Information on how to place your OTC order can be

found on the last page.

As a member of Care1st Health Plan, 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.

H5928_15_245_PD_OTC Accepted

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

Special Benefit for Care1st Health

Plan Members

Get Over-the-Counter Products Every

Quarter at No Cost to You!

2015 Over-the-Counter (OTC) Benefit Catalog

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

Anticandial (Yeast)

Clotrimazole Vaginal Cream w/applicator *D 1115 $12.80

Micanozole 3 Day Treatment 1117 $16.90

Tioconazole 1 Day Treatmentwith applicator 1119 $29.10

Antidiarrheal

Bismatrol (Bismuth Subsalicylate) 30 tabs 1045 $7.90

Loperamide HCL *D 12 tabs 1133 $5.90

Pepto-Bismol 1317 $15.40

Pink Bismuth 1318 $8.40

Antifungal

Clotrim Antifungal Cream 1047 $13.00

Miconazole 2% Cream 1135 $13.60

TerbinafineHCLTube 1046 $16.70

Tolnaftate Cream 1064 $5.90

Anti-Itch Lotions and Creams

Bactine Solution 1142 $12.60

Pramoxine Topical Analgesic 1144 $10.80

Diphenhydramine HCL/ Zinc Acetate 1140 $5.80

Hydrocortisone 1% Cream 1074 $5.80

Cold Sore, Fever Blister and OtherMedicated Lip Products

Abreva 1152 $20.60

Blistex Lip Ointment 1256 $5.90

Carmex 1255 $5.40

Herpecin-L Lip Balm 1153 $9.10

Releev Cold Sore Treatment 1359 $40.10

Contact Lens Supplies

Multi Purpose Contact Lens Solution 1468 $8.40

Cough Suppressants and Expectorants

Cherry Cough Drop 30 lozenges 1056 $10.10

Diabetic Tussin DM 1323 $9.60

Guaifenesin Cough Expectorant 60 tabs 1180 $11.00

Cough Syrup, Expectorant 1054 $5.00

Mucus Relief DM (Guaifenesin Expectorant and Dextromethorphan Cough Suppressant) 30 tabs, 400-20 mg 1178 $8.00

