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ADVANTAGE Over the counter items and drugs guide OTC 2020 NOW SIMPLIFIED AND EASIER TO USE!

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Page 1: NOW SIMPLIFIED AND EASIER TO USE! - Triple-S Advantage€¦ · Urinary Pain Relief Azo _____ INSOMNIA RELIEF Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10

ADVANTAGE

Over the counter items and drugs guide OTC

2020

NOW SIMPLIFIED AND EASIER TO USE!

Page 2: NOW SIMPLIFIED AND EASIER TO USE! - Triple-S Advantage€¦ · Urinary Pain Relief Azo _____ INSOMNIA RELIEF Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10

BUY AND SAVE MORE ON YOUR OTC

Without prescriptionChoose brand and generic products

• Items for common symptoms and ailments• Products to stop smoking• Adult diapers• Nutritional drinks like

Products in all formats and varietiesSame day at your favorite pharmacy

Amount varies by coverage.

With more than 1,400 drugs and products available

Y0082_20CI189E_C

Page 3: NOW SIMPLIFIED AND EASIER TO USE! - Triple-S Advantage€¦ · Urinary Pain Relief Azo _____ INSOMNIA RELIEF Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10

OVER THE COUNTER ITEMS AND DRUGS GUIDE OTC

Pain relief Pain relief at night

Urinary analgesics

Insomnia reliefMotion sicknessCongestion reliefCough, cold, and allergy relief Sugar free

Nauseas reliefAntifungals for foot and nailsFemenine care itemsNutritional drinksDandru� shampooWeight controlDiabetes careSkin care Wound care

Moisturizers

Sunscreens

Others Ear careEye careDigestive/colorectal careOral careProducts to stop smoking Urinary incontinenceMiscellaneousBlood pressure monitorFirst aidOrthopedic braces and supportsVitamins and mineralsFrequently ask questions

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Page 4: NOW SIMPLIFIED AND EASIER TO USE! - Triple-S Advantage€¦ · Urinary Pain Relief Azo _____ INSOMNIA RELIEF Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10

DRUG NAME TRADE NAME

PAIN RELIEF

TylenolBayer / Ecotrin

ThermacareMotrin / AdvilIcy HotBengayExcedrin

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Acetaminophen Aspirin BiofreezeCapzasin Cream & Lotion Dragon Pain Relief CreamHeat Wrap Pad MiscellaneousIbuprofen Ice Blue 2 % GelMuscle Rub External CreamTension HeadacheSalonpas Pads

PAIN RELIEF AT NIGHTAdvil PM Aleve PM Bayer PM Diphenhydramine-Apap (Sleep) Tablet Excedrin PM Tablet

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

*This guide is subject to change. The included brands are for reference only. Other brands and variations may also be covered. Y0082_20CI002E_C 1

Tylenol PM

URINARY ANALGESICS

Cranberry Oral CapsuleUrinary Pain Relief Azo

______________________________________________________________________________________

INSOMNIA RELIEF

Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10 mg TabletSleep Aid 25 mg Tablet

Melatonin

Unisom______________________________________________________________________________________

MOTION SICKNESSMotion Sickness Relief 50 mg Tablet Dramamine

CONGESTION RELIEF Oxymetazoline HCL Nasal SolutionAllergy Spray 24 Hour Nasal Aerosol Saline Nasal Spray Nasal Mist Budesonide Nasal SuspensionFluticasone Propionate Nasal SuspensionSaline Nasal Spray Nasal Solution

Afrin Nasal Spray Nasal SolutionNasacort Allergy 24hrAyr Nasal SolutionRhinocort AquaFlonase & Flonse SensimistOcean

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Page 5: NOW SIMPLIFIED AND EASIER TO USE! - Triple-S Advantage€¦ · Urinary Pain Relief Azo _____ INSOMNIA RELIEF Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10

*This guide is subject to change. The included brands are for reference only. Other brands and variations may also be covered. Y0082_20CI002E_C 2

