges 1360 Compare to Cepacolreg Quantity 16 lozengesA registered trademark of Reckitt Benckiser Group

$700

Sore Throat Lozenges Cherry

1176 Compare to CepacolA registered trademark of Reckitt Benckiser

$700

Sore Throat Spray Cherry 1904 Compare to Chloraseptic Sore Throat Spray - Cherry A registered trademark of Prestige Brands

$900

Sudogest PE (Nasal amp Sinus Decongestant)

1352 Compare to Sudafed PEreg 10mg 36 tablets per box A registered trademark of Johnson amp Johnson

$500

Antacids amp Acid Reducers

Antacid Anti-Gas Liquid 1006 Compare to Maaloxreg Regular Strength 12 oz per bottle A registered trademark of William H Rorer Inc

$600

Antacid Chewables 1346 Compare to Tumsreg 500 mg 150 tablets per bottle A registered trademark of SmithKline Beecham

$600

Effervescent Pain Reliever

1314 Compare to Alka-SeltzerA registered trademark of Bayer AG

$800

Famotidine Acid Reducer

1108 Compare to Pepcidreg 10 mg tablets 30 per box A registered trademark of Merck amp Co Inc

$600

Omeprazole Acid Reducer

1110 Compare to Prilosec OTCreg 20 mg tablets 28 per box A registered trademark of AstraZeneca

$2300

Ranitidine Acid Reducer 1900 Compare to ZantacA registered trademark of Sanofi

$800

Simethicone Anti-Gas Chewables

1800 Compare to ZantacA registered trademark of Sanofi

$1000

Anticandidal (yeast)

Clotrimazole 7-DayTreatment Vaginal Cream (with applicator)

1115 Compare to Gyne-Lotriminreg45 gm per tube A registered trademark of Schering-Plough HealthCare Products Inc

$800

Micanozole 3-Day Treatment

1117 Compare to Monistat 3reg 200 mg - 2 1 kitA registered trademark of McNeil-PPC Inc

$1400

Tioconazole 1-Day Treatment Vaginal Cream (with applicator)

1119 Compare to Monistat 1reg 65 1 tubeA registered trademark of McNeil-PPC Inc

$2000

13

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 14: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

OTC MEDICATIONS AND PRODUCTS

14

Category Product Item Brand EquivalentDescription Cost

Anti-diarrheal Laxatives amp Digestive Health

Bisacodyl EntericCoated Laxative

1128 Compare to Dulcolaxreg 5mg tabs 100 tabs per pack A registered trademark of Boehringer Ingelheim International GmbH

$600

Bismatrol Chewable Tablets

1045 Compare to Chewable Pepto-Bismolreg 262 mg 30 chewable tablets per boxA registered trademark of Proctor amp Gamble

$600

Docusate Sodium Stool Softener

1126 Compare to Colacereg 100 mg capsules 100 per bottleA registered trademark of Purdue Products

$600

Glycerin Suppository 1125 Compare to Fleetreg Glycerin Suppositories 25 suppositories per bottle A registered trademark of CB Fleet Co Inc

$500

Lactase Capsules 1067 Compare to Lactaidreg 9000 ICC 60 tabletsA registered trademark of McNeil Nutritionals LLC

$1000

Loperamide HCL Anti-Diarrheal

1133 Compare to Imodium A-Dreg2 mg tablets 12 per boxA registered trademark of McNeil-PPC Inc

$500

Methylcellulose Fiber Therapy

1354 Compare to Citrucelreg 16 oz per bottleA registered trademark of GlaxoSmithKline

$1200

Milk of Magnesia 1011 Compare to Phillipsrsquoreg Milk of Magnesia 400 mg 12 oz bottle A registered trademark of Bayer HealthCare LLC

$600

Natural VegetableLaxative

1340 Compare to Metamucilreg 13 oz powder per bottleA registered trademark of Procter amp Gamble

$1000

Pink Bismuth 1318 Compare to Pepto-Bismolreg 262 mg 8 oz per bottle A registered trademark of Procter amp Gamble

