DOCSLIB.ORG

Your 2020 Over-The-Counter Ordering Catalog

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Your 2020 Over-The-Counter Ordering Catalog Your 2020 Over-the-Counter Ordering Catalog Hundreds of common health products you can buy with your Gateway Health benefit. Look Inside for More Details and How to Order. Use this Catalog Jan. 1, 2020-Dec. 31, 2020 Y0097_1537_M VISIT US ONLINE AT WWW.FIELDTEX-GATEWAY.COMY0097_1537_M1 2020_Gateway_OTC_Catalog.indd 1 9/26/19 10:01 AM Welcome! Start using your Over-the-Counter (OTC) benefit. Your Gateway Health coverage just keeps getting better. Starting January 1, 2020 you have access to hundreds of retail wellness products when you use your quarterly over-the-counter allowance. And even better, any unused portion of your quarterly allowance can be rolled over to the next quarter. It’s a service powered by our partners at Fieldtex, and it’s unbelievably simple to use. How Much You Get: $300 per Quarter $120 per Quarter Medicare Assured Medicare Assured DiamondSM Members RubySM Members Use this catalog to choose and order your health products from January 1, 2020 to December 31, 2020. All orders must be placed by then. See next page for easy instructions on how to order. 2 CALL US TOLL-FREE AT 1-855-350-0074 (TTY 711) Y0097_1537_M 2020_Gateway_OTC_Catalog.indd 2 9/26/19 10:01 AM Gateway Health Ordering Process 3 Easy Ways to Order Order Online Order by Phone www.Fieldtex-Gateway.com 1-855-350-0074 (TTY 711) Monday-Friday 8:00 AM to 5:00 PM Order by Mail Saturday 9:00 AM to 5:00 PM Fill out the attached mail order form and send it in the postage- Sunday paid envelope. 10:00 AM to 5:00 PM - You will need to provide your Gateway Health Member ID number (found on the front of your ID card) and your birth date to access your account. - Choose the items you would like and write the number on your order form. Have the form available when you call or go online for fast and easy ordering. - Total all the items, be sure to stay within your available quarterly allowance. Y0097_1537_M VISIT US ONLINE AT WWW.FIELDTEX-GATEWAY.COM 3 2020_Gateway_OTC_Catalog.indd 3 9/26/19 10:01 AM Important Things to Remember Please keep this catalog for your entire 2020 benefit year. - Your OTC benefit covers only the items included - Fieldtex Products is the supplier of all the in this catalog. products in this catalog and can only answer questions pertaining to your order. Medical - If an item is deemed to be medically necessary, information regarding the use of these it might be covered by the health plan rather products is not available. Please consult your than using your OTC benefit for the item. Please physician. check with your physician before ordering. - The health information provided in this catalog - The website is available 24/7, unless down for is general in nature and is not medical advice maintenance. The call center is available to or a substitute for professional health care. It is take orders Monday – Friday from 8:00 AM to provided for your information and convenience 5:00 PM, Saturday 9:00 AM to 5:00 PM, Sunday only. Fieldtex Products does not guarantee the 10:00 AM to 5:00 PM. If you want to place your accuracy or completeness of the information, order by mail, please allow at least 7 days for and does not recommend or endorse the the mail order form to reach us. products which are referenced in the catalog. - Please allow 7 - 10 days for delivery of in-stock - The OTC benefit only guarantees members a items. You will be notified if an item is out of credit to use while ordering items listed in this stock and may take longer for delivery. If mailing catalog. Please note, however, that the items your order, please allow 1 week for mail delivery themselves are not offered or guaranteed by to Fieldtex. Mail orders will be processed the Gateway Health. month in which they are received. - Products in this catalog should only be ordered - If you receive a damaged item, call Fieldtex for the enrolled member. Products immediately at 1-800-353-7763 (TTY Hearing Impaired: 711) Monday - Friday 8:00 - Products with two asterisks (**) next to their am to 5:00 pm. The item will be exchanged for name are Dual Purpose items. In order to an identical item at no cost to you. Please note purchase these items under your plan, your that only damaged products can be exchanged personal physician must recommend them to within 30 days of purchase, no other returns you for a specific diagnosed condition. Please are allowed. We will not substitute brand name speak to your physician before ordering these products with generic products. items. - Gateway Health and Fieldtex Products are not - Limitations and restrictions may apply. Up to responsible for lost or stolen packages. For 9 items may be ordered from each category delivery issues, please contact your local post per quarter. Diagnostic equipment, including office. kitchen scales, are limited to 2 like-items per year. 4 CALL US TOLL-FREE AT 1-855-350-0074 (TTY 711) Y0097_1537_M 2020_Gateway_OTC_Catalog.indd 4 9/26/19 10:01 AM Table of Contents Allergy ...............................................................................................................................................................6-7 Cold and Flu ....................................................................................................................................................7-9 Cough Drops .................................................................................................................................................9-10 Dental Care (Denture, Dry Mouth, Toothbrush, Toothpaste) ......................................................10-14 Diabetic Supplies .............................................................................................................................................14 Diabetic Supplies - Socks .............................................................................................................................14 Diagnostic Equipment (Thermometers) ..................................................................................................15 Ear Care .........................................................................................................................................................15-16 Eye Care ..............................................................................................................................................................16 Feminine and UTI .............................................................................................................................................17 Fiber Supplements ..........................................................................................................................................17 First Aid (Bandages, Dressings and Gauze, Gloves, Tape, Kits) ...............................................18-20 Foot Care .....................................................................................................................................................20-21 Hemorrhoid .......................................................................................................................................................22 Home Testing ...................................................................................................................................................22 Hot and Cold Therapy ............................................................................................................................22-23 Incontinence .....................................................................................................................................................24 Lactose ...............................................................................................................................................................25 Lice ......................................................................................................................................................................25 Lip Care ..............................................................................................................................................................26 Motion Sickness Medication .......................................................................................................................26 Ointments and Topicals (Analgesics, Cleaners) ............................................................................26-29 Pain Relief ...................................................................................................................................................29-32 Respiratory Relief ...........................................................................................................................................32 Skin Care .....................................................................................................................................................32-33 Skin Care - Sunscreen ............................................................................................................................33-34 Sleep Aid ...........................................................................................................................................................34 Smoking Cessation .........................................................................................................................................35 Stomach - Antacids and Acid Reducers ..........................................................................................36-37 Stomach and Laxatives ..........................................................................................................................37-38
Load more

