UnitedHealthcare Dual Complete™ ONE (HMO SNP) Non-Part D and Over the Counter Medicaid Covered Drugs PDL CLASS PDL CATEGORY DRUG NAME ANALGESICS ANALGESICS ACETAMINOPHEN ANALGESICS ANALGESICS ACETAMINOPHEN-CAFFEINE-PYRILAMINE TAB ANALGESICS ANALGESICS ACETAMINOPHEN-PAMABROM-PYRILAMINE TAB ANALGESICS NSAIDS ASPIRIN ANALGESICS NSAIDS ASPIRIN BUFFERED (CA CARB-MG CARB-MG OX) TAB ANALGESICS NSAIDS ASPIRIN-ACETAMINOPHEN-CAFFEINE TAB ANALGESICS NSAIDS ASPIRIN-AL HYDRO-MG HYDRO-CA CARB TAB ANALGESICS NSAIDS ASPIRIN-CAFFEINE TAB ANALGESICS NSAIDS IBUPROFEN ANALGESICS NSAIDS MAGNESIUM SALICYLATE TETRAHYDRATE TAB ANALGESICS NSAIDS NAPROXEN SODIUM ANTIHISTAMINES ANTIHISTAMINE CHLORPHENIRAMINE MALEATE ANTIHISTAMINES ANTIHISTAMINES BROMPHENIRAMINE MALEATE LIQUID ANTIHISTAMINES ANTIHISTAMINES CHLORPHENIRAMINE ANTIHISTAMINES ANTIHISTAMINES CLEMASTINE FUMARATE TAB ANTIHISTAMINES ANTIHISTAMINES CYCLIZINE HCL TAB ANTIHISTAMINES ANTIHISTAMINES DEXBROMPHENIRAMINE MALEATE TAB ANTIHISTAMINES ANTIHISTAMINES DIPHENHYDRAMINE ANTIHISTAMINES SECOND GENERATION ANTIHISTAMINES CETIRIZINE ANTIHISTAMINES SECOND GENERATION ANTIHISTAMINES CETIRIZINE-PSEUDOEPHEDRINE TAB SR ANTIHISTAMINES SECOND GENERATION ANTIHISTAMINES FEXOFENADINE ANTIHISTAMINES SECOND GENERATION ANTIHISTAMINES LORATADINE ANTIHISTAMINES SECOND GENERATION ANTIHISTAMINES LORATADINE & PSEUDOEPHEDRINE TAB SR CONTRACEPTIVES CONTRACEPTIVES CONDOMS LATEX LUBRICATED CONTRACEPTIVES CONTRACEPTIVES LEVONORGESTREL TAB CONTRACEPTIVES CONTRACEPTIVES NONOXYNOL-9 GEL
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COUGH AND COLD ALLERGY AND ANTIHISTAMINES CHLORCYCLIZINE & PSEUDOEPHEDRINE LIQUID COUGH AND COLD ALLERGY AND ANTIHISTAMINES CHLORCYCLIZINE HCL TAB COUGH AND COLD ALLERGY AND ANTIHISTAMINES CHLORCYCLIZINE-PHENYLEPHRINE CHEW TAB COUGH AND COLD ALLERGY AND ANTIHISTAMINES CHLORCYCLIZINE-PHENYLEPHRINE SYRUP COUGH AND COLD ALLERGY AND ANTIHISTAMINES CHLORCYCLIZINE-PHENYLEPHRINE TAB COUGH AND COLD ALLERGY AND ANTIHISTAMINES CHLORPHEN TAN-PE TAN-METHSCOPOLAMINE SUSP COUGH AND COLD ALLERGY AND ANTIHISTAMINES CHLORPHEN-PHENYLTOLOX-PE- APAP TAB SR 12HR DIPHENHYDRAMINE HCL-PHENYLEPH HCL TANNATE CHEW COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS TAB COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS DIPHENHYDRAMINE-ACETAMINOPHEN TAB COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS DIPHENHYDRAMINE-PHENYLEPHRINE COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS DIPHENHYDRAMINE-PHENYLEPHRINE-APAP COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS DOXYLAMINE SUCCINATE CHEW TAB COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS DOXYLAMINE-PHENYLEPHRINE-APAP CAP COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS DOXYLAMINE-PSEUDOEPHEDRINE LIQUID COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS PYRILAMINE-PHENYLEPHRINE TAB COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS THONZYLAMINE-CHLOPHEDIANOL LIQUID COUGH AND COLD ANTIHISTAMINE - ALLERGY DRUGS THONZYLAMINE-PHENYLEPHRINE LIQUID COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS BROMPHENIRAMINE & PHENYLEPHRINE COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS BROMPHENIRAMINE & PSEUDOEPHEDRINE COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS CHLORPHENIRAMINE & PHENYLEPHRINE COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS CHLORPHENIRAMINE & PSEUDOEPHEDRINE COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS CHLORPHENIRAMINE-PE-METHSCOPOLAMINE COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS CHLORPHEN-PE-APAP TAB & PE-APAP TAB PACK COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS CHLORPHEN-PE-METHSCOPOLAMINE TAB SR 12HR COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS CHLORPHEN-PHENYLEPHRINE W/ APAP COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS CHLORPHEN-PSE & METHSCOPOLAMINE COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS CHLORPHEN-PSE-ATROPINE-HYOS-SCOPOL TAB SR 12HR COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS DEXBROMPHENIRAMINE & PSEUDOEPHEDRINE TAB COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS DEXBROMPHENIRAMINE-PHENYLEPHRINE TAB COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS DEXCHLORPHENIRAMINE & PSEUDOEPHEDRINE TAB COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS DEXCHLORPHENIRAMINE-PHENYLEPHRINE TAB COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS DEXCHLORPHENIRAMINE-PSEUDOEPHED-APAP TAB COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS DEXCHLORPHEN-PSEUDOEPHED-METHSCOP TAB SR 12HR
UnitedHealthcare Dual Complete™ ONE (HMO SNP) Non-Part D and Over the Counter Medicaid Covered Drugs COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS TRIPROLIDINE & PSEUDOEPHEDRINE COUGH AND COLD ANTIHISTAMINE AND DECONGESTANTS TRIPROLIDINE HCL LIQUID COUGH AND COLD ANTITUSSIVES ACETAMINOPHEN W/ DM LIQUID COUGH AND COLD ANTITUSSIVES BENZONATATE CAP COUGH AND COLD ANTITUSSIVES CARBET CIT-CARBET TAN-PE HCL-PE TAN SUS COUGH AND COLD ANTITUSSIVES CARBETAPENTANE CIT-PSEUDOEPH HCL TANNATE SUSP COUGH AND COLD ANTITUSSIVES CHLOPHEDIANOL-CHLORCYCLIZINE COUGH AND COLD ANTITUSSIVES CHLOPHEDIANOL-GUAIFENESIN LIQUID COUGH AND COLD ANTITUSSIVES CHLOPHEDIANOL-PSEUDOEPHEDRINE LIQD COUGH AND COLD ANTITUSSIVES CHLOPHEDIANOL-PYRILAMINE LIQUID COUGH AND COLD ANTITUSSIVES CHLOPHEDIANOL-TRIPROLIDINE LIQUID COUGH AND COLD ANTITUSSIVES CHLORPHEN TANNATE-CARBETAPENTANE TANNATE TAB COUGH AND COLD ANTITUSSIVES CHLORPHENIRAMINE W/ CODEINE COUGH AND COLD ANTITUSSIVES CHLORPHENIRAMINE-DM COUGH AND COLD ANTITUSSIVES CODEINE-CHLORPHENIRAMINE-ACETAMINOPHEN TAB COUGH AND COLD ANTITUSSIVES CODEINE-PHENYLEPHRINE-CHLORCYCLIZINE LIQD COUGH AND COLD ANTITUSSIVES CODEINE-PYRILAMINE SYRUP COUGH AND COLD ANTITUSSIVES DEXTROMETHORPHAN HBR LIQUID COUGH AND COLD ANTITUSSIVES DEXTROMETHORPHAN POLISTIREX LIQUID CR COUGH AND COLD ANTITUSSIVES DEXTROMETHORPHAN-APAP-CHLORPHENIRAMINE COUGH AND COLD ANTITUSSIVES DEXTROMETHORPHAN-DOXYLAMINE-APAP COUGH AND COLD ANTITUSSIVES DEXTROMETHORPHAN-GUAIFENESIN COUGH AND COLD ANTITUSSIVES DEXTROMETHORPHAN-PHENYLEPHRINE-APAP COUGH AND COLD ANTITUSSIVES DIHYDROCODEINE-GUAIFENESIN LIQUID COUGH AND COLD ANTITUSSIVES DOXYLAMINE-DM LIQUID COUGH AND COLD ANTITUSSIVES GUAIFENESIN-CODEINE COUGH AND COLD ANTITUSSIVES HYDROCOD POLST-CHLORPHEN POLST
