As a member of University of Maryland Health Advantage Dual Plan (HMO SNP), you have an Over-the-Counter (OTC) benefit every quarter. This benefit allows you to get OTC products you may need such as bandages, cold and allergy medicines, pain relievers, and vitamins – at no cost to you. Benefit amounts do not roll over, so be sure to use them before the end of every quarter. Simply call the toll-free number OR fill out and mail the order form provided. Your order will be shipped directly to your door.

2016 Over-the-Counter (OTC) Benefit Catalog

Special Health Plan Benefit

Get Over-the-Counter Products Every

Quarter at No Cost to You!

Information on how to place your OTC order can be

found on the last page.

*B - May be covered by Medicare Part B.*D - May be covered by Medicare Part D.

H8854_16_1097-07_002_OECMS Approved: 09/11/2015

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You can get 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 regimen.

Acne Treatment

Acne Gel 10% Benzoyl Peroxide 1.5 oz 1076 $8.00

Allergy, Cold, Flu, Decongestant and Sinus

All Day Allergy Tablets 14 tabs, 10 mg 1090 $8.00

All-Nite Cold/Flu 6 oz, 6.25 mg 1361 $7.00

Children's Dimaphen 4 oz 2.5 mg/5 ml 1426 $8.00

Children's Diphenhydramine HCL 4 oz, 12.5 mg/5 ml 1428 $7.00

Chlorpheniramine Maleate100 tabs, 4 mg 1008 $7.00

Cromolyn Sodium (AllergyNasal Spray), 26 ml 1356 $15.00

Cough & Cold for High Blood Pressure 16 tabs 1166 $8.00

Diphenhist (Antihistamine)100 tabs, 25 mg 1308 $8.00

Diphenhydramine HCL (Antihistamine) 24 caps, 25 mg 1009 $7.00

Multi Symptom Cold Formula 24 tabs 1357 $8.00

Nasal Decongestant Spray12 Hr, 1oz, 0.05% 1091 $7.00

Nasal Spray (Saline) 1.5 oz, 0.655% 1052 $7.00

Sudogest PE (Nasal & Sinus Decongestant) 36 tabs, 10 mg 1352 $7.00

Vapor Rub 1 oz 1164 $8.00

Antacids and Acid Reducers

Alka-Seltzer 36 tabs 1313 $12.00

Antacid/Anti-Gas Liquid 12 oz 1006 $8.00.

Antacids and Acid Reducers (continued) Chewable Antacid150 tabs, 500mg 1346 $8.00

Effervescent Pain Reliever 36 tabs 1314 $9.00

Famotidine *D 30 tabs, 10 mg 1108 $8.00

Gas-X 36 chewables, 80 mg 1312 $11.00

Omeprazole *D 28 caps, 20 mg 1110 $25.00

Anti-Arthritic

Arthritis Pain Reliever 100 tabs, 650 mg 1311 $14.00

Capsaicin 2 oz, 0.025% 1367 $10.00

Glucosamine Joint/Muscle 1114 $10.00 60 capsules, 500 mg

Glucosamine/Chondroitin 60 caps, 250-200 mg 1003 $12.00

Anticandidal (Yeast)

Clotrimazole Vaginal Cream w/applicator *D 45 gm, 1% 1115 $9.00

Micanozole 3-Day Treatment 2% 1117 $15.00

Tioconazole 1-Day Treatmentwith applicator, 6.50% 1119 $21.00

Antidiarrheal

Bismatrol (Bismuth Subsalicylate) 30 tabs, 525 mg 1045 $8.00

Loperamide HCL *D 12 tabs, 2 mg 1133 $7.00

Pepto-Bismol 12 oz, 525 mg 1317 $12.00

Pink Bismuth 8 oz, 262 mg 1318 $8.00

Antifungal

Clotrim Cream 1 oz, 1% 1047 $8.00

Miconazole 2% Cream 1 oz 1135 $8.00

Terbinafine HCL Tube .5 oz, 1% 1046 $13.00

Tolnaftate Cream .5 oz, 1% 1064 $8.00

*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D.