SUGAR FREECoditussin AC Liquid Robitussin DM Sugar Free SyrupCough Drops Sugar Free Lozenges Diabetic Tussin Cold & Flu Guaifenesin Tablet & Liquid

Diabetic Tussin C

Halls Sugar Free

Diabetic Tussin / Robitussin Sugar Free

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

COUGH, COLD, AND ALLERGY RELIEFAllergy Multi-Symptom Tablet

Af-Apap Allergy Sinus Tablet Af-Pseudoephedrine Sinus CapsuleBenadryl Allergy 25 mg CapsuleChlorphen-Phenyleph-Ibuprofen Tablet Chlorpheniramine-Pse-Ibuprofen TabletPseudoephedrine-Ibuprofen Capsule Phenylephrine-Ibuprofen Tablet Phenyleph-Cpm-Dm-Apap Phenyleph-Doxylamine-Dm-Apap Biobron SF SyrupBiodesp DM Syrup Cold & Flu Relief Nighttime LiquidCoricidin D 2-30-325 mg TabletCoricidin HBP 10-325-2 mg TabletCoricidin HBP Cold/Flu 2-325 mg TabletCold/Flu Relief Day/Night Oral MiscellaneousCough & Cold (Chlorpheniramine-Acetaminophen) Tablet Cough Drops Lozenges Day Time Multi-Symptoms Cold/Flu CapsulesDextromethorphan Polistirex Suspension Extended Release Dextromethorphan-Guaifenesin TabletDextromethorphan-Guaifenesin-Phenylephrine Oral Tablet & Liquid Guaifenesin Extended Release Guaifenesin-Dextromethorphan Syrup Mucus Relief DM Extended Release Pseudoephedrine-Guaifenesin Extended ReleaseSodium Chloride Inhale Nebulizer Solution Sore Throat Oral Liquid Vicks Vaporub Ointment

Tylenol Multi-Symptom / Mucinex / Sudafed PETylenol Allergy SinusRobitussin Severe Congestion

Advil Allergy & Congestion Advil Allergy Sinus Advil Cold & Sinus Advil Sinus Congestion & PainAlka-Seltzer Plus Cold & Cough Alka-Seltzer Plus Cold & Flu Brontuss SFDespec DMCoricidin HBP

Vicks Dayquil/Nyquil Cold & FluCoricidin HBP Cold/FluHalls / CepacolMucinex / RobitussinDelsymZyncof / Broncotron-S Giltuss / Panatuss Dxp / Broncotron D/ DeconexMucinex ERRobitussin DM / Trispec DMXMucinex DMMucinex DNebusalChloraseptic

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DRUG NAME TRADE NAME

Page 6: NOW SIMPLIFIED AND EASIER TO USE! - Triple-S Advantage€¦ · Urinary Pain Relief Azo _____ INSOMNIA RELIEF Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10

*This guide is subject to change. The included brands are for reference only. Other brands and variations may also be covered. Y0082_20CI002E_C 3

ANTIFUNGALS FOR FOOT AND NAILS

Clotrimazole Cream, External Solution, & Ointment Miconazole Nitrate CreamScholls Fungal Nail Management Ext KitTerbinafine Cream

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Fungicure / Lotrimin AF / Mycelex Neosporin AF / Secura

Silka

NAUSEAS RELIEFAnti-Nausea 1.87-1.87-21.5 Solution Emetrol

FEMENINE CARE ITEMS

Anti-Itch Vaginal Cream

Clotrimazole Vaginal Cream Complete Menopause Health TabMiconazole 1 Combo PackFeminease Vaginal Cream Miconazole Cream & Vaginal Suppository Norforms Vaginal SuppositoryPoise Body Cooling TowelettesReplens Vaginal GelTioconazole Vaginal OintmentVagisil Yeast-Control Vaginal Suppository

Vagisil Vaginal Cream / Vagisil Feminine Moisturizer Vagina Lotion LotriminEstroven Monistat 1 Day