$600

PolycarbophilFiber Tablets

1012 Compare to Fiberconreg 625 mg tablets 90 per bottle A registered trademark of Whitehall-Robins Healthcare

$1000

Senna Plus Stool Softener Plus Laxative

1130 Compare to Senokot- Sreg 86 - 50 mg 60 tablets per bottle A registered trademark of Purdue Products

$600

Anti-fungal amp Anti-itch

Clotrimazole Antifungal Athletersquos Foot Cream

1047 Compare to Lotrimin AFreg Strength 1 Quantity 1 oz A registered trademark of MSD Consumer Care Inc

$600

DiphenhydramineHCL Zinc Acetate Anti-itch Cream

1140 Compare to Benadrylreg Itch Stopping Quantity 1 oz A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Hydrocortisone1 Cream

1074 Compare to Cortaidreg Maximum Strength Cream 1 1 oz per tubeA registered trademark of Johnson amp Johnson Corporation

$600

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 15: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

15

Category Product Item Brand EquivalentDescription Cost

Anti-fungal amp Anti-itch (continued)

Medicated Antifungal Foot Powder Spray

1874 Compare to Lotrimin AFA registered trademark of Bayer AG

$1000

Miconazole Nitrate 2 Antifungal Cream

1135 Compare to MicatinA registered trademark of WellSpring

$800

Terbinafine HCL Antifungal Cream

1046 Compare to Lamisil ATreg Strength 1 Quantity 05 oz A registered trademark of Novartis Consumer Health Inc

$1200

Tolnaftate Antifungal Cream

1064 Compare to Tinactinreg Strength 1Quantity 05 oz A registered trademark of MSD Consumer Care Inc

$500

Cold Sore amp Medicated Lip Products

Abreva 1152 Compare to Abrevareg 10 2 gm per tubeA registered trademark of GlaxoSmithKline

$2600

Herpecin-L Lip Balm 1153 Compare to Herpecin-Lreg Lip Balm 1 01 oz A registered trademark of Chattem Inc

$800

Releev Cold Sore Treatment

1359 Releevreg Cold Sore Treatment Strength013 Quantity 6 ml A registered trademark of Merix Pharmaceutical Corporation

$2500

Dental amp Denture Care

Denture Cleaning Tablets

1032 Compare to Efferdentreg Anti-Bacterial Denture Cleanser 40 tablets per boxA registered trademark of Warner-Lambert Consumer Healthcare

$700

Fixodent 1187 Compare to Fixodentreg 075 oz per tubeA registered trademark of Procter amp Gamble

$700

Interdental Flossups 1751 Compare to Oral-Breg Complete Floss Picks 90 ct A registered trademark of Procter amp Gamble

$700

Orajel Pain Relief 1454 Compare to Orajelreg 7 gm tube A registered trademark of Church amp Dwight Co Inc

$1100

Oral Pain Relief 1286 Compare to Anbesolreg Strength 20 Quantity 15 ml A registered trademark of Pfizer labs

$600

Polident Denture Cream 1324 Compare to Super PoligripA registered trademark of GlaxoSmithKline

$800

Reach Waxed Dental Floss Mint

1455 Compare to Reachreg Dental Floss 55 Yards Quantity 1 A registered trademark of Johnson amp Johnson Consumer Products Co

$500

Rechargeable Toothbrush

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

Toothbrush Colgate Adult Soft

1413 Compare to Colgatereg ToothbrushA registered trademark of Procter amp Gamble

$500

Toothbrush Rechargeable

1450 Compare to Oral Breg VitalityA registered trademark of Procter amp Gamble

$4000

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 16: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Dental amp Denture Care (continued)

Water Jet 1744 Compare to Conair Water JetA registered trademark of Conair

$3900

Water Jet Replacement Tips

1743 Compare to Conair Replacement TipsA registered trademark of Conair

$1800

Toothbrush Tek Pro Straight Soft

1412 Compare to Tek Proreg ToothbrushA registered trademark of Dr Fresh

$400

Toothpaste - Pepsodent 1414 Compare to Pepsodentreg Complete CareFluoride Toothpaste Quantity 6 oz A registered trademark of Church amp Dwight Co