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COUGH AND COLD ANTITUSSIVES HYDROCODONE W/ HOMATROPINE COUGH AND COLD ANTITUSSIVES HYDROCODONE-CHLORPHENIRAMINE SOLN COUGH AND COLD ANTITUSSIVES PHENYLEPH HCL-PYRIL MAL-DM HBR TANNATE CHEW TAB COUGH AND COLD ANTITUSSIVES PHENYLEPH TAN-PYRILAMINE TAN-DM TAN SUSP COUGH AND COLD ANTITUSSIVES PHENYLEPH-CHLORPHEN-DM W/APAP COUGH AND COLD ANTITUSSIVES PHENYLEPH-DEXCHLORPHEN-PYRIL-DM SYRUP COUGH AND COLD ANTITUSSIVES PHENYLEPH-EPHED-CPM W/ CARBETAPENTANE TAB COUGH AND COLD ANTITUSSIVES PHENYLEPH-PYRILAMINE-CHLOPHEDIANOL LIQD COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE TAN-CARBETAPENTANE TAN SUSP COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE W/ ACETAMINOPHEN COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE W/ CODEINE COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE W/ DM COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-BROMPHEN W/ CODEINE COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-BROMPHEN-CARBETAPENTANE SUSP COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-BROMPHEN-DIHYDROCODEINE LIQD COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-BROMPHENIRAMINE-DM COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-CHLOPHEDIANOL-GG COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-CHLORPHEN W/ CODEINE SYRUP COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-CHLORPHEN-DIHYDROCODEINE COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-CHLORPHEN-DM COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-CODEINE-GUAIFENESIN-APAP COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-DEXBROMPHEN-CHLOPHEDIANOL LIQD COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-DEXCHLORPHENIR-CODEINE LIQUID COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-DIHYDROCODEINE COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-DM SYRUP COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-DM-GG W/ APAP COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-DOXYLAMINE-DM-APAP LIQUID COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-PROMETHAZINE W/ CODEINE SYRUP COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-PYRILAMINE W/ CODEINE SYRUP COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-PYRILAMINE-DIHYDROCOD LIQUID COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-PYRILAMINE-DM COUGH AND COLD ANTITUSSIVES PHENYLEPHRINE-THONZYLAMINE-DM LIQUID COUGH AND COLD ANTITUSSIVES PHENYLEPH-THONZYLAMINE-CHLOPHEDIANOL LIQUID COUGH AND COLD ANTITUSSIVES PHENYLEPH-TRIPROLIDINE-CHLOPHEDIANOL LIQUID
UnitedHealthcare Dual Complete™ ONE (HMO SNP) Non-Part D and Over the Counter Medicaid Covered Drugs COUGH AND COLD ANTITUSSIVES PROMETHAZINE W/ CODEINE SYRUP COUGH AND COLD ANTITUSSIVES PROMETHAZINE-DM SYRUP COUGH AND COLD ANTITUSSIVES PSE-CHLORCYCLIZINE-CHLOPHEDIANOL LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPH-CHLORPHEN W/ HYDROCODONE COUGH AND COLD ANTITUSSIVES PSEUDOEPH-CHLORPHEN-DM W/ APAP COUGH AND COLD ANTITUSSIVES PSEUDOEPH-DOXYLAMINE-DM W/APAP LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHED TAN-DEXCHLORPHEN TAN-DM TAN SUSP COUGH AND COLD ANTITUSSIVES PSEUDOEPHED-BROMPHEN-DIHYDROCODEINE LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHED-BROMPHEN-DM COUGH AND COLD ANTITUSSIVES PSEUDOEPHED-CHLORPHEN-DIHYDROCODEINE SYRUP COUGH AND COLD ANTITUSSIVES PSEUDOEPHED-CHLORPHEN-DM COUGH AND COLD ANTITUSSIVES PSEUDOEPHED-CODEINE-GUAIFENESIN-APAP COUGH AND COLD ANTITUSSIVES PSEUDOEPHED-DEXBROMPHENIRAMINE-DM LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHED-DEXCHLORPHEN-CHLOPHEDIANOL LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHED-DOXYLAMINE-DM LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE TAN-CARBETAPENTANE