Monistat / Monistat 3 / Monistat 7

Monistat 1

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

NUTRITIONAL DRINKSBoost LiqEnsure LiqGlucerna Liq Preprotein Liq

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Head & Shoulders ShampooNizoral A-D ShampooSelsun Blue Shampoo

____________________________________________________________________________________________________________________________________________________________________________

DANDRUFF SHAMPOO

WEIGHT CONTROL

Alli 60 mg CapsuleSlim-Fast Liquid

______________________________________________________________________________________

DRUG NAME TRADE NAME

Page 7: NOW SIMPLIFIED AND EASIER TO USE! - Triple-S Advantage€¦ · Urinary Pain Relief Azo _____ INSOMNIA RELIEF Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10

EAR CAREEar Dry Otic LiquidEar Wax Removal Drops Otic Solution Ear Wax Removal System Otic Oil

Auro-DriDebroxMurine

____________________________________________________________________________________________________________________________________________________________________________

EYE CAREArtificial Tears Ophthalmic Solution Eye Wash Irrigation SolutionLubricant Eye Drops Ophtalmic Solution

Naphazoline Ophthalmic SolutionRedness Relief Ophthalmic Solution

Genteal TearsBoraquaRefresh Tears / Systane / Systane Balance / Retaine / TheratearsNaphcon-A Visine

____________________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________

SKIN CARE

MOISTURIZERS A & D Zinc Oxide CreamAloe Vera GelAmmonium Lactate Moisturizing CreamZinc Oxide

Banana BoatLac-HydrinCeraveDesitin / Cozima

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________

SUNSCREENS Sunscreen Spf 30 LotionSunscreen Spf 50 Lotion

CoppertoneCoppertone

______________________________________________________________________________________

*This guide is subject to change. The included brands are for reference only. Other brands and variations may also be covered. Y0082_20CI002E_C 4

DIABETES CARE

Glucose Tablets Gold Bond Ultimate Diabetics CreamDiabetic Socks Ankle Black Medium & Large Diabetic Socks Ankle White Medium & Large

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Trueplus

WOUND CARE

Pedi-Pre Tape Spray

OTHERS Advanced Hand SanitizerAgua MaravillaInsect Repellent External Liquid

PurellAgua HamamelisO�

DRUG NAME TRADE NAME

Page 8: NOW SIMPLIFIED AND EASIER TO USE! - Triple-S Advantage€¦ · Urinary Pain Relief Azo _____ INSOMNIA RELIEF Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10

*This guide is subject to change. The included brands are for reference only. Other brands and variations may also be covered. Y0082_20CI002E_C 5

ORAL CARE Anbesol Maximum Strength Biotene Dry Mouth Cepacol SoreDental Floss Waxed MiscellaneousFinaftaFixodent Original CreamOrajel 10 % M/T Gel, 20 % M/T Gel, 20 % M/T Liq Soft Toothbrush MiscellaneousToothpaste Miscellaneous

Colgate / Oral-B

Colgate / Oral-BBiotene / Colgate / Sensodyne

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PRODUCTS TO STOP SMOKING Nicotine PatchNicotine Polacrilex Gum

Nicoderm CQNicorette

______________________________________________________________________________________

DIGESTIVE/COLORECTAL CARE

Acid Control 75 mg Tablet Acid Reducer 10 mg Tablet Antacid Anti-Gas SuspensionAntacid Extra Strength Chewable & Oral Suspension Antacid Maximum ChewableBisacodyl Rectal Suppository & Tablet Bismatrol Maximum Strength SuspensionBismuth 262 mg Tablet ChewCastor Oil Stimulant Laxative 100% Oral OilClear Soluble Fiber Oral Powder Dairy Digestive Supplement Docusate Sodium Capsule, Tablet, Liquid, & Syrup Fiber Oral Poder Fiber Laxative Capsule & TabletGas Relief Extra Strength Capsule Glycerin (Adult) Rectal SuppositoryHemorrhoidal Rectal Suppository, Ointment, Cream & Gel Lidocaine-Glycerin External Pads Loperamide Hcl Tablet And Liquid Lactase Enzyme Phillips Milk Of MagnesiaMineral Oil Natural Fiber Laxative Oral Powder Senna Oral Capsule, Syrup & Powder