$600

Diabetes Diabetic Sock Black Medium

1491 Compare to Dr Schollsreg Black Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock Black Large

1492 Compare to Dr Schollsreg Black Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Medium

1489 Compare to Dr Schollsreg White Size Medium Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Diabetic Sock White Large

1490 Compare to Dr Schollsreg White Size Large Quantity 1 pair A registered trademark of MSD Consumer Care Inc

$800

Ear Care Cotton Tipped Swabs 1742 Compare to Q-Tipsreg Cotton Swabs 300 ct A registered trademark of Unilever

$700

Ear Pain Relief Ear Drops 1841 Compare to Hylandrsquos Ear ReliefA registered trademark of Hylandrsquos

$1300

Ear Wax Removal Drops

1190 Compare to Murinereg Ear Drops 15 ml per bottle A registered trademark of Prestige Brands International Inc

$500

Ear Wax Removal System with Rubber Bulb

1363 Compare to Murinereg Ear Wax Removal System 15 ml per bottle with syringeA registered trademark of Prestige Brands International Inc

$700

Eye Care Artificial Tears Drops

1192 Compare to Visinereg Tears Eye Drops Quantity 05oz A registered trademark of Johnson amp Johnson Healthcare Products

$600

Artificial Tears Ointment

1194 Compare to lsquoRefresh PMrsquo 35 gm per tubeA registered trademark of Allergan Inc

$600

Eye Wash Solution 1196 Compare to Bausch amp LombA registered trademark of Bausch amp Lomb

$800

Multi-Purpose Contact Lens Solution

1468 Compare to Renu MultipurposeSolutionreg Quantity 120 mlA registered trademark of Bausch amp Lomb

$600

Redness Relief Eye Drops

1061 Compare to Visinereg Original15 ml per bottle A registered trademark of Johnson amp Johnson Healthcare Products

$500

16

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 17: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

Category Product Item Brand EquivalentDescription Cost

First Aid amp Medical Supplies

Adhesive Bandages

AdjustableTransfer Bench

After Bite Relief

Alcohol Pads

Antiseptic Towelettes

1344

1764

1803

1200

1201

Compare to Band-Aidreg Sheer Box of 60 per box A registered trademark of McNeil-PPC Inc Compare to Drive Medical Adjustable Transfer Bench A registered trademark of Medical Depot Inc Compare to After Bite Relief 5 ozA registered trademark of Tender Corporation Compare to Curadreg Alcohol Swabs 100 per box A registered trademark of Beiersdorf Inc Antiseptic Towelettes Quantity 100

$700

$8000

$900

$600

$700

Bacitracin Ointment 1020 Compare to Bacitracin 1 oz per tube $600

Bath Bench with Back

Bath Bench without Back

Bath Mat Non-Skid

1728

1727

1459

Compare to Essentialreg Shower Bench with back A registered trademark of Essential Medical Supply Compare to Essentialreg Shower BenchA registered trademark of Essential Medical Supply Bath Mat Non-Skid

$6500

$5500

$1700

Bath Tub Safety Rail 1730 Compare to Carexreg Bathrub Rail with chrome finish A registered trademark of Carex Health Brands

$3700

Cotton Balls 1763 Cotton Balls Quantity 200 $700

Cushion Foam Ring 1732 Compare to Carexreg FoamCushion A registered trademark of Carex Health Brands

$2100

Cushion Gel Foam Seat

Cushion Lumbar

1466

1731

Compare to Drive MedicalregA registered trademark of Drive Medical Design and Manufacturing Compare to Carexreg Lumbar SupportCushion A registered trademark of Carex Health Brands

$4200

$2700

Elastic Bandage- 2 in x 45 yd

1207 Compare to Acereg Elastic Bandage 2rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 3 in x 5 yd

1209 Compare to Acereg Elastic Bandage 3rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$400

Elastic Bandage- 4 in x 5 yd

1211 Compare to Acereg Elastic Bandage 4rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare

$500

17

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 18: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