Sore Throat Lozenges Cherry 18 lozenges 1176 $7.10

Sugar Free Cough Drop Cherry 25 lozenges 1182 $6.40

Dental/Denture Care

Dental Floss 55 yards 1455 $5.90

Denture Cleaning Tablets 40 tabs 1032 $7.90

Fixodent 1187 $9.10

Oral Pain Relief 1286 $8.70

Orajel Pain Relief 1454 $9.30

Rechargeable Toothbrush 1450 $38.20

ToothBrush•ColgateClean Adult Soft 1413 $5.20

ToothBrush•TekProStraight Soft 1412 $4.80

ToothPaste•Pepsodent 1414 $5.90

Polident Denture Cream 1324 $11.20

Acne Treatment

Acne Gel 10% Benzoyl Peroxide 1.5 oz 1076 $7.20

Allergy, Cold, Flu, Decongestant and Sinus

All Day Allergy Tablets 14 tabs 1090 $7.90

All-Nite Cold/Flu 500-15-6.25 mg 1361 $8.30

Children's Dimaphen 4 oz 1426 $6.10

Children's Diphenhydramine HCL 1428 $6.60

Chlorpheniramine Maleate100 tabs, 4 mg 1008 $6.00

Cromolyn Sodium(Allergy Nasal Spray) 1356 $21.40

Cough & Cold for High Blood Pressure 16 tabs 1166 $9.30

Diphenhist (Antihistamine) 100 tabs 1308 $7.90

Diphenhydramine HCL 24 capsules, 25 mg 1009 $8.30

Multi Symptom Cold Formula 24 tabs 1357 $8.40

Nasal Decongestant Spray 12 Hr, 1oz 1091 $9.50

Nasal Spray (Saline) 1.5 oz 1052 $9.50

Sudogest PE 36 tabs, 10 mg(Nasal and Sinus Decongestant) 1352 $6.00

Vapor Rub 1 oz 1164 $8.40

Pain Relievers and Fever Reducers

Acetaminophen 100 tabs, 325 mg 1001 $8.60

Acetaminophen 50 tabs, 500 mg 1105 $6.00

Aleve 100 tabs, 220 mg 1104 $14.20

Aspirin 100 tabs, 325 mg 1095 $4.90

Aspirin Enteric Coated100 tabs, 325 mg 1096 $7.10

Aspirin Low Dose 1002 $7.10120 tabs, 81 mg

Children's Acetaminophen30 chewables, 80 mg 1423 $6.20

Children's Ibuprofen 100 mg/ 5 ml 1421 $8.20

Ibuprofen 100 tabs, 200 mg 1004 $8.70

Menstrual Relief 24 tabs 1257 $6.90

Naproxen *D 100 tabs, 220 mg 1097 $14.40

Pain Reliever PM Extra Strength 100 tabs 1332 $11.60

Antacids and Acid Reducers

Alka-Seltzer 36 tabs 1313 $15.20

Chewable Antacid150 tabs, 500mg 1346 $7.00

Effervescent Pain Reliever 36 tabs 1314 $8.90

Famotidine *D 30 tabs 1108 $7.30

Gas-X 36 chewables, 80 mg 1312 $8.60

Antacid/Anti-Gas Liquid 1006 $9.50

Omeprazole *D 28 caps 1110 $39.80

Anti-Arthritic

Arthritis Pain Reliver 100 tabs 1311 $19.40

Capsaicin 1367 $11.40

Glucosamine Joint/Muscle 1114 $13.30 60 capsules

Glucosamine/Chondroitin 60 capsules 1003 $16.50

2. 3.

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.