ZantacPepcid AcMaaloxGavisconTumsDulcolax / Ex-LaxKaopectate / Pepto-BismolPepto-BismolCastor OilBenefiberFast ActColace JuvenCitrucel / Konsyl / MetamucilGas-XColacePreparation HRecticare 5-20 % PadImodium A-DLactaid

RobertsMetamucil / KonsylSenna / Senokot / Agoral

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DRUG NAME TRADE NAME

Page 9: NOW SIMPLIFIED AND EASIER TO USE! - Triple-S Advantage€¦ · Urinary Pain Relief Azo _____ INSOMNIA RELIEF Melatonin 1 mg Tablet, 2.5 mg Tablet, 3 mg Tablet, 5 mg Tablet, 10

*This guide is subject to change. The included brands are for reference only. Other brands and variations may also be covered. Y0082_20CI002E_C 6

URINARY INCONTINENCE

Poise Incontinence LinersDiapersDisposable Underpads Miscellaneous

Certainty / DependCurity / Prevail

____________________________________________________________________________________________________________________________________________________________________________

MISCELLANEOUS

Cotton Balls MiscellaneousDigital Thermometer MiscellaneousEar, Oral, Rectal Thermometer MiscellaneousFood Scales MiscellaneousHeating Pad Moist/Dry Pad MiscellaneousIce Bag Miscellaneous7 Days Pill Box MiscellaneousPill Cutter Miscellaneous

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

BLOOD PRESSURE MONITOR

Blood Pressure Cu� MiscellaneousBlood Pressure Monitor Dev, kit

______________________________________________________________________________________

FIRST AIDAdhesive Bandages MiscellaneousAdhesive Paper TapeAgua De AzaharAlcoholadoAnti-Itch Maximum Strength CreamBacitracin OintmentPramoxine-Calamine External LotionCalamine-Zinc Oxide External LotionCurity Gauze Sponge PadsCurity Non-Adherent StripElastic Bandage MiscEpsom Salt Exoderm 10-3 % BarFirst Aid KitHydrocortisone Cream, Lotion, & Ointment Hydrocortisone-Aloe Cream & Ointment Isopropyl Alcohol (Rubbing) Lice Killing ShampooLice Treatment Petroleum Jelly OintRemove Adhesive Remover External Liquid

Band-Aid Band-Aid EkoSuperior 70Benadryl

CaladrylCalamine

Epsom Salt

Cortizone-10 / Ala-Cort / CortaidAla-Cort

RidNix / RidVaselineBand-Aid / Nexcare

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DRUG NAME TRADE NAME

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*This guide is subject to change. The included brands are for reference only. Other brands and variations may also be covered. Y0082_20CI002E_C 7

Ankle Support Adjustable MiscellaneousArm Sling MiscellaneousBack Support MiscellaneousKnee Stabilizer Small, Medium and Large Sizes MiscellaneousKnee Wrap Open Patella MiscellaneousTennis Elbow Strap MiscellaneousThigh Wrap MiscellaneousWrist Splint/Reversible MiscellaneousWrist Support MiscellaneousWrist Wrap Miscellaneous

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ORTHOPEDIC BRACES AND SUPPORTS

FIRST AID cont.

Restore Contact Layer 8"x12" PadRestore Duo Dressing 2"x4" Pad, 4"x5" PadRestore Foam Dressing 2.5"x2.5" Pad, 6"x8" Pad, 8"x8" PadRestore Foam Heel Dressing 4.7"x7.5" PadRestore Odor Absorbing Dress 6"x10" PadSterile Gauze PadStretch Gauze Bandage Triple Antibiotic Neosporin