Anti-Itch Lotions and Creams

Bactine Solution 4 oz 1142 $11.00

Diphenhydramine HCL/ Zinc Acetate 1 oz 1140 $7.00

Hydrocortisone 1% Cream 1 oz 1074 $7.00

Pramoxine Topical Analgesic 6 oz, 1% 1144 $9.00

Cold Sore, Fever Blister andMedicated Lip Products

Abreva 2 gm, 10% 1152 $26.00

Herpecin-L Lip Balm 0.1 oz, 1% 1153 $11.00

Releev Cold Sore Treatment 6 ml, 0.13% 1359 $25.00

Contact Lens Supplies

Multi Purpose Contact Lens Solution 120 ml 1468 $9.00

Cough Suppressants and Expectorants

Cough DropsCherry, 30 lozenges 1056 $7.00

Cough Drops (Sugar Free)Cherry, 25 lozenges, 5 gm 1182 $7.00

Cough Syrup, Expectorant 4 oz, 100 mg 1054 $7.00

Guaifenesin Cough Expectorant 60 tabs, 200 mg 1180 $10.00

Mucus Relief DM (Guaifenesin Expectorant / Dextromethorphan Cough Suppressant) 30 tabs, 400-20 mg 1178 $10.00

Sore Throat Lozenges Cherry, 18 lozenges 1176 $8.00

Dental/Denture Care

Dental Floss 55 yards 1455 $7.00

Denture Cleaning 40 tabs 1032 $8.00

Fixodent 0.75 oz 1187 $8.00

3.

Dental/Denture Care (continued)

Orajel Pain Relief 7 gm, 20% 1454 $13.00

Oral Pain Relief 0.5 oz, 20% 1286 $9.00

Polident Denture Cream 3.9 oz 1324 $10.00

Rechargeable Toothbrush 1450 $37.00

Tooth Brush, Tek ProStraight Soft 1412 $5.00

Tooth Paste • Pepsodent 6 oz 1414 $6.00

Diabetes

Diabetic Socks White Medium 1489 $8.00White Large 1490 $8.00Black Medium 1491 $8.00Black Large 1492 $8.00

Diagnostic Supplies

Desktop Talking Blood Pressure Monitor 8.7" to 13.4" 1503 $34.00

Finger Pulse Oximeter 1505 $31.00 Wrist Blood Pressure Monitor 1501 $22.00

Wrist Talking Blood Pressure Monitor 9" to 14.6" 1502 $26.00

Digestive Health

Beano 30 tabs 1316 $11.00

Enema 4.5 oz 1733 $8.00

Lactase Capsules60 capsules, 9000 FCC units 1067 $11.00

Ear Care

Ear Drops 15 ml, 6.50% 1190 $7.00

Ear Wax Removal Systemwith Rubber Bulb, 15 ml 1363 $9.00

Eye Care

Artificial Tears Drops 0.5 oz 1192 $7.00

Artificial Tears Ointment 3.5 gm 1194 $9.00

Eye Care (continued)

Clear Eyes Eye Drops 0.20 oz 1199 $9.00

Eye Drops Redness Relief 15 ml 1061 $7.00

Eye Wash Solution 4 oz 1196 $8.00

First Aid and Medical Supplies

Adhesive Bandages box of 60 1344 $8.00

Alcohol Pads *D 100 pads 1200 $7.00

Ankle Support 1225 $10.00

Antiseptic Towelettes 100 pack 1201 $8.00

Automatic Blood Pressure Monitor Desktop 1253 $35.00

Back Support Elastic 24-46" 1487 $17.00Elastic With Lumbar 1488 $27.00

Bath Mat (non-skid) 1459 $15.00

Bath Seat w/o Back 1727 $55.00

Bath Tub Safety Rail 1730 $38.00

Conforming Gauze Sterile *B 12 pads, 3” X 4 yd 1223 $9.00

Cushion FOAM RING 1732 $22.00

LUMBAR 1731 $27.00

Elastic Bandage *B2” X 5 yd 1207 $6.003” X 5 yd 1209 $6.004” X 5 yd 1211 $7.00 6” X 5 yd 1213 $7.00

Elbow Support 1224 $12.00

First Aid Kit 48-piece 1215 $11.00

Folding Cane with Ergonomic Handle 1726 $22.00

Gel Foam Seat Cushion 1466 $27.00

Hot/Cold Pack1 small / 1 large 1062 $8.00

First Aid and Medical Supplies (continued)

