OTC MEDICATIONS Brand name is listed in The following is a list of OTC products available on the UnitedHealthcare ALL CAPS. Generic available PDL. OTC products covered are restricted to generics when available. is listed in lowercase. Brand names are provided as reference only. Acne Diabetes benzoyl peroxide CLEARASIL alcohol swabs CURITY ALCOHOL PADS — crm, gel, lotion glucose oral tablets Antifungals Earwax Removal Products clotrimazole LOTRIMIN AF carbamide peroxide DEBROX miconazole — crm, soln MICATIN Family Planning terbinafine LAMISIL AT condoms TROJAN tolnaftate TINACTIN contraceptive gel GYNOL II vaginal products MONISTAT First Aid GYNE-LOTRIMIN calamine lotion Asthma dermatological baths COLLOIDAL OATMEAL saline for nebulization BRONCHO SALINE BATHS Cough/Cold Allergy hydrocortisone — crm, oint CORTIZONE Antihistamines povidone-iodine 10% BETADINE cetirizine QL ZYRTEC topical antibacterials NEOSPORIN chlorpheniramine CHLOR-TRIMETON MYCITRACIN diphenhydramine BENADRYL BACITRACIN loratadine QL ALAVERT, CLARITIN Gastrointestinal Antihistamines/Decongestant Combinations Antacids — liquids, chew tabs cetirizine/pseudoephedrine ZYRTEC-D MYLANTA LIQUID chlorpheniramine/ ACTIFED MAALOX LIQUID phenylephrine TUMS loratadine/ ALAVERT ALLERGY/ pseudoephedrine QL ST SINUS, CLARITIN-D Antidiarrheals bismuth subsalicylate susp KAOPECTATE Cough/Cold* * Age edit applied. DELSYM loperamide IMODIUM A-D Not covered for GUAIFEN PSE electrolyte rehydrating soln PEDIALYTE members under MUCINEX famotidine PEPCID AC the age 2. MUCINEX DM laxative enemas FLEET ENEMA ROBITUSSIN Laxatives ROBITUSSIN DM bisacodyl DULCOLAX ROBITUSSIN PE casanthranol/ BL STOOL/LAX ROBITUSSIN CF docusate sodium TUSSIN DM docusate calcium SURFAK docusate potassium CORRECTOL Nasal Sprays cromolyn sodium NASALCROM glycerin suppository GLYCERIN SUPP oxymetazoline AFRIN sennosides SENOKOT phenylephrine NEO-SYNEPHRINE saline nasal spray 0.65% OCEAN NASAL SPRAY Atopic Dermatitis emollients DERMAPHOR OINTMENT E-OINTMENT GLYCERIN TOPICAL Probiotic Supplementation Smoking Cessation Products acidophilus caps and tabs ACIDOPHILUS nicotine COMMIT LOZENGES QL acidophilus/bifidus ACIDOPHILUS/ NICODERM CQ QL BIFIDUS WAFER NICORETTE GUM QL acidophilus/citrus ACIDOPHILUS/ Vitamins/Minerals pectin tabs CITRUS PECTIN acidophilus/pectin caps ACIDOPHILUS/PECTIN calcium OSCAL lactobacillus chew tabs FLORANEX cholecalciferol VITAMIN D TAB 400 UNIT probiotic product caps PROBIOTIC FORMULA VITAMIN D TAB 1000 UNIT psyllium METAMUCIL VITAMIN D TAB 2000 UNIT simethicone MYLICON VITAMIN D CAP 400 UNIT VITAMIN D CAP 2000 UNIT stool softeners COLACE D3-50 CAP 50000 UNIT sugar+orthophosphoric EMETROL acid BIO-D-MULSION DROPS 400 UNITS/0.03 ML Lice Products BIO-D-MULSION permethrin NIX FORTE DROPS 2000 pyrethrins/piperonyl but. 4% RID SHAMPOO UNITS/0.03 ML — gel, liquid, shampoo Iron Ophthalmics ferrous fumarate FERRO-SEQUELS ketotifen fumarate ALAWAY ferrous gluconate FERGON artificial tears HYPOTEARS ferrous sulfate FEOSOL naphazoline HCL VASOCLEAR iron polysaccharides NIFEREX soln 0.02% caps, elixir naphazoline/antazoline magnesium oxide MAG-OX naphazoline/glycerin CLEAR EYES REDNESS multivitamins/minerals CENTRUM naphazoline/zinc sulfate RELIEF vitamins VITAMIN A tetrahydrozoline/ VASOCLEAR A VITAMIN B-1 zinc sulfate VISINE-AC VITAMIN B-6 Pain VITAMIN C acetaminophen TYLENOL vitamins pediatric VI-DAYLIN — tabs, liquid, drops, — members <3 years old suppositories POLY-VI-SOL TRI-VI-SOL aspirin — tabs, EC. tabs BAYER ECOTRIN zinc ZINC capsaicin 0.025% cream Warts aspirin/ acetaminophen/ EXCEDRIN MIGRAINE salicylic acid 17%/ DUOFILM caffeine collodion 250-250-65 mg tabs Miscellaneous ibuprofen — tabs, chew ADVIL artificial saliva tabs and susp Sleep Aids diphenhydramine NYTOL
©2012 United HealthCare Services, Inc. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by UnitedHealthcare Insurance Company, United HealthCare Services, Inc. or their affiliates. Health Plan coverage provided by or through a UnitedHealthcare company. OptumRx is an affiliate of UnitedHealthcare Insurance Company. UHC6203-RI_121218