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

VITAMINS AND MINERALS

Airborne Lozenge & Tablet Apetex Oral ElixApetigen-Plus SolutionAscorbic Acid Oral TabletB Complex Oral Capsule & Tablet B-12 (Cynocobalamin) Oral TabletBiotin Caspules & TabletBody/Hair/Skin/Nails Oral Capsule Calcium Oral TabletCalcium /Vitamin D3 Oral TabletCalcium-Magnesium-Vitamin D Oral Capsule, Tablet & Liquid Calcium-Magnesium-Zinc Oral Tablet Cinnamon Oral Tablet Citracal +D3 Citracal Calcium Gummies Citracal Plus Heart Health Oral Tablet Co Q10 Oral Capsules

Vitamin CB Complex Vitamin B12

ActicalCaltrateCaltrate D

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DRUG NAME TRADE NAME

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*This guide is subject to change. The included brands are for reference only. Other brands and variations may also be covered. Y0082_20CI002E_C 8

VITAMINS AND MINERALS cont.

Emergen-C Vitamin C Oral Package Ferrous Aspartate Oral Tablet Ferrous Fumarate Oral TabletFerrous Gluconate Oral Tablet Ferrous Sulfate Oral Tablet Folic Acid 400 mcg Tablet, 800 mcg TabletGarlic Oral Tablet & CapusleGinkgo Biloba Oral Tablet & CapsuleGinger Oral Capsule Glucosamine-Chondroitin Oral CapsuleIcaps Lutein & Zeaxanthin Oral Tablet Iron Oral Tablet Lipoflavonoid TabletMagnesium Oxide Oral TabletMultivitamin Capsule, Liquid, & Tablet Multi-Vitamin/Minerals Oral TabletOmega 3 Oral Capsule Omega 3-6-9 Oral Capsule Oyster Shell Calcium +Vitamin D Oral Tablet Pyridoxine Hcl Oral TabletPreservision Areds Oral TabletRenal Vitamin Oral Tablet Saw PalmettoVitamin C/Bioflavonoids Oral Tablet Vitamin D3 Vitamins For Hair Oral Tablet Wee Care Suspension

Folic Acid

Feosol

Mag-OxCentrum / One-A-DayCentrum / Ocusoft / Ocuvite-EyeFish Oil

Os-Cal + DVitamin B6

Nephro-Vite

Vasoflex / Ester-CMaximum D3CentrumIcar

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DRUG NAME TRADE NAME

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What are Over the Counter (OTC) drugs and Items?OTC drugs are non-prescription drugs that are not normally covered by the Medicare Part D prescription drug benefit. OTC drugs are used for the treatment of medical symptoms such as cough, cold, pain, diarrhea and upset stomach, among others.

When can I begin to use my OTC drugs and Items benefit and what does it include?You can begin to use your OTC benefit, once your enrollment is e�ective with the plan. This guide includes OTC drugs and items for the health and wellness over the counter. It contains a list of some common-use drugs. The guide does not include the drugs and brands in all variations, formats and trade names.

What are the rules for getting OTC drugs and items?You will be able to obtain OTC drugs and items without a medical order. The following rules apply for getting OTC drugs and items:

1. Triple-S Advantage will provide the maximum amount of money set forth in your Evidence of Coverage every 3 months for the purchase of OTC drugs and items. After the maximum dollar amount is reached, Triple-S Advantage will not cover these drugs until the following three months, when the maximum quarterly coverage starts again. The quarters are according to calendar year, for example: January-March, April-June, July-September and October-December, with a total of four quarters per year. The amounts must be used in full as they do not accumulate from quarter to quarter.

2. If the quantity of the products you wish to purchase is greater than the maximum quarterly amount set out in your Evidence of Coverage, you must assume payment of the di�erence.

3. OTC drugs must be obtained through the Triple-S Advantage network, and they may only be purchased and used by the enrollee.

4. The categories of OTC drugs and items must be included in this guide, to be covered. The availability of brands and costs may vary depending on the network pharmacy you visit.

FREQUENTLY ASK QUESTIONS

Y0082_20CI002E_C 9

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What are the advantages of using OTC drugs?The use of OTC drugs allows the patient to have greater access to a variety of drugs available in the market for the treatment of some common symptoms.