Hydrogen Peroxide 8 oz, 3% 1228 $6.00

Knee Stabilizer 1465 $23.00

Knee Support SMALL 1481 $10.00 MEDIUM 1482 $10.00LARGE 1483 $10.00SMALL with stays 1484 $16.00 MEDIUM with stays 1485 $16.00LARGE with stays 1486 $16.00

Lantiseptic Skin Protectant Ointment 2.5 oz, 50% 1202 $10.00

Neosporin Plus 0.5 oz 1326 $12.00

Night Wrist SupportSmart Glove 1463 $27.00

Povidone Iodine 4 oz 1203 $8.00

Raised Toilet Seat 1729 $36.00

Rib Belt One size fits mostMALE 1456 $20.00FEMALE 1457 $20.00

Shower Mat (non-skid) 1460 $16.00

Tape, Paper Surgical *B 1” X 10 yd 1217 $6.00 2” X 10 yd 1218 $7.00

Tape, Silk Surgical *B1” X 10 yd 1219 $7.00 2” X 10 yd 1220 $8.00

Tape, Transparent Surgical *B 1” X 10 yd 1221 $7.00 2” X 10 yd 1222 $7.00

Thermometer DIGITAL 1063 $8.00 DIGITAL - EAR 1285 $24.00

Wintergreen Isopropyl Alcohol 16 oz, 70% 1229 $8.00

Wrist Splint 1230 $18.00

Wrist Support 1227 $12.004.

Foot Care

Callus Remover Pads 6 pads 1238 $9.00

Corn Remover Pads 9 pads 1236 $8.00

Medicated Foot Powder 4 oz 1240 $8.00

Hemorrhoidal Preparations

Hemorrhoidal Ointment 2 oz 1066 $9.00

Hemorrhoidal Suppository 1247 $8.00 12 pk

Preparation H Cream 26 gm 1248 $14.00

Pre-Moist Hemorrhoid Pads 1364 $9.00 100 pads

Home DiagnosticsColon Cancer Test 1416 $14.00 Home Access Cholesterol Test 1251 $25.00

Incontinence Supplies

A&D Ointment 2 oz 1300 $8.00

Adult Briefs Med 32" - 44” waist, 12 pk 1303 $10.00LG 45” - 58” waist, 18 pk 1304 $14.00 XL 59” - 64” waist, 15 pk 1305 $15.00

Barrier Cream 4 oz 1302 $10.00

Bladder Control LinerMODERATE Absorbency 24 pk 1478 $17.00HEAVY Absorbency 24 pk 1479 $18.00MAXIMUM Absorbency 18 pk 1480 $17.00

Disposable Underwear MEDIUM 34" - 44” waist 20 pk 1021 $15.00LARGE 44" - 58” waist 18 pk 1026 $15.00XLARGE 58" - 68” waist 14 pk 1027 $15.00

Underpads 23" x 36" 25 pads 1299 $12.0023" x 24" 50 disposable pads 1476 $15.0030" x 30" 10 disposable pads 1477 $9.00

Washcloth w/Lanolin, 64 pk 1348 $9.00

Laxatives

Bisacodyl 100 tabs, 5 mg 1128 $7.00

Docusate Sodium100 capsules, 100 mg 1126 $8.00

Ex-Lax 8 tabs, 15 mg 1124 $9.00

Glycerin Suppository 25 tabs, 2 gm 1125 $8.00

Methylcellulose 16 oz 1354 $14.00

Milk of Magnesia 12 oz, 400 mg 1011 $8.00

Natural Vegetable Laxative 13 oz 1340 $11.00

Polycarbophil Fiber Tablets 90 tabs, 625 mg 1012 $12.00

Senna Plus 60 tabs, 8.6-50 mg 1130 $8.00

Migraine Relief

Migraine Relief100 tabs, 250-250-65 mg 1365 $9.00

Wellpatch Migraine box of 4 1261 $10.00

Minerals

Calcium Carbonate Tabs60 tabs, 600 mg 1291 $7.00

Calcium-Vitamin D60 tabs, 600 mg/400u 1373 $8.00

Ferrous Sulfate 100 tabs, 325 mg 1376 $7.00

Niacin 100 tabs, 100 mg 1378 $8.00

Niacin 100 tabs, 500 mg 1394 $8.00

Magnesium 110 tabs, 250 mg 1418 $8.00

Magnesium Oxide 100 tabs, 250 mg 1377 $9.00

Rena-Vite 100 tabs 1395 $14.00

Zinc Chelated 100 tabs, 50 mg 1419 $8.00

*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D. 5.