TAN CHEW TAB COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE W/ APAP-DM COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE W/ CODEINE COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE W/ DM COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE W/ HYDROCODONE SOLN COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE-BROMPHEN-CODEINE LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE-CHLOPHEDIANOL COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE-CHLORCYCLIZINE-CHLOPHEDIANOL TAB COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE-CHLORPHEN W/ CODEINE LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE-DEXBROMPHEN-CODEINE LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE-DM-GG W/ APAP LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE-PYRILAMINE-CODEINE SYRUP
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COUGH AND COLD ANTITUSSIVES PSEUDOEPHEDRINE-TRIPROLIDINE W/ COD LIQUID COUGH AND COLD ANTITUSSIVES PSEUDOEPHED-TRIPROLIDINE-DM SUSP COUGH AND COLD BRONCHODILATOR EPHEDRINE SULFATE CAP COUGH AND COLD BRONCHODILATOR RACEPINEPHRINE HCL SOLN NEBULIZER COUGH AND COLD DECONGESTANTS PHENYLEPHRINE HCL TAB COUGH AND COLD DECONGESTANTS PSEUDOEPHEDRINE HCL COUGH AND COLD DECONGESTANTS PSEUDOEPHEDRINE W/ ACETAMINOPHEN TAB COUGH AND COLD DECONGESTANTS PSEUDOEPHEDRINE-IBUPROFEN COUGH AND COLD DECONGESTANTS PSEUDOEPHEDRINE-METHSCOPOLAMINE TAB SR COUGH AND COLD EXPECTORANTS GUAIFENESIN COUGH AND COLD EXPECTORANTS GUAIFENESIN TAB SR COUGH AND COLD EXPECTORANTS PHENYLEPHRINE TANNATE-GUAIFENESIN SUSP COUGH AND COLD EXPECTORANTS PHENYLEPHRINE-APAP COUGH AND COLD EXPECTORANTS PHENYLEPHRINE-GUAIFENESIN COUGH AND COLD EXPECTORANTS PHENYLEPHRINE-GUAIFENESIN TAB SR COUGH AND COLD EXPECTORANTS PSEUDOEPHEDRINE-ACETAMINOPHEN-GUAIFENESIN TAB COUGH AND COLD EXPECTORANTS PSEUDOEPHEDRINE-GUAIFENESIN CAP COUGH AND COLD EXPECTORANTS PSEUDOEPHEDRINE-GUAIFENESIN TAB SR COUGH AND COLD LOCAL ANESTHETICS THROAT LOZENGES - LOZENGES COUGH AND COLD MISCELLANEOUS PHENYLEPHRINE IN HARD FAT RECTAL SUPPOS COUGH AND COLD MISCELLANEOUS PHENYLEPH-SHARK LIVER OIL-COCOA BUTTER SUPPOS DRUGS TO REGULATE BLOOD DRUGS TO REGULATE BLOOD SUGAR GLUCOSE CHEW TAB SUGAR DRUGS TO REGULATE BLOOD DRUGS TO REGULATE BLOOD SUGAR GLUCOSE GEL SUGAR DRUGS TO REGULATE BLOOD DRUGS TO REGULATE BLOOD SUGAR GLUCOSE-VITAMIN C CHEW TAB SUGAR EAR DRUGS EAR DRUGS CARBAMIDE PEROXIDE 6.5% OTIC SOLN EYE DROPS EYE ALLERGIES KETOTIFEN FUMARATE OPHTH SOLN EYE DROPS EYE ALLERGIES TETRAHYDROZOLINE HCL OPHTH SOLN 0.05% EYE DROPS EYE ALLERGIES TETRAHYDROZOLINE W/ ZINC SULFATE OPHTH SOLN EYE DROPS MISCELLANEOUS ARTIFICIAL TEAR OPHTHALMIC EYE DROPS MISCELLANEOUS CARBOXYMETHYLCELLULOSE SODIUM OPHTH SOLN EYE DROPS MISCELLANEOUS CARBOXYMETHYLCELLULOSE-HYPROMELLOSE GEL EYE DROPS MISCELLANEOUS GLYCERIN-POLYSORBATE 80 OPHTH SOLN