Consult your physician or pharmacist and remember to always read the package labeling for specific instructions on how to take them, as well as any warnings or precautions you should consider when taking them.

How do I use this OTC Drugs and Items Guide?This guide classifies OTC drugs and items by category, according to the most common symptoms they are used for. For example, drugs to treat cough and congestion are classified under the category Cough, cold, and allergy relief. If you know what your OTC drug is used for, look for the category name in the Table of Contents. Then look for your OTC drug under that category.

How can I know the available amount that I have for OTC drugs or medications? The available amount of the benefit varies by coverage. For more information regarding the available amount you can call us at our Member Service Center or visit the nearest service center.

Where I should contact in case of doubts and questions?This guide is e�ective from January 1, 2020 through December 31, 2020. For more information, contact our Member Service Center at 1-888-620-1919, toll free. Hearing impaired with TTY should call 1-866-620-1919, Monday through Sunday from 8:00 A.M. to 8:00 P.M., or visit our website www.sssadvantage.com.

FREQUENTLY ASK QUESTIONS cont.

Y0082_20CI002E_C 10

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MY OTC LIST

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11

NOTES ____________________________________________________________________

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MULTI-LANGUAGE INTERPRETER SERVICES

Y0082_4036_17_012_E 12

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Triple-S Advantage, Inc. complies with applicable federal civil rights laws and does notdiscriminate on the basis of race, color, national origin, age, disability or sex. Triple-S Advantage, Inc. does not exclude people or treat them di�erently because of race, color national origin, age, disability, or sex.

Triple-S Advantage:• Provides free aids and services to people with disabilities to communicate e�ectively with us, such as: - Qualified sign language interpreters - Written information in other formats (large print, audio, accessible electronic formats, other formats)• Provides free language services to people whose primary language is not Spanish, such as: - Qualified interpreters - Information written in other languages.

If you need these services, contact a Service Representative.

If you believe that Triple-S Advantage, Inc. has failed to provide these services or discriminated in another way on the basis of race, color national origin, age, disability, or sex, you can file a grievance with:

Service RepresentativePO Box 11320San Juan, PR 00922-1320

Telephone 1-888-620-1919 • TTY: 1-866-620-2520

Fax 787-993-3261

[email protected]

NOTICEINFORMING INDIVIDUALS ABOUT NONDISCRIMINATION AND

ACCESSIBILITY REQUIREMENTS AND NONDISCRIMINATION STATEMENT:DISCRIMINATION IS AGAINST THE LAW

Y0082_3032_17_CI_034_E 12

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You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, a Service Representative is available to help you.

You can also file a civil rights complaint with the US Department of Health and Human Services, O�ce of Civil Rights electronically through the O�ce of Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/o�ce/file/index.html.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-888-620-1919 (TTY: 1-866-620-2520).

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 1-888-620-1919(TTY: 1-866-620-2520) 。

ATENCIÓN: si usted habla español, servicios de asistencia lingüística están disponibles libre de cargo para usted. Llame al: 1-888-620-1919 (TTY: 1-866-620-2520).

NOTICEINFORMING INDIVIDUALS ABOUT NONDISCRIMINATION AND

ACCESSIBILITY REQUIREMENTS AND NONDISCRIMINATION STATEMENT:DISCRIMINATION IS AGAINST THE LAW

Y0082_3032_17_CI_034_E 13

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ADVANTAGE

Guide subject to change. Triple-S Advantage, Inc. is an independent licensee of BlueCross BlueShield Association.

TTY (hearing impaired)1.866.620.2520

MONDAY THROUGH SUNDAYFROM 8 A.M. TO 8 P.M.

Toll free1.888.620.1919

CALL US TODAY!