First Aid amp Elastic BandageMedical Supplies - 6 in x 5 yd (continued)

Fast Freeze Pain Relief Spray

1213

1846

Compare to Acereg Elastic Bandage $500 6rdquo x 5 yd 1 per pack A registered trademark of BD Consumer Healthcare Compare to Biofreeze Pain Relief $1400 Spray A registered trademark of Hygenic Corporation

First Aid Kit 1738 Compare to Curadreg First Aid Kit 175 pieces A registered trademark of Medline Industries

$1700

First Aid Kit 75 Pieces

1215 Compare to First Aid Onlyreg FAO-120 75 pieces A registered trademark of First Aid Only

$1000

Folding CaneErgonomic Handle

1726 Compare to Novareg Folding CanesA registered trademark of NOVA Medical Products

$2000

HotCold Pack1 small amp 1 large

1062 Compare to Nexcarereg 2 per packA registered trademark of 3M

$700

Humidifier Ultra-Sonic Cool Mist

1795 Compare to Vicks Ultrasonic HumidifierA registered trademark of Procter amp Gamble

$6000

Hydrogen Peroxide 1228 Hydrogen Peroxide 3 8 oz $500

Isopropyl Alcohol Wintergreen

1229 Isopropyl Alcohol Wintergreen 16 oz $600

Insect Repellant Spray (Deet)

1796 Compare to Benrsquosreg Spray Pump Insect Repellent - 30 Percent DEET 4 ozA registered trademark of Ariens Specialty Brands LLC

$1200

Neosporin Plus 1326 Compare to Neosporin Antibiotic and Pain Relieving Cream A registered trademark of Johnson amp Johnson

$1100

Povidone Iodine Solution Antiseptic

1203 Povidone Iodine Solution Antiseptic 4 oz $800

Quad Cane Large Base 1776 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$3000

Quad Cane Small Base 1777 Compare to Drive Medical Quad CaneA registered trademark of Medical Depot Inc

$2500

Raised Toilet Seat 1729 Compare to Quick-Lockreg Raised Toilet Seat A registered trademark of Carex Health Brands

$3500

Shower Mat Non-Skid 1460 Shower Mat Non-Skid $1400

Talking Ear and Forehead Thermometer

1925 Thermometer Talking Ear and Forehead $4500

Tape Paper Surgical - 1 in x 10 yd

1217 Compare to 3M TapeA registered trademark of 3M

$600

18

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 19: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

Category Product Item Brand EquivalentDescription Cost

First Aid amp Tape Paper Surgical Medical Supplies - 2 in x 10 yd (continued) Tape Silk Surgical

- 1 in x 10 yd

1218

1219

Compare to 3M Tape $800 A registered trademark of 3M Compare to 3M Tape $600 A registered trademark of 3M

Tape Silk Surgical - 2 in x 10 yd Tape Transparent Surgical - 1 in x 10 yd Tape Transparent Surgical - 2 in x 10 yd Thermometer Digital 60 seconds Thermometer Flexible Tip Digital 10 seconds Thermometer Digital Ear

Toilet Safety Rails

1220

1221

1222

1063

1697

1285

1779

Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to 3M TapeA registered trademark of 3M Compare to Nexcarereg A registered trademark of 3M Consumer Health Compare to ProCheckreg A registered trademark of Microlife Corporation Compare to Braunreg ThermoScanCompact Ear Thermometer 1 per packA registered trademark of Procter amp Gamble Toilet Safety Rails

$800

$600

$800

$500

$1200

$2400

$5000

Triple Antibiotic Ointment

1014 Compare to Neosporinreg 1 oz per tubeA registered trademark of Pfizer

$700

Foot Care Callus Remover Pads 1238 Compare to Dr Schollsreg 6 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Corn Remover Pads 1236 Compare to Dr Schollsreg 9 per packA registered trademark of Schering-Plough Healthcare Products Inc

