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Over-The-Counter (OTC) Medications Applies To: Tufts Health Ritogether and Tufts Health Together*

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Over-The-Counter (OTC) Medications Applies To: Tufts Health Ritogether and Tufts Health Together* Over-the-Counter (OTC) Medications Applies to: Tufts Health RITogether and Tufts Health Together* As communicated in the November 1, 2018 Provider Update, the following changes are effective for fill dates on or after January 1, 2019. As a result of this change, some OTC medications will require prior authorization in certain circumstances as outlined below: Brand-Name OTC Medication Has a Covered Interchangeable Generic Version Available Afrin No Drip Advil capsule Advil tablet Advil PM tablet Afrin Nasal Spray Original nasal solution Afrin No Drip Aveeno Oatmeal Severe nasal Aleve tablet Baciguent ointment Benadryl capsule Bath Pak Treatment solution Benadryl Allergy Benadryl Allergy Benadryl Allergy Benadryl Extra Benefiber powder tablet capsule Liquid Strength cream Caltrate 600 +D Centrum Silver Betadine Swabstick Caltrate + D tablet Centrum liquid Plus Minerals tablet tablet Centrum Silver Centrum Ultra Men’s Children’s Advil Centrum tablet Cheracol-D syrup Adult 50+ tablet tablet suspension Children’s Benadryl Citracal Calcium + Children’s Benadryl Children’s Tylenol Chlor-Trimeton Allergy chewable D Slow Release Allergy liquid suspension syrup tablet tablet Citrucel Fiber Claritin-D 12 hour Claritin-D 24 hour Clear Cough Liquid Citrucel tablet Laxative powder tablet tablet PM Dimetapp DM Dex4 Fast Acting Dimetapp Cold and Colace capsule Conceptrol 4% gel Cough and Cold Glucose liquid Allergy elixir elixir Dristan nasal spray Dulcolax tablet D-Vi-Sol liquid Ecotrin tablet Evac powder Ex-Lax chewable Gas-X chewable Feosol tablet Fer-In-Sol solution Fleet enema tablet tablet Gas-X Extra Gaviscon Extra Genteal Mild to Gelusil chewable Strength chewable Strength chewable Genteal Gel Moderate tablet tablet tablet ophthalmic solution Geritol Complete Glycerin Adult Gonak ophthalmic Gyne-Lotrimin 1% Gyne-Lotrimin 3 tablet suppository solution vaginal cream cream Hydrocil Instant Icar Pediatric Hemocyte tablet Hibiclens liquid Imodium A-D liquid packet Suspension Maalox Advanced Infants’ Tylenol Imodium A-D tablet Konsyl powder Lotrimin AF cream Maximum strength Suspension tablet Monistat 3 Combo Monistat 3 Magox tablet Monistat 1 Monistat-3 cream Pack Combination pack Monistat Soothing Muro 128 Monistat 7 Motrin Infant Drops Care Itch Relief Mucinex-DM tablet ophthalmic cream ointment Muro 128 Mylanta DS Naphcon-A Mylanta suspension Nasalcrom spray ophthalmic solution suspension ophthalmic solution Revised 10/2018 1 Over-the-Counter (OTC) Medications – Tufts Health RITogether and Tufts Health Together Brand-Name OTC Medication Has a Covered Interchangeable Generic Version Available Neosporin Plus Pain Neosporin Original One-A-Day Men’s Relief Maximum Nicoderm CQ patch Ocean Nasal Spray ointment tablet Strength One-A-Day One-A-Day One-A-Day Scooby Vitacraves Gummies Opcon-A ophthalmic Pedia-Lax Women’s Formula Chewables + Omega 3 DHA solution suppository tablet chewable tablet Pedialyte Advanced Pedialyte Electrolyte Pedialyte Freezer Pepcid AC Maximum Pedialyte solution Care solution Singles Pops Strength tablet Pepto-Bismol Pepto-Bismol Refresh Plus Pepto-Bismol tablet Phillips tablet chewable tablet suspension ophthalmic solution Refresh Tears Sudafed