Aklovir 800 mg Film Tablet - pdf.ilacprospektusu.com

Step Therapy Criteria - stewardhcgenerations.org · JANUVIA TABLET 100 MG ORAL JANUVIA TABLET 25 MG ORAL JANUVIA TABLET 50 MG ORAL JENTADUETO TABLET 2.5-1000 MG ORAL JENTADUETO TABLET

2021 Step Therapy (ST) Criteria...etodolac ER 500 mg tablet,extended release 24 hr • etodolac ER 600 mg tablet,extended release 24 hr • fenoprofen 600 mg tablet • flurbiprofen

Prescription Drug Monitoring Programs Maximizing … · dextroamp-amphetamin 20 mg tab hydrocodone-acetamin 10-325 mg methadone hcl 10 mg tablet methadone hcl 10 mg tablet dextroamp-amphetamin

Friday, May 19, 2006 - ACCE€¦ · Web view31.99 CLONAZEPAM 1 MG TABLET 60 9.06 26.09 ZOLPIDEM TARTRATE 10 MG TABLET 30 10.82 52.59 AZITHROMYCIN 250 MG TABLET 6 21.39 37.99 CYCLOBENZAPRINE

TALK WITH YOUR DOCTOR ABOUT $3 GENERIC DRUGS · LISINOPRIL TABLET 40 MG LISINOPRIL-HCTZ TABLET 20-25MG LISINOPRIL-HCTZ TABLET 20-12.5 MG LISINOPRIL-HCTZ TABLET 10-12.5MG LOSARTAN

web.persi.or.id · 2020. 10. 1. · HARGA PER KEMASAN NAMA OBAT ACT (Artesunate tablet 50 mg + Amocliaquine anhydrida tablet 200 mg) ACT (Artesunate tablet 50 mg + Amocliaquine anhydrida

2 · nabumetone oral tablet 500 mg, 750 mg 2 naproxen oral suspension 125 mg/5 ml (Naprosyn) 2 naproxen oral tablet 250 mg, 375 mg 1 naproxen oral tablet 500 mg (Naprosyn) 1 naproxen

Drug GCN NDC TRAMADOL HCL 50 MG TABLET 07221 …brand.excellusbcbs.com/broker/downloads/SA_Opioids_071516.pdftramadol hcl 50 mg tablet 07221 76439013650 ultram 50 mg tablet 07221 50458065960

4-tier Drug Discount Program - Preferred Prescription Card · 4-tier Drug Discount Program ... IBUPROFEN 800 MG TABLET per 30 NAPROXEN 375 MG TABLET per 60 ETODOLAC 400 MG TABLET

UPMC Medicare 2016 · 2016-10-31 · 1 ABILIFY Products Affected aripiprazole oral tablet 10 mg, 15 mg, 2 mg, 20 mg, 30 mg, 5 mg aripiprazole oral tablet,disintegrating 10 mg, 15

ioni.pom.go.idioni.pom.go.id/sites/default/files/obat_baru/3 TC Tablet salut... · This may be administered as 150 mg (1 x 150 mg tablet) twice daily or 300 mg (2 x 150 mg tablet)

UUHP Exchange Formulary Table of Contents 3 7sulfasalazine oral tablet 500 mg. 2: sulfasalazine oral tablet,delayed release (dr/ec) 500 mg. 2: sulindac oral tablet 150 mg, 200 mg

Tablet Clomid 50 mg | Mydrugpill

RITALINE 10 mg, tablet CONCERTA LP 18 mg, 36 mg, 54 mg, tablet · TABLE OF CONTENTS ... depression, tics and Tourette’s syndrome). According to the DSM-IV classification, there

Blue Cross Blue Shield of Massachusetts Formulary: $9 ... · 7/1/2020  · labetalol hcl 100 mg tablet 180 labetalol hcl 200 mg tablet 180 labetalol hcl 300 mg tablet 180 lisinopril

pionas.pom.go.idpionas.pom.go.id/sites/default/files/obat_baru/Xarelto Tablet salut... · 1 film-coated tablet contains 15 mg rivaroxaban. Xarelto 20 mg I film-coated tablet contains

CPL - 18013 · 2018-10-31 · products affected step 2: • trintellix 10 mg tablet • trintellix 20 mg tablet • trintellix 5 mg tablet • viibryd 10 mg (7)-20 mg (23) tablets