Digestive Health

Beano 30 tabs 1316 $9.40

Lactase Capsules 60 capsules 1067 $12.30

Ear Care

Ear Drops 1190 $6.30

Ear Wax Removal Systemwith Rubber Bulb 1363 $9.90

Eye Care

ArtificialTearsDrops 1192 $6.10

Clear Eyes Eye Drops 1199 $8.20

Eye Drops (Redness Relief) 1061 $6.10

Eye Wash Solution 1196 $7.00

ArtificialTearsOintment 1194 $11.40

First Aid and Medical Supplies

Adhesive Bandages (Sheer)60 bandages 1344 $8.00

Alcohol Pads *D 100 pads 1200 $7.10

Ankle Support 1225 $11.50

Antiseptic Towelettes 100 pack 1201 $7.60

Automatic Blood Pressure Monitor Desktop 1253 $44.40

Hot/Cold Pack for Injury 1062 $8.50

Conforming Gauze Sterile *B 12 pads, 3” X 4 yd 1223 $15.00

Digital Ear Thermometer 1285 $16.70

Elastic Bandage 2” *B 1207 $4.50

Elastic Bandage 3” *B 1209 $4.80

Elastic Bandage 4” *B 1211 $5.20

Elastic Bandage 6” *B 1213 $6.10

Elbow Support 1224 $14.60

First Aid Kit 1215 $10.60

Hydrogen Peroxide 1228 $5.10

Knee Support 1226 $11.70

Lantiseptic Skin Protectant Ointment 1202 $10.60

Knee Stabilizer 1465 $27.10

Neosporin Plus 1326 $14.70

Night Wrist SupportSmart Glove 1463 $35.40

Non-skid Bath Mat 1459 $18.50

Non-skid Shower Mat 1460 $28.50

Povidone Iodine 1203 $5.30

Rib Belt - Male One size fits most 1456 $25.20

Rib Belt - Female One size fits most 1457 $25.20

Tape, Paper Surgical *B 1” X 10 yd 1217 $4.70

Tape, Paper Surgical *B 2” X 10 yd 1218 $5.90

Tape, Silk Surgical *B1” X 10 yd 1219 $5.40

Tape, Silk Surgical *B 2” X 10 yd 1220 $7.20

Tape, Transparent Surgical *B 1” X 10 yd 1221 $5.30

Tape, Transparent Surgical *B2” X 10 yd 1222 $7.00

Thermometer Digital 1063 $9.60

Wintergreen Isopropyl Alcohol 1229 $7.40

Wrist Splint 1230 $23.90

Wrist Support 1227 $13.50

Foot Care

Callus Remover Pads 6 pads 1238 $9.80

Corn Remover Pads 9 pads 1236 $9.80

Medicated Foot Powder 1240 $7.40

Hemorrhoidal Preparations

Anu-Med Suppository box of 12 1245 $8.50

Hemorrhoidal Ointment 1066 $9.00

Hemorrhoidal Suppository 1247 $6.60 box of 12

Preparation H Cream 1248 $18.50

Pre-Moist Hemorrhoid Pads 1364 $12.10 100 pads

Incontinence Supplies

A&D Ointment 1300 $6.60

Adult Briefs Med 32" - 44” waist 1303 $12.60

Adult Briefs LG 45” - 58” waist 1304 $15.60

Adult Briefs XL 59” - 64” waist 1305 $15.60

Barrier Cream 1302 $10.50

Underpad 23" x 36" 1299 $16.00

Washcloth w/Lanolin 1348 $9.60

Laxatives

Bisacodyl 100 tabs 1128 $6.50

Docusate Sodium 100 capsules 1126 $18.10

Ex-Lax 8 tabs 1124 $8.20

Glycerin Suppository 1125 $6.8025 tabs, 2 gm

Methylcellulose 1354 $19.90

Milk of Magnesia 12 oz 1011 $8.40

Natural Vegetable Laxative 1340 $16.00

Polycarbophil Fiber Tablets 1012 $13.7090 tabs

Senna Plus 60 tabs, 8.6-50 mg 1130 $8.70

Migraine Relief

Migraine Relief 100 tabs 1365 $9.90

Wellpatch Migraine box of 4 1261 $11.10

Minerals

Calcium Carbonate Tabs 1291 $8.3060 tabs

Calcium-Vitamin D 60 tabs 1373 $6.50

Ferrous Sulfate 100 tabs, 325 mg 1376 $7.60

Niacin 100 tabs, 100 mg 1378 $7.00

Niacin 100 tabs, 500 mg 1394 $9.60

Magnesium 110 tabs, 250 mg 1418 $8.40

Magnesium Oxide 100 tabs, 250 mg 1377 $9.30

Rena-Vite 100 tabs 1395 $21.40

Zinc Chelated 100 tabs, 50 mg 1419 $7.40

*B - May be covered by Medicare Part B. *D - May be covered by Medicare Part D.4. 5.

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

Motion Sickness

Dramamine Orange 8 chews 1264 $10.70

Driminate 12 tabs 1263 $6.00

Meclizine 100 tabs 1366 $12.00

Pediculicide

Lice Treatment Shampoo 1271 $14.00

Permethrin Cream Rinse 1269 $17.70

Personal Care

Ammonium Lactate 1368 $14.30

Aloe Vera Cream 1070 $10.70

Hand Sanitizer 1065 $7.20

Sunscreen Lotion SPF 15 1283 $11.10

Sunscreen Lotion SPF 30 1284 $12.80

Sleep Aids

Nasal Strips Sm/Med box of 30 1724 $14.00

Nasal Strips Med/Large 1725 $14.00box of 30

Sleep Tabs 24 tabs 1276 $7.10

Smoking Cessation

Nicorelief Gum 1372 $27.00

Nicotine Patch Step 1 1369 $40.30

Nicotine Patch Step 2 1370 $40.30

Nicotine Patch Step 3 1371 $40.30

Support Items

Men's Compression Knee Hi SocksBlack Large Shoe size 101/2-12(15-20 mmhg) 1399 $27.40

Men's Compression Knee Hi Socks White Med Shoe Size 8-10 (15-20 mmhg) 1400 $27.40

Men's Compression Knee Hi SocksWhite Large Shoe Size 101/2-12(15-20 mmhg) 1401 $27.40

Women's Compression Knee Hi SocksNude Small Shoe Size 4-5 (8-15 mmhg) 1406 $16.60

Women's Compression Knee Hi SocksNude Med Shoe Size 51/2-71/2 (8-15 mmhg) 1407 $16.60

Women's Compression Knee Hi SocksNude Large Shoe Size 8-101/2 (8-15 mmhg) 1408 $16.60

Women's Compression Knee Hi SocksBlack Small Shoe Size 4-5 (8-15 mmhg) 1409 $16.60

Women's Compression Knee Hi SocksBlack Med Shoe Size 51/2-71/2 (8-15 mmhg) 1410 $16.60

Women's Compression Knee Hi SocksBlack Large Shoe Size 8-101/2 (8-15 mmhg) 1411 $16.60

Topical Antibiotics

Bacitracin Ointment 1020 $5.80

Triple Antibiotic Ointment 1014 $9.90

Wart Remover

Dr. Scholl’s Wart Removal System 1288 $19.70

Wart Remover 1075 $9.00

Wartners Wart Removal System Kit 1289 $27.90

Home Diagnostics

Colon Cancer Test 1416 $18.60

Home Access Cholesterol Test 1251 $38.10

Vitamins

Centrum Silver 60 tabs 1420 $33.50

Daily Multiple Vitamin Tabs100 tabs 1385 $7.10

Ferrous Gluconate (Iron Supplement) 100 tabs 1375 $7.60

Iron 110 tabs, 27 mg 1417 $10.00

Multi Vitamin Children's100 chewables 1422 $10.00

Prenatal Vitamins 100 tabs 1274 $10.00

Vitamin A 100 tabs, 10 mu 1379 $6.30

Vitamin B-Complex 100 tabs 1382 $8.20

Vitamin B-1 100 tabs, 100 mg 1016 $7.50

Vitamin B-6 100 tabs, 50 mg 1380 $6.60

Vitamin B-6 100 tabs, 100 mg 1388 $7.10

Vitamin B-12 100 tabs, 500 mg 1389 $8.20

Vitamin B-12 100 tabs, 1000 mcg 1381 $11.20

Vitamin C 500 mg, 100 tabs 1017 $6.50

Vitamin Century Senior 90 tabs 1392 $13.10

Vitamin D 100 tabs, 1000 iu 1390 $8.10

Vitamin D 100 tabs, 400 iu 1383 $8.00

Vitamin E 100 tabs, 100 iu 1391 $7.40

Vitamin E 100 tabs, 400 iu 1384 14.40

Vitamin One A Day 100 tabs 1393 $8.10

6. 7.