$700

Medicated Foot Powder 1240 Compare to Gold Bond Foot PowderA registered trademark of Chattem Inc

$700

Hemorrhoidal Preparations

Hemorrhoidal Ointment

1066 Compare to Preparation Hreg Hemorrhoidal Ointment 2 oz per tube A registered trademark of Pfizer Consumer Healthcare

$700

Hemorrhoidal Suppository

1247 Compare to FleetA registered trademark of CB Fleet Company

$700

Pre-moist Hemorrhoid Pads

1364 Compare to Tucksreg 100 per boxA registered trademark of Warner-Lambert Consumer Healthcare

$800

DHEA 1737 DHEA Quantity 50 $1200 Hormone Replacement Incontinence A amp D Ointment 1300 Compare to A amp D Ointment $800

A registered trademark of Schering-Plough Healthcare Products Inc

Supplies

Adult Briefs 1303 Compare to Prevailreg 12 per bag $1000 Medium - 32rdquo to 44rdquo A registered trademark of First Quality

Enterprises Inc

19

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 20: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Incontinence Supplies (continued)

Adult Briefs Large - 45rdquo to 58rdquo

Adult Briefs X-Large - 59rdquo to 64rdquo

Attends Discreet Menrsquos Guard

1304

1305

1811

Compare to Prevailreg 12 per bagA registered trademark of First Quality Enterprises Inc Compare to Prevailreg 10 per bagA registered trademark of First Quality Enterprises Inc Compare to DependsA registered trademark of Kimberly-Clark

$1200

$1200

$1600

Attends Discreet Menrsquos Shield

1810 Compare to DependsA registered trademark of Kimberly-Clark

$1500

Attends Discreet Womenrsquos Maximum Bladder Control Pad Attends Discreet Womenrsquos Moderate Bladder Control Pad Attends Discreet Womenrsquos Panty Liner

1812

1813

1815

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1800

$1400

Attends Discreet Womenrsquos Ultimate Bladder Control Pad Attends Discreet Womenrsquos Ultrathin Pad

1814

1816

Compare to DependsA registered trademark of Kimberly-Clark

Compare to DependsA registered trademark of Kimberly-Clark

$2000

$1400

Barrier Cream 1302 Compare to Lantiseptic Barrier CreamA registered trademark of Santus

$1000

Bladder Control Shaped Pad Moderate Absorbency

1478 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1700

Bladder Control Shaped Pad Heavy Absorbency

1479 Compare to Attendsreg 24 per packA registered trademark of Attends Healthcare Products Inc

$1900

Bladder Control Shaped Pad Maximum Absorbency

1480 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Medium - 34rdquo to 44rdquo

1021 Compare to Attendsreg 20 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear Large - 44rdquo to 58rdquo

1026 Compare to Attendsreg 18 per packA registered trademark of Attends Healthcare Products Inc

$1600

Disposable Underwear X-Large - 58rdquo to 68rdquo

1027 Compare to Attendsreg 14 per packA registered trademark of Attends Healthcare Products Inc

$1600

20

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 21: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

Category Product Item Brand EquivalentDescription Cost

Incontinence Underpad Supplies Disposable - 23rdquo x 24rdquo (continued)

Underpad Disposable - 23rdquo x 36rdquo

1476

1299

Compare to Attendsreg 50 per pack $1500 A registered trademark of Attends Healthcare Products Inc Compare to Attendsreg 25per pack $1000 A registered trademark of Attends Healthcare Products Inc

Underpad 1477 Compare to Attendsreg 10 per pack $800 Disposable - 30rdquo x 30rdquo A registered trademark of Attends

Healthcare Products Inc Motion Sickness Dramamine Chewables

Orange 1264 Compare to Dramaminereg 50 mg tablets

8 chewable tablets per pack A registered trademark of GD Searle amp Co Corporation

$700

Driminate Antiemetic 1263 Compare to Dramaminereg 50 mg tablets 12 per pack A registered trademark of GD Searle amp Co Corporation