UnitedHealthcare Dual Complete™ ONE (HMO SNP) Non-Part D and Over the Counter Medicaid Covered Drugs EYE DROPS MISCELLANEOUS HYPROMELLOSE OPHTH EYE DROPS MISCELLANEOUS OPHTHALMIC IRRIGATION SOLUTION EYE DROPS MISCELLANEOUS POLYETHYLENE GLYCOL-POLYVINYL ALCOHOL OPHTH SOLN EYE DROPS MISCELLANEOUS POLYETHYLENE GLYCOL-PROPYLENE GLYCOL OPHTH GEL EYE DROPS MISCELLANEOUS POLYVINYL ALCOHOL OPHTH SOLN EYE DROPS MISCELLANEOUS POLYVINYL ALCOHOL-POVIDONE OPHTH SOLN EYE DROPS MISCELLANEOUS PROPYLENE GLYCOL OPHTH SOLN EYE DROPS MISCELLANEOUS SODIUM CHLORIDE HYPERTONIC OPHTH GASTROINTESTINAL PRODUCTS ANTACIDS ALUM & MAG HYDROXIDE-SIMETHICONE GASTROINTESTINAL PRODUCTS ANTACIDS ALUMINUM & MAGNESIUM HYDROXIDES SUSP GASTROINTESTINAL PRODUCTS ANTACIDS ALUMINUM HYDROXIDE GEL SUSP GASTROINTESTINAL PRODUCTS ANTACIDS ALUMINUM HYDROXIDE-MAGNESIUM CARBONATE ALUMINUM HYDROXIDE-MAGNESIUM TRISILICATE CHEW GASTROINTESTINAL PRODUCTS ANTACIDS TAB GASTROINTESTINAL PRODUCTS ANTACIDS CALCIUM CARBONATE (ANTACID) GASTROINTESTINAL PRODUCTS ANTACIDS CALCIUM CARBONATE-MAG HYDROXIDE GASTROINTESTINAL PRODUCTS ANTACIDS CHARCOAL ACTIVATED-SORBITOL LIQ GASTROINTESTINAL PRODUCTS ANTACIDS MAGNESIUM OXIDE TAB GASTROINTESTINAL PRODUCTS ANTACIDS SODIUM BICARBONATE TAB GASTROINTESTINAL PRODUCTS ANTIDIARRHEALS BISMUTH SUBSALICYLATE GASTROINTESTINAL PRODUCTS ANTIDIARRHEALS LACTOBACILLUS RHAMNOSUS (GG) CAP GASTROINTESTINAL PRODUCTS ANTIDIARRHEALS LACTOBACILLUS TAB GASTROINTESTINAL PRODUCTS ANTIDIARRHEALS LOPERAMIDE GASTROINTESTINAL PRODUCTS ANTIDIARRHEALS LOPERAMIDE-SIMETHICONE TAB GASTROINTESTINAL PRODUCTS ANTIDIARRHEALS PROBIOTIC PRODUCT - CAP GASTROINTESTINAL PRODUCTS ANTIDIARRHEALS SACCHAROMYCES BOULARDII PACKET GASTROINTESTINAL PRODUCTS ANTIEMETICS DIMENHYDRINATE TAB
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GASTROINTESTINAL PRODUCTS ANTIEMETICS FRUCTOSE-DEXTROSE-PHOSPHORIC ACID ORAL SOLN GASTROINTESTINAL PRODUCTS ANTIEMETICS IPECAC SYRUP GASTROINTESTINAL PRODUCTS ANTIEMETICS MECLIZINE GASTROINTESTINAL PRODUCTS ANTI-GAS SIMETHICONE GASTROINTESTINAL PRODUCTS H2-ANTAGONISTS CIMETIDINE TAB 200 MG GASTROINTESTINAL PRODUCTS H2-ANTAGONISTS FAMOTIDINE TAB GASTROINTESTINAL PRODUCTS H2-ANTAGONISTS FAMOTIDINE-CA CARBONATE-MAG HYDROXIDE CHEW TAB GASTROINTESTINAL PRODUCTS H2-ANTAGONISTS RANITIDINE HCL TAB GASTROINTESTINAL PRODUCTS LAXATIVES ALOE LIQUID GASTROINTESTINAL PRODUCTS LAXATIVES BENZOCAINE-DOCUSATE SODIUM RECTAL ENEMA GASTROINTESTINAL PRODUCTS LAXATIVES BISACODYL GASTROINTESTINAL PRODUCTS LAXATIVES CALCIUM POLYCARBOPHIL TAB GASTROINTESTINAL PRODUCTS LAXATIVES CASTOR OIL GASTROINTESTINAL PRODUCTS LAXATIVES DOCUSATE CALCIUM CAP GASTROINTESTINAL PRODUCTS LAXATIVES DOCUSATE SODIUM GASTROINTESTINAL PRODUCTS LAXATIVES GLYCERIN GASTROINTESTINAL PRODUCTS LAXATIVES MAGNESIUM CITRATE SOLN GASTROINTESTINAL PRODUCTS LAXATIVES MAGNESIUM HYDROXIDE SUSP GASTROINTESTINAL PRODUCTS LAXATIVES MAGNESIUM SULFATE ORAL GRANULES GASTROINTESTINAL PRODUCTS LAXATIVES METHYLCELLULOSE POWDER GASTROINTESTINAL PRODUCTS LAXATIVES METHYLCELLULOSE TAB GASTROINTESTINAL PRODUCTS LAXATIVES MINERAL OIL GASTROINTESTINAL PRODUCTS LAXATIVES POLYETHYLENE GLYCOL 3350 ORAL GASTROINTESTINAL PRODUCTS LAXATIVES PSYLLIUM GASTROINTESTINAL PRODUCTS LAXATIVES SENNA TAB GASTROINTESTINAL PRODUCTS LAXATIVES SENNOSIDES GASTROINTESTINAL PRODUCTS LAXATIVES SENNOSIDES-DOCUSATE SODIUM TAB GASTROINTESTINAL PRODUCTS LAXATIVES SENNOSIDES-PSYLLIUM CAP GASTROINTESTINAL PRODUCTS LAXATIVES SODIUM PHOSPHATES GASTROINTESTINAL PRODUCTS MISCELLANEOUS LACTASE CAP 250 MG GASTROINTESTINAL PRODUCTS PROTON-PUMP INHIBITORS LANSOPRAZOLE CAP DELAYED RELEASE 15 MG GASTROINTESTINAL PRODUCTS PROTON-PUMP INHIBITORS OMEPRAZOLE 20 MG GASTROINTESTINAL PRODUCTS PROTON-PUMP INHIBITORS OMEPRAZOLE-SODIUM BICARBONATE CAP INHALATION SOLUTIONS INHALATION SOLUTIONS SODIUM CHLORIDE SOLN NEBU 0.9%