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

Care1st Health Plan is an HMO and an HMO SNP plan with a Medicare contract and a contract with the California State Medicaid Program. Enrollment in Care1st Health Plan depends on contract renewal.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply.

This information is available for free in other languages. Please call our Member Services at 1-800- 544-0088 (TTY 711) 8 a.m. to 8 p.m., seven days a week from October 1 through February 14, except Thanksgiving and Christmas, and 8 a.m. to 8 p.m., Monday through Friday from February 15 through September 30, except holidays.

Esta información está disponible gratuitamente en otros idiomas. Comuníquese con Servicios para los Miembros: 1-800-544-0088 (TTY 711), de 8 a.m. a 8 p.m., los siete días de la semana del 1° de octubre al 14 de febrero, excepto el Día de Acción de Gracias y Navidad, y de 8 a.m. a 8 p.m., de lunes a viernes, del 15 de febrero al 30 de septiembre, excepto los días festivos.

這項免費資訊以其它語言提供。懇請聯絡會員服務處：免費熱線 1-800-544-0088 (聽障及語障人士專線711) 從10月1日至2月14日，上午8點至下午8點，每週七天，除感恩節和聖誕節外。從2月15日至9月30日，上午8點至下午8點，週一至週五，假日除外

Helpful Information• Ifyouhavequestionsorwouldliketoplaceanorderoverthephone,OTC

AdvocatesareavailableMonday–Fridayfrom8:00amto5:00pmPSTat 1-800-355-7913(TTY711).

• Ifyouplaceyourorderusinganorderform,yourordertotalwillbeappliedto thequarterinwhichwereceiveyourform.Forexample,ifyoumailyourorder formonJune29th,butwereceiveitonJuly1st,yourordertotalwillbeappliedto

yourJuly(orthirdquarter)benefit,notyourJune(orsecondquarter)benefit. If you’re getting close to the end of the quarter and you do not think your

order form will be received in time, you can call in your order.

• Weencourageyoutouseyourfullquarterlybenefitamountinoneorder.Thisbenefitamountdoesnotrolloverfromquartertoquarter.

• Yourordertotalmaynotexceedthequarterlybenefitamountshownintheletteryoureceivedwiththiscatalog.Cash,checksormoneyordersarenotacceptedunderthisOTCbenefit.

• Ordersmayonlybeplacedbythemember,anauthorizedrepresentativeverballyapprovedbythememberattimeoftheorder,and/orthemember’spowerofattorneyrepresentativeonfile.

• Touseyourbenefit,youmustselectproductsfromthiscatalogthatwillhelpyouwithahealthormedicalneed.Yourordertotalmaynotexceedyourbenefitamount.OTCproductsareintendedformembersuseonly.Care1stHealthPlanprohibitstheuseofthisbenefittoorderOTCitemsforfamilymembersandfriends.OTCitemsareavailablethroughmail-orderonly.

• Onceyourorderisreceived,pleaseallow7-10businessdaysfordelivery.

• ProductsmaynotbepurchasedatalocalretailpharmacyorthroughanyothersourceotherthantheCare1stHealthPlanOTCBenefitCatalog.

• IfyoudisenrollfromCare1stHealthPlan,yourOTCbenefitwillautomaticallyterminate.

• Returnsarenotaccepted.

• SomeitemslistedinthiscatalogmayalsobecoveredunderyourMedicare Part B (medical)benefitorPartD(pharmacy)benefit.Theseitemshavea*Bora*Daftertheirname.Forexample,alcoholpadsarecoveredunderPartDiftheyareusedforadministeringinsulin.Forallotherpurposes,thisitemiscoveredunderyourOTCbenefit.

• Itemsinthe2015OTCBenefitCatalogmaychangethroughouttheyear. AcopyofthiscatalogisalsoavailableontheCare1stHealthPlanwebsiteat www.care1st.com/ca/medicare.Forup-to-dateinformation,pleasecallourOTC

AdvocatesfromMonday-Fridayfrom8:00amto5:00pmPSTat1-800-355-7913(TTY711).