PUBLIC SECTOR (LOCAL PURCHASE) MEDICINES WHOLESALE PRICE ... · Abiraterone 250 mg Tablet Zytiga 250mg Tablet Patheon Inc L02B ... Alprazolam 0.5mg Tablet Besquil Tablets 0.5 mg

5 Tahun Perjalanan E-Katalog Obat - FARMASI INDUSTRI...Amoksisilin tablet 500 mg Klorfeniramina Maleat (CTM) t 4 mg Vitamin B Kompleks tablet Asam Mefenamat tablet 500 mg Deksametason

203826Orig1s000...and in oral cold/cough combination products (e.g., Advil Congestion Relief, ibuprofen 200 mg/phenylephrine 10 mg film coated tablet, up to 6 tablets per day if needed)

Drug Target Maximum QuantityCADUET 10 MG-80 MG TABLET 30 tablets per prescription CADUET 2.5 MG-10 MG TABLET 30 tablets per prescription CADUET 2.5 MG-20 MG TABLET 30 tablets per prescription

-K 500/30/10 mg tablet

Texas Prior Authorization Program Clinical Criteria Drug ... · clonazepam 0.5 mg tablet : 17470 . clonazepam 1 mg tablet : 17471 . clonazepam 2 mg tablet : 17472 . diazepam 5 mg/ml

pionas.pom.go.idpionas.pom.go.id/sites/default/files/obat_baru/Clarinase Tablet... · Each sugar coated tablet contains 5 mg loratadine in the tablet coating and 120 mg pseudoephedrine

2 · nabumetone oral tablet 500 mg, 750 mg 1 naproxen oral suspension 125 mg/5 ml (Naprosyn) 1 naproxen oral tablet 250 mg, 375 mg 1 naproxen oral tablet 500 mg (Naprosyn) 1 naproxen

State of Montana · alendronate sodium FOSAMAX 35 MG TABLET ORAL Generic $0.44857 alendronate sodium FOSAMAX 70 MG TABLET ORAL Generic $0.32525 alfuzosin hcl UROXATRAL 10 MG TABLET,

2020 Cigna STAR+PLUS Quantity Limit Criteria · ambien 10 mg tablet tablet 30 30 ambien 5 mg tablet tablet 30 30 ambien cr 12.5 mg tablet tablet, extended release multiphase 30 30

2021 Step Therapy Protocols - Imperial Health Plan...• saphris tablet sublingual 10 mg sublingual • saphris tablet sublingual 2.5 mg sublingual • saphris tablet sublingual 5

LOSARTANKALIUM 25 50 100 MG PCH filmomhulde tabletten ...€¦ · Elke tablet Losartankalium 25 mg PCH bevat 25 mg losartan (als kaliumzout). Elke tablet Losartankalium 50 mg PCH

Preferred Drug List February 2020...ibuprofen oral tablet 200 mg Advil OTC ibuprofen oral tablet 400 mg, 600 mg, 800 mg IBU INDOCIN ORAL SUSPENSION 25 MG/5ML INDOCIN RECTAL SUPPOSITORY

204441Orig1s000 - Food and Drug Administration...60-mg tablets. The 45-mg tablet is exactly 0.75 times and the 90-mg tablet is exactly 1.5 times the 60-mg tablet. . Dissolution similarity:

Quantity Limit Program Target Drugs Dosage/Strength...Paxil (paroxetine)a 30 mg tablet 2 tablets Paxil (paroxetine)a 40 mg tablet 1 tablet Paxil (paroxetine) 10 mg/5 mL suspension

SKRIPSI - CORE tahap intensif 5 resep (6%) yaitu rifampisin 450 mg (1 kaplet), isoniazid 300 mg (2 tablet), pirazinamid 500mg (3 tablet) dan etambutol 250 mg (3 tablet) serta tahap

Angeliq Tablet 1 mg + 2 mg_Estradiol+