UnitedHealthcare Dual Complete™ ONE (HMO SNP) Non-Part D and Over the Counter Medicaid Covered Drugs IRON PREPARATIONS IRON PREPARATIONS CARBONYL IRON SUSP IRON PREPARATIONS IRON PREPARATIONS FE FUM-FE POLYSAC-C-B3 CAP IRON PREPARATIONS IRON PREPARATIONS FERROUS FUMARATE TAB IRON PREPARATIONS IRON PREPARATIONS FERROUS FUM-IRON POLYSACCH CAP IRON PREPARATIONS IRON PREPARATIONS FERROUS GLUCONATE TAB IRON PREPARATIONS IRON PREPARATIONS FERROUS SULFATE IRON PREPARATIONS IRON PREPARATIONS FERUMOXYTOL INJ IRON PREPARATIONS IRON PREPARATIONS IRON DEXTRAN INJ IRON PREPARATIONS IRON PREPARATIONS IRON SUCROSE INJ IRON PREPARATIONS IRON PREPARATIONS IRON-VIT C-VIT B12-FOLIC ACID CAP CR IRON PREPARATIONS IRON PREPARATIONS POLYSACCH FE COMPLEX-CHOLECALCIFEROL LIQ IRON PREPARATIONS IRON PREPARATIONS POLYSACCHARIDE FE COMPLEX-FE HEME POLYPEPTIDE TAB IRON PREPARATIONS IRON PREPARATIONS POLYSACCHARIDE IRON COMPLEX CAMPHOR-EUCALYPTUS-MENTHOL-TURP OIL-WHITE PET - MISCELLANEOUS AGENTS MISCELLANEOUS OINT MISCELLANEOUS AGENTS MISCELLANEOUS COENZYME Q10 CAP MISCELLANEOUS AGENTS MISCELLANEOUS COENZYME Q10-LEVOCARNITINE CAP MISCELLANEOUS AGENTS MISCELLANEOUS OMEGA-3 FATTY ACIDS CAP MISCELLANEOUS AGENTS MISCELLANEOUS PROPYLENE GLYCOL MISCELLANEOUS AGENTS MISCELLANEOUS SODIUM FLUORIDE RINSE MISCELLANEOUS AGENTS MISCELLANEOUS UBIQUINOL LIPOSOMAL LIQUID MISCELLANEOUS AGENTS PHARMACEUTICAL AIDS AQUABASE MISCELLANEOUS AGENTS PHARMACEUTICAL AIDS HYPROMELLOSE (BULK) POWDER MISCELLANEOUS AGENTS PHARMACEUTICAL AIDS ORAL VEHICLES MISCELLANEOUS AGENTS PHARMACEUTICAL AIDS POLYETHYLENE GLYCOL OINTMENT MISCELLANEOUS AGENTS PHARMACEUTICAL AIDS VEHICLE S MISCELLANEOUS AGENTS PHARMACEUTICAL AIDS WATER FOR INJECT, BACTERIOSTATIC BENZYL ALCOHOL
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MISCELLANEOUS AGENTS PHARMACEUTICAL AIDS WATER FOR INJECTION NASAL PRODUCTS MISCELLANEOUS NASAL MOISTURIZER COMBINATION - GEL NASAL PRODUCTS MISCELLANEOUS SALINE NASAL NASAL PRODUCTS NASAL DECONGESTANT OXYMETAZOLINE HCL NASAL SOLN NASAL PRODUCTS NASAL DECONGESTANT PHENYLEPHRINE HCL NASAL SOLN NASAL SPRAYS ANTIALLERGIC AGENTS CROMOLYN SODIUM NASAL AEROSOL SOLN PROGESTINS PROGESTINS MEGESTROL ACETATE SCABICIDES AND PEDICULICIDES SCABICIDES AND PEDICULICIDES PERMETHRIN PYRETH-PIPERONYL BUTOX SHAM-PERMETH AERO-NIT SCABICIDES AND PEDICULICIDES SCABICIDES AND PEDICULICIDES REMOVER GEL KIT SCABICIDES AND PEDICULICIDES SCABICIDES AND PEDICULICIDES PYRETHRINS-PIPERONYL BUTOXIDE SEDATIVE/HYPNOTICS SEDATIVE/HYPNOTICS DIPHENHYDRAMINE HCL (SLEEP) TAB SEDATIVE/HYPNOTICS SEDATIVE/HYPNOTICS DIPHENHYDRAMINE-ACETAMINOPHEN TAB (SLEEP) SEDATIVE/HYPNOTICS SEDATIVE/HYPNOTICS DOXYLAMINE SUCCINATE (SLEEP) TAB SEDATIVE/HYPNOTICS SEDATIVE/HYPNOTICS MELATONIN TAB SMOKING CESSATION SMOKING CESSATION NICOTINE POLACRILEX GUM SMOKING CESSATION SMOKING CESSATION NICOTINE POLACRILEX LOZENGE SMOKING CESSATION SMOKING CESSATION NICOTINE TD PATCH 24HR THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM CARBONATE-CHOLECALCIFEROL THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM CARBONATE-ERGOCALCIFEROL TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM CARBONATE-VITAMIN D THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM CARB-VIT D W/ MINERALS CHEW TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM CITRATE TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM CITRATE-VITAMIN D TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM GLUBIONATE SYRUP THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM GLUCONATE TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM LACTATE TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CALCIUM-CHOLECALCIFEROL TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CHROMIUM CHLORIDE INJ 4 MCG/ML THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS CUPRIC CHLORIDE INJ 0.4 MG/ML THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS MAGNESIUM CHLORIDE TAB CR THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS MAGNESIUM CHLORIDE-CALCIUM TAB DR THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS MAGNESIUM CL-CA CARBONATE TAB DR THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS MAGNESIUM GLUCONATE TAB
UnitedHealthcare Dual Complete™ ONE (HMO SNP) Non-Part D and Over the Counter Medicaid Covered Drugs THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS MAGNESIUM OXIDE TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS MAGNESIUM TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS MANGANESE CHLORIDE INJ 0.1 MG/ML THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS ORAL ELECTROLYTE SOLUTION THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS ORAL ELECTROLYTE TAB THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS OYSTER SHELL CALCIUM TAB 500 MG THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS ZINC CHLORIDE INJ 1 MG/ML THERAPEUTIC NUTRIENTS THERAPEUTIC NUTRIENTS ZINC SULFATE CAP TOPICAL AGENTS ACNE BENZOYL PEROXIDE TOPICAL AGENTS ASTRINGENTS ALUMINUM SULFATE & CALCIUM ACETATE POWD PACK TOPICAL AGENTS ASTRINGENTS CALAMINE LOTION TOPICAL AGENTS ASTRINGENTS WITCH HAZEL LIQUID TOPICAL AGENTS ASTRINGENTS ZINC OXIDE OINT TOPICAL AGENTS KERATOLYTIC AGENTS SALICYLIC ACID TOPICAL AGENTS KERATOLYTIC AGENTS UREA TOPICAL AGENTS LOCAL ANESTHETICS CAMPHOR & MENTHOL LOTION TOPICAL AGENTS LOCAL ANESTHETICS DIBUCAINE OINT TOPICAL AGENTS LOCAL ANESTHETICS DIPHENHYDRAMINE HCL SOLN TOPICAL AGENTS LOCAL ANESTHETICS DIPHENHYDRAMINE-ZINC ACETATE CREAM TOPICAL AGENTS LOCAL ANESTHETICS LIDOCAINE CREAM TOPICAL AGENTS LOCAL ANESTHETICS PRAMOXINE HCL RECTAL FOAM TOPICAL AGENTS LOCAL ANESTHETICS PRAMOXINE-BENZYL ALCOHOL GEL TOPICAL AGENTS LOCAL ANESTHETICS PRAMOXINE-CALAMINE LOTION TOPICAL AGENTS LOCAL ANESTHETICS PRAMOX-PE-GLYCERIN-PETROLATUM RECTAL CREAM TOPICAL AGENTS MISCELLANEOUS SKIN PRODUCTS CHLORHEXIDINE GLUCONATE LIQUID TOPICAL AGENTS MISCELLANEOUS SKIN PRODUCTS HYDROGEN PEROXIDE SOLN TOPICAL AGENTS MISCELLANEOUS SKIN PRODUCTS ISOPROPYL ALCOHOL
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TOPICAL AGENTS MISCELLANEOUS SKIN PRODUCTS POVIDONE-IODINE TOPICAL AGENTS PHARMACEUTICAL AIDS EMOLLIENT TOPICAL AGENTS PHARMACEUTICAL AIDS HYDROPHILIC OINTMENT TOPICAL AGENTS PHARMACEUTICAL AIDS LANOLIN TOPICAL AGENTS SKIN PROTECTANT COLLOIDAL OATMEAL PACKET TOPICAL AGENTS SKIN PROTECTANT DIAPER RASH PRODUCTS - OINTMENT TOPICAL AGENTS SKIN PROTECTANT DIMETHICONE TOPICAL AGENTS SKIN PROTECTANT EMOLLIENT - LOTION TOPICAL AGENTS SKIN PROTECTANT RECTAL PROTECTANT-EMOLLIENT OINTMENT TOPICAL AGENTS SKIN PROTECTANT SKIN PROTECTANTS MISC TOPICAL AGENTS SKIN PROTECTANT VITAMINS A & D OINTMENT TOPICAL AGENTS SKIN PROTECTANT WHITE PETROLATUM GEL TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS ALOE VERA TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS ALUMINUM HYDROXIDE OINT TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS AMMONIUM LACTATE TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS CAPSAICIN CREAM TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS CAPSAICIN-MENTHOL-METHYL SALICYLATE CREAM TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS CAPSICUM OLEORESIN CREAM TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS DERMATOLOGICAL PRODUCTS MISC - LIQUID TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS DOCOSANOL CREAM TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS HYDROQUINONE CREAM TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS LINIMENTS & RUBS TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS LIVE YEAST CELL & SHARK LIVER OIL W/ EMOLLIENTS OINT TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS MENTHOL-METHYL SALICYLATE CREAM TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS MINERAL OIL-HYDROPHILIC PETROLATUM OINTMENT TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS PETROLATUM-ZINC OXIDE OINT TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS PHENYLEPHRINE-SHARK LIVER OIL-MO-PET OINT TOPICAL AGENTS TOPICAL AGENTS - MISCELLANEOUS TROLAMINE SALICYLATE CREAM TOPICAL AGENTS TOPICAL ANTIBIOTICS BACITRACIN OINT TOPICAL AGENTS TOPICAL ANTIBIOTICS BACITRACIN ZINC OINT TOPICAL AGENTS TOPICAL ANTIBIOTICS BACITRACIN-POLYMYXIN B OINT TOPICAL AGENTS TOPICAL ANTIBIOTICS NEOMYCIN-BACITRACIN-POLYMYXIN OINT TOPICAL AGENTS TOPICAL ANTIBIOTICS NEOMYCIN-BACITRACIN-POLYMYXIN-PRAMOXINE OINT TOPICAL AGENTS TOPICAL ANTIFUNGALS BUTENAFINE
UnitedHealthcare Dual Complete™ ONE (HMO SNP) Non-Part D and Over the Counter Medicaid Covered Drugs TOPICAL AGENTS TOPICAL ANTIFUNGALS CLOTRIMAZOLE TOPICAL AGENTS TOPICAL ANTIFUNGALS MICONAZOLE NITRATE TOPICAL AGENTS TOPICAL ANTIFUNGALS TERBINAFINE TOPICAL AGENTS TOPICAL ANTIFUNGALS TOLNAFTATE TOPICAL AGENTS TOPICAL STEROIDS HYDROCORTISONE TOPICAL AGENTS TOPICAL STEROIDS HYDROCORTISONE ACETATE CREAM TOPICAL AGENTS TOPICAL STEROIDS HYDROCORTISONE-ALOE VERA TOPICAL AGENTS VAGINAL ANTIFUNGALS CLOTRIMAZOLE VAGINAL CREAM TOPICAL AGENTS VAGINAL ANTIFUNGALS MICONAZOLE NITRATE VAGINAL TOPICAL AGENTS VAGINAL ANTIFUNGALS TIOCONAZOLE VAGINAL OINT URINARY ANALGESICS URINARY ANALGESICS PHENAZOPYRIDINE HCL TAB VITAMINS CHOLESTEROL CONTROL NIACIN VITAMINS MULTIVITAMIN PREPARATIONS MULTIPLE VITAMINS VITAMINS MULTIVITAMIN PREPARATIONS MULTIPLE VITAMINS W/ IRON VITAMINS MULTIVITAMIN PREPARATIONS MULTIPLE VITAMINS W/ MINERALS VITAMINS MULTIVITAMIN PREPARATIONS PEDIATRIC MULTIPLE VITAMIN W/ MINERALS VITAMINS MULTIVITAMIN PREPARATIONS PEDIATRIC MULTIPLE VITAMIN W/ IRON VITAMINS PRENATAL VITAMINS PRENATAL VITAMINS VITAMINS VITAMINS ASCORBIC ACID VITAMINS VITAMINS B-COMPLEX VITAMINS VITAMINS VITAMINS CHOLECALCIFEROL VITAMINS VITAMINS CYANOCOBALAMIN VITAMINS VITAMINS ERGOCALCIFEROL VITAMINS VITAMINS FOLIC ACID VITAMINS VITAMINS HYDROXOCOBALAMIN INJ VITAMINS VITAMINS NIACINAMIDE TAB VITAMINS VITAMINS PHYTONADIONE
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VITAMINS VITAMINS PYRIDOXINE VITAMINS VITAMINS THIAMINE VITAMINS VITAMINS TOCOPHEROLS-TOCOTRIENOLS LIQUID VITAMINS VITAMINS VITAMIN A VITAMINS VITAMINS VITAMIN E
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