*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D.6.

Motion Sickness

Dramamine Orange 8 chews, 50 mg 1264 $10.00

Driminate 12 tabs, 50 mg 1263 $7.00

Meclizine 100 tabs, 12.5 mg 1366 $9.00

Pain Relievers and Fever Reducers

Acetaminophen 100 tabs, 325 mg 1001 $7.00

Acetaminophen 50 tabs, 500 mg 1105 $7.00

Aspirin Enteric Coated100 tabs, 325 mg 1096 $7.00

Aspirin Low Dose 1002 $7.00120 tabs, 81 mg

Children's Acetaminophen30 chewables, 80 mg 1423 $8.00

Children's Ibuprofen 4 oz, 100 mg/ 5 ml 1421 $10.00

Ibuprofen 100 tabs, 200 mg 1004 $8.00

Naproxen *D 100 tabs, 220 mg 1097 $11.00

Pain Reliever PM Extra Strength 100 tabs 1332 $11.00

Pain Relieving Muscle Rub2 oz, 2.50% 1475 $7.00

Pediculicide

Lice Treatment Shampoo 4 oz 1271 $12.00

Permethrin Cream Rinse 59 ml, 1% 1269 $12.00

Personal Care

Aloe Vera Cream 240 ml 1070 $7.00

Ammonium Lactate 8 oz, 12% 1368 $11.00

Personal Care (continued)

Hand Sanitizer 8 oz, 62% 1065 $7.00

Sunscreen LotionSPF 30 3.5 oz 1284 $7.00

Sleep Aids

Nasal Strips box of 30SMALL/MEDIUM 1724 $14.00MEDIUM/LARGE 1725 $14.00

Sleep Tabs 50 tabs, 25 mg 1276 $8.00

Smoking Cessation

Nicorelief Gum 50 pack, 4 mg 1372 $23.00

Nicotine Lozenges 72 pack, 4 mg 1281 $50.00

Nicotine Patches box of 14STEP 1 21 mg/24 hr 1369 $37.00STEP 2 14 mg/24 hr 1370 $37.00STEP 3 7 mg/24 hr 1371 $37.00

Support Items

Men's Compression Knee Hi Socks BLACK - LG Shoe size 101/2-12(15-20 mmhg) 1399 $20.00WHITE - MED Shoe Size 8-10 (15-20 mmhg) 1400 $20.00WHITE - LG Shoe Size 101/2-12(15-20 mmhg) 1401 $20.00

Women's Compression Knee Hi SocksNUDE - SM Shoe Size 4-5 (8-15 mmhg) 1406 $13.00NUDE - MED Shoe Size 51/2-71/2 (8-15 mmhg) 1407 $13.00NUDE - LG Shoe Size 8-101/2 (8-15 mmhg) 1408 $13.00BLACK - SM Shoe Size 4-5 (8-15 mmhg) 1409 $13.00 BLACK - MED Shoe Size 51/2-71/22 (8-15 mmhg) 1410 $13.00 BLACK -LG Shoe Size 8-101/2 (8-15 mmhg) 1411 $13.00

Topical Antibiotics

Bacitracin Ointment1 oz, 500U/gm 1020 $8.00

Triple Antibiotic Ointment 1 oz 1014 $8.00

Before ordering any of the items below, you should talk with your doctor.