$500

Meclizine HCL Antiemetic

1366 Compare to Boninereg 125 mg 100 tabletsA registered trademark of Pfizer

$800

Pain Relievers amp Fever Reducers

Acetaminophen 1001 Compare to Tylenolreg 325 mg tablets 100 per bottle A registered trademark of McNeil-PPC Inc

$600

Acetaminophen 1600 Compare to Tylenol Extra StrengthA registered trademark of Johnson amp Johnson

$1000

Arthritis Pain Reliever

1311 Compare to Tylenol Arthritisreg 650 mg tablets 100 per bottleA registered trademark of McNeil-PPC Inc

$1200

Aspirin 1095 Compare to Bayerreg Genuine Aspirin325 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$500

AspirinEnteric Coated

1096 Compare to Ecotrinreg Regular Strength325 mg tablets 100 per bottle A registered trademark of Prestige Brands Inc

$500

AspirinLow Dose

1002 Compare to Ecotrinreg Low Strength 81mg tablets 120 per bottle A registered trademark of Prestige Brands Inc

$600

Aspirin Low Dose Chewables

1802 Compare to Bayer Aspirin Chewable wLow Dose A registered trademark of Bayer AG

$500

Capsaicin 1367 Compare to Capzasinreg 2 oz per tubeA registered trademark of Chattem Inc

$1000

Heating Pad 12 in X 15 in

1861 Compare to Sunbeam Heating PadA registered trademark of Newell Brands

$2600

Ibuprofen 1004 Compare to Advilreg 200 mg tablets 100 per bottle A registered trademark of Pfizer Consumer Healthcare

$700

21

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 22: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Pain Relievers amp Fever Reducers

Lidocaine Patch 1871 Compare to AspercremeA registered trademark of Chattem Inc

$1700

(continued) Migraine Relief 1365 Compare to Excedrinreg Migraine 250mg Acetaminophen 250mg Aspirin 65mgCaffeine tablets 100 per bottle A registered trademark of Bristol-Myers Company

$600

Naproxen 1097 Compare to Alevereg 220 mg tablets 100 per bottle A registered trademark of Bayer HealthCare LLC

$1100

Pain Relief Patches 1739 Compare to Salonpasreg Pain Relief Patch 5 per box A registered trademark of Hisamitsu America Inc

$1400

Pain Reliever PM - Extra Strength

1332 Compare to Tylenol PM A registered trademark of Johnson amp Johnson

$1000

Pain Relieving Muscle Rub

1475 Compare to Bengayreg 2 oz bottleA registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Thermacare Knee amp Elbow

1911 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Lower Back amp Hip

1912 Compare to ThermacareA registered trademark of Pfizer

$1500

Thermacare Menstrual Relief

1913 Compare to ThermacareA registered trademark of Pfizer

$1500

Pediculicide (lice treatment)

Lice Treatment Shampoo

1271 Compare to Ridreg 240 ml per bottleA registered trademark of Pfizer

$900

Permethrin Lice Treatment

1269 Compare to Nixreg 1 59 ml per bottleA registered trademark of Insight Pharmaceuticals Corporation

$1400

Personal Care Acne Gel 10 Benzoyl Peroxide

1076 Compare to Clean and Clearreg 10 15oz tube A registered trademark of Johnson amp Johnson Consumer Companies Inc

$600

Ammonium Lactate 1368 Compare to AmLactinreg 8 oz A registered trademark of Upsher-Smith Laboratories Inc

$900

Hand Sanitizer 1065 Compare to Purellreg 62 8 oz per bottleA registered trademark of Basell NV Corporation

$600

Sleep Aids Nasal Strips Small Medium

1724 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Nasal Strips Medium Large

1725 Compare to Breathe Rightreg 30 per boxA registered trademark of CNS Inc

$1200

Sleep Tablets 1276 Compare to Sominexreg Nighttime Sleep-Aid 25 mg 50 tabs per box A registered trademark of Prestige Brands Inc

$600

22

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 23: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