Congestion Rid Aerosol Senokot-S tablet Slo-Niacin tablet ophthalmic solution tablet Tums Lasting Tinactin 1% aerosol Tums chewable Tagamet HB tablet Tinactin 1% aerosol Effects chewable powder tablet tablet Tylenol Children’s Tylenol Children’s Tylenol tablet Tylenol Arthritis Tylenol 8 Hour Pain and Fever Chewable tablet Chewable tablet Tylenol Infants Tylenol Cough Sore Tylenol Extra Tylenol PM Extra Fever and Pain Unisom tablet Throat liquid Strength tablet Strength tablet suspension Vick’s Sinex 12 Visine Advanced Visine ophthalmic Visine Extra Vitacraves + Omega Hour Decongestant Relief ophthalmic solution ophthalmic solution 3 Chews solution solution Zantac 150 Zaditor ophthalmic Zyrtec Allergy Zantac 75 tablet Maximum Strength Zyrtec Allergy tablet solution capsule tablet Zyrtec Children’s Zyrtec-D Allergy/ Zyrtec tablet ZZZquil liquid Allergy oral solution Congestion tablet Brand-Name OTC Medication Does Not Have an Interchangeable Generic Version Available and Requires Prior Authorization Allergy Multi Pak Antacid Soft chews Aquaphor Advanced Aquadeks Aquaphor Day/Night tablet Therapy Ayr Nasal Drops Baridium tablet Benefiber Drink Mix Brotapp DM elixir Cerave cream Centravites Adults Centrum Silver Ultra Centrum Silver Ultra Centrum Silver Centrum Ultra tablet Men’s tablet Women’s tablet Women’s tablet Women’s tablet Children’s Zyrtec Cerovite Advanced Certavite Senior Children’s Claritin Claritin chewable Allergy orally Formula liquid tablet chewable tablet tablet disintegrating tablet Eq Sinus Relief Clean & Clear Eq One Daily Men’s Eq One Daily Claritin Reditabs Maximum Strength Advantage lotion tablet Women’s tablet tablet Freshkote Isopto Tears Histex Liquid Hydralyte solution Lohist-D liquid ophthalmic solution ophthalmic solution Revised 10/2018 2 Over-the-Counter (OTC) Medications – Tufts Health RITogether and Tufts Health Together Brand-Name OTC Medication Does Not Have an Interchangeable Generic Version Available and Requires Prior Authorization Metamucil Fiber Metamucil Metamucil Smooth Miconazole 1 kit Mucinex tablet Singles Multihealth Fiber Texture packet Combo Nexafed Sinus Multivitamin Adults Multivitamin Men’s Multi-Delyn liquid Multi Prenatal tablet Pressure and Pain tablet tablet tablet Non-Drying Sinus Nortemp Infants Pedia-Lax chewable Prenatal One Daily Oncovite tablet PE tablet suspension tablet tablet Refresh Optive Prenatal Vitamin RA APAP Flu Severe Refresh Liquigel Prilosec OTC tablets Advanced tablet Cold tablet ophthalmic solution ophthalmic solution Refresh Optive Spectravite Senior Right Step Prenatal Spectravite Adult Spectravite Adult Sensitive Ultra Women’s Vitamin tablet 50+ tablet gummies ophthalmic solution tablet Spectravite Ultra Spectravite Ultra Spectravite Ultra Sudafed Severe Women’s Health Thera-M tablet Men's tablet Men’s 50+ tablet Cold tablet tablet Theranatal Lactation Tums Chewy Thera M Plus tablet Thera-Tabs M tablet Therems-M tablet One tablet Delights tablet Tylenol Allergy Pack Tylenol Sinus MS Unicomplex-M tablet Vanicream Multi Symptom tablet Brand-Name and Generic Versions of the Same OTC Medication Require Prior Authorization Clear Eyes Redness Robitussin Pediatric Delsym suspension Fibercon tablet Lamisil AT cream Relief solution syrup Thick-It Vivarin tablet *Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans (ACPPs) Revised 10/2018 3 Over-the-Counter (OTC) Medications – Tufts Health RITogether and Tufts Health Together .
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