Vitamins

Centrum Silver 60 tabs 1420 $21.00

Daily Multiple Vitamin Tabswith Minerals 100 tabs 1385 $8.00

Ferrous Gluconate (Iron Supplement) 100 tabs, 240 mg 1375 $8.00

Iron 110 tabs, 27 mg 1417 $9.00

Multi Vitamin Children's100 chewables 1422 $9.00

Prenatal Vitamins 100 tabs 1274 $10.00

Vitamin A 100 tabs, 10 mu 1379 $8.00

Vitamin B-Complex 100 tabs 1382 $8.00

Vitamin B-1 100 tabs, 100 mg 1016 $8.00

Vitamin B-6 100 tabs, 50 mg 1380 $8.00

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Vitamins (continued)

Vitamin B-6 100 tabs, 100 mg 1388 $8.00

Vitamin B-12 100 tabs, 500 mg 1389 $8.00

Vitamin B-12 100 tabs, 1000 mcg 1381 $9.00

Vitamin C 500 mg, 100 tabs 1017 $8.00

Vitamin Century Senior 90 tabs 1392 $11.00

Vitamin D 100 tabs, 1000 iu 1390 $8.00

Vitamin D 100 tabs, 400 iu 1383 $8.00

Vitamin E 100 tabs, 100 iu 1391 $8.00

Vitamin E 100 tabs, 400 iu 1384 11.00

Vitamin One A Day 90 tabs 1393 $8.00

Wart Remover

Dr. Scholl’s Wart Removal System 18 pack 1288 $14.00

Wart Remover 0.5 oz, 17% 1075 $10.00

Wartners Wart Removal System Kit 1289 $20.00

Helpful Information• If you have questions or would like to place an order over the phone, OTC

Advocates are available Monday – Friday from 8:00am to 8:00pm EST at1-844-479-6334 (TTY: 711).

If you place your order using an order form, your order total will be applied tothe quarter in which we receive your form. For example, if you mail your orderform on June 29th, but we receive it on July 1st, your order total will be applied toyour July (or third quarter) benefit, not your June (or second quarter) benefit.

If you’re getting close to the end of the quarter and you do not think yourorder form will be received in time, you can call in your order.

You must use your full quarterly benefit amount in one order. This benefit amountdoes not roll over from quarter to quarter.

Your order total may not exceed the quarterly benefit amount of $55. Cash, checksor money orders are not accepted under this OTC benefit.

Orders may only be placed by the member, an authorized representative verballyapproved by the member at time of the order, and/or the member’s power ofattorney representative on file.

To use your benefit, you must select products from this catalog that will helpyou with a health or medical need. Your order total may not exceed your benefitamount. OTC products are intended for member's use only. University of MarylandHealth Advantage Dual Plan prohibits the use of this benefit to order OTC items for family members and friends. OTC items are available through mail-order only.

Once your order is received, please allow 7 - 10 business days for delivery.

Products may not be purchased at a local retail pharmacy or through any other source other than the University of Maryland Health Advantage Dual Plan OTC Catalog.

If you disenroll from the University of Maryland Health Advantage Dual Plan, yourOTC benefit will automatically terminate.

Returns are not accepted.

Some items listed in this catalog may also be covered under your Medicare Part B(medical) benefit or Part D (pharmacy) benefit. These items have a *B or a *D aftertheir name. For example, alcohol pads are covered under Part D if they are usedfor administering insulin. For all other purposes, this item is covered under yourOTC benefit.

Items in the 2016 OTC Benefit Catalog may change throughout the year.A copy of this catalog is also available on the University of Maryland HealthAdvantage Dual Plan website at www.UMMedicareAdvantage.org. For up-to-dateinformation, please call our OTC Advocates from Monday - Friday from 8:00am to8:00pm EST at 1-844-479-6334 (TTY: 711).

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@ .com

2016 OVER–THE–COUNTER (OTC) BENEFIT ORDER FORM

STEP 1 - COMPLETE YOUR INFORMATION BELOW:

1

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4

Member ID (found on Health ID card) Date of Birth

First Name Last Name MI

Street Number Street Name Apt/Suite #

City State Zip Code

Please check box if this is a new addressDaytime Phone Email

STEP 2 - PRODUCT SELECTION:Your quarterly order total may not exceed $55. Cash, checks or money orders are not accepted under this Over-the-Counter (OTC) benefit.

Item # Product Name Quantity Price

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Total Order $

Please mail the completed form back in the postage-paid envelope provided.

If you place your order using an order form, your order total will be applied to the quarter in which we receive your form. For example, if you mail your order form on June 29th, but we receive it on July 1st, your order total will be applied to your July (or third quarter) benefit, not your June (or second quarter) benefit.

H8854_16_1097-07_002_OE CMS Approved: 09/11/2015