Category Product Item Brand EquivalentDescription Cost

Smoking Nicotine Lozenges 1281 Compare to Commitreg 4 mg 72 per box $4700 A registered trademark of GlaxoSmithKline Cessation

Nicorelief Gum Before orderingany of these items you should talk Nicotine Patch with your doctor Step 1

1372

1369

Compare to Nicorettereg 4 mg 50 per box $2500 A registered trademark of GlaxoSmithKline Compare to Nicodermreg CQreg $4500 21mg24hr 14 per box A registered trademark of Hoechst Marion Roussel Inc

Nicotine Patch 1370 Compare to Nicodermreg CQreg $4500 Step 2 14mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Nicotine Patch 1371 Compare to Nicodermreg CQreg $4500 Step 3 7mg24hr 14 per box A registered

trademark of Hoechst Marion Roussel Inc Supportive Items

Ankle Support 1225 Compare to Acereg Ankle Brace 1 per pack A registered trademark of BD Consumer Healthcare

$800

Arthritis Gloves Small 1767 Arthritis Gloves Small 1 pair $2500 Arthritis Gloves Medium 1766 Arthritis Gloves Medium 1 pair $2500 Arthritis Gloves Large 1765 Arthritis Gloves Large 1 pair $2500 Back SupportElastic - 24rdquo to 46rdquo

1487 Compare to FuturoregA registered trademark of 3M

$2500

Back SupportElastic with Lumbar

1488 Compare to FuturoregA registered trademark of 3M

$2900

Carpal Tunnel Brace Small

1770 Carpal Tunnel Brace Small Quantity 1 $2500

Carpal Tunnel Brace Medium

1769 Carpal Tunnel Brace Medium Quantity 1 $2500

Carpal Tunnel Brace Large

1768 Carpal Tunnel Brace Large Quantity 1 $2500

Compression Knee HighSocks Menrsquos Black Medium (Shoe Size 8 - 10)

1398 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos Black Large(Shoe Size 105 - 12)

1399 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Medium (Shoe Size 8 - 10)

1400 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee HighSocks Menrsquos White Large(Shoe Size 105 - 12)

1401 Compare to TherafirmregA registered trademark of Knit-Rite Inc

$1700

Compression Knee High Socks Womenrsquos Black Small (Shoe Size 4-5)

1409 Compare to FuturoregA registered trademark of 3M

$1200

23

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 24: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

24

OTC MEDICATIONS AND PRODUCTS

Category Product Item Brand EquivalentDescription Cost

Supportive Items (continued)

Compression Knee High Socks Womenrsquos Black Medium (ShoeSize 55 - 75)

1410 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Black Large (Shoe Size 8 - 105)

1411 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Small (Shoe Size 4 - 5)

1406 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Medium (Shoe Size 55 - 75)

1407 Compare to FuturoregA registered trademark of 3M

$1200

Compression Knee High Socks Womenrsquos Nude Large (Shoe Size 8 - 105)

1408 Compare to FuturoregA registered trademark of 3M

$1200

Elbow Support 1224 Compare to Futuro Elbow SupportA registered trademark of 3M

$1500

Hip Protector Small 1864 Hip Protector Small Quantity 1 $4500

Hip Protector Medium 1863 Hip Protector Medium Quantity 1 $4500

Hip Protector Large 1862 Hip Protector Large Quantity 1 $4500

Hip Protector X-Large 1865 Hip Protector X-Large Quantity 1 $4500

Knee Support ElasticSmall

1481 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticSmall with Stays

1484 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticMedium

1482 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticMedium with Stays

1485 Compare to FuturoregA registered trademark of 3M

$1600

Knee Support ElasticLarge

1483 Compare to FuturoregA registered trademark of 3M

$1000

Knee Support ElasticLarge with Stays

1486 Compare to FuturoregA registered trademark of 3M

$1600

Night Wrist Support Smart Glove

1463 Compare to Futuro Night Wrist SupportA registered trademark of 3M

$2800

Rib Belt - Female (one size fits most)

1457 Compare to Curad Rib BeltA registered trademark of Medline Industries

$2100

Rib Belt - Male (one size fits most)

1456 Compare to Curad Rib Belt A registered trademark of Medline Industries

$2100

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 25: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

Category Product Item Brand EquivalentDescription Cost

Wrist Splint 1230 Compare to Futuro Wrist Splint A registered trademark of 3M

$1900

Wrist Support 1227 Compare to Futuro Wrist SupportA registered trademark of 3M

$1500

Supportive Items (continued)

Therapeutic Skin amp Sun Care

Aloe Vera Cream 1070 Compare to Fruit of the Earthreg 240ml per tube A registered trademark of Fruit of the Earth Inc

$600

Moisturizing BodyLotion with Aloe

1893 Compare to Gold Bond Skin Therapy LotionA registered trademark of Chattem Inc

$800

Sunscreen Lotion SPF 30

1284 Compare to Coppertonereg 35 oz per bottleA registered trademark of Schering-Plough HealthCare Products Inc

$600

Wart Remover Wart Remover (Liquid)

1075 Compare to Compound Wreg Wart RemoverStrength 17 Quantity 9 ml A registered trademark of Medtech Products Inc

$900

Weight Loss Vitafusion Fiber 1735 Compare to Vitafusion Fiber Well Fit $1600 Weight Management A registered trademark of Church

amp Dwight Co Inc

1-866-851-1579 (TTY 711) You can place your OTC order Monday ndash Friday 8 am ndash 9 pm EST

Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheas anti-fungals anti-gas antishyhistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg eucerin aquaphor) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants chap stick deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible

25

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 26: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

KEEP TRACK OF YOUR ORDERS BELOW

Date Item

26

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 27: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

00000

English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)

Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711)

Chinese ndash注意如果您使用繁體中文您可以免費獲得語言援助服務請致電 1-877-653-0327 (TTY 711)

Tiếng Việt (Vietnamese) ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)

Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오

Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711)

Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (телетайп 711)

0327Arabic-653-877-1اتصل برقم تتحدث اذكر اللغة فإن خدمات المساعدة اللغویة تتوافر لك بالمجانإذا كنت ملحوظة (711كم والبم الصم هاتف رق

French ndash ATTENTION Si vous parlez franccedilais des services daide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711)

Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711)

Italian ndash ATTENZIONE In caso la lingua parlata sia litaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711)

German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711)

Japanese ndash注意事項日本語を話される場合無料の言語支援をご利用いただけます 1-877-653-0327 )TTY 711(までお電話にてご連絡ください

(

Farsi

ກບຫບ

Hindi ndash धयान द अगर आप ह िदी बोलत तो आपक ललए भाषा स ायता सवाएि ननशलक उपलबध 1-877-653-0327 (TTY 711) पर कॉल कर

Gujarati ndash સચના જો તમ ગજરાતી બોલતા હો તો નનશલક ભાષા સહાય સવાઓ તમારા માટ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711)

Urdu ل کا ںيہياب تدسں يمفت ممات خدد کی ن کی مدکو زبا آپ تو ںيہتے بولردو ار آپ گار داخبر1-877-653-0327 (711 TTT) ک

Lao ndash ເອາໃຈໃ ສ ຖາທານເວາພາສາລາວ ານ ລການໃ ຫຄວາມຊວຍ ເຫອດານພາສາຈະໃ ລການຟຣແ ທານໂທ 1-877-653-0327 (TTY 711)

Greek ndash ΠΡΟΣΟΧΗ Αν μιλάτε ελληνικά στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης οι οποίες παρέχονται δωρεάν Καλέστε 1-877-653-0327 (TTY 711)

دباشی مم اهفرا می شرابن گايراصورت بی نزبايالت هست نيدکی مگو تفگی ارسفن ه زبابر گا هوجتد يريگبتماس (TTY 711) 0327-653-877-1ا ب

27

CignaHealthSpringcom

Page 28: OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS · Choose from the list of covered medications and products in this catalog Check your Cigna-HealthSpring Evidence of Coverage to see

CignaHealthSpringcom