Recommended publications
  • First Quarter 2019
    Press release First quarter 2019 Issued: Wednesday, 1 May 2019, London U.K. GSK delivers sales of £7.7 billion +6% AER, +5% CER Total EPS 16.8p, +50% AER, +42% CER; Adjusted EPS 30.1p, +22% AER, +18% CER Financial highlights • Pharmaceuticals sales £4.2 billion, +4% AER, +2% CER; Vaccines £1.5 billion, +23% AER, +20% CER; Consumer Healthcare £2.0 billion, flat AER, +1% CER. • Total Group operating margin 18.6%. Adjusted Group operating margin 28.2%, +1.6 percentage points AER, +1.0 percentage point CER (Pharmaceuticals 29.8%; Vaccines 40.3%; Consumer Healthcare 21.7%). Benefits from strong sales growth and phasing of R&D. • Total EPS 16.8p, +50% AER, +42% CER. • Adjusted EPS 30.1p, +22% AER, +18% CER, driven by strong operating performance, continued financial efficiencies, reduction in minority share and a one-off benefit to associates. • Net cash flow from operations £663 million. Free cash flow £165 million. • 19p dividend declared for the quarter; continue to expect 80p for full year 2019. • 2019 Guidance reaffirmed. Product and pipeline highlights • Total HIV sales £1.1 billion, +7% AER, +4% CER, including Juluca sales of £70 million. - Dovato (dolutegravir+lamivudine), first once-daily 2-drug regimen for treatment-naive HIV patients, launched in US. - Long-acting cabotegravir+rilpivirine filed in the US for treatment of HIV. • Total new Respiratory product sales £631 million, +29% AER, +25% CER, including Trelegy £87 million; Nucala £152 million. • Shingrix sales £357 million driven by continued strong launch execution in US. • Continued
    [Show full text]
  • Case No COMP/M.2192 - 3* SMITHKLINE BEECHAM / BLOCK DRUG
    EN Case No COMP/M.2192 - 3* SMITHKLINE BEECHAM / BLOCK DRUG Only the English text is available and authentic. REGULATION (EEC) No 4064/89 MERGER PROCEDURE Article 6(1)(b) NON-OPPOSITION Date: 11/01/2001 Also available in the CELEX database Document No 301M2192 Office for Official Publications of the European Communities L-2985 Luxembourg COMMISSION OF THE EUROPEAN COMMUNITIES Brussels, 11.01.2001 SG(2000)D/285020 In the published version of this decision, some PUBLIC VERSION information has been omitted pursuant to Article 17(2) of Council Regulation (EEC) No 4064/89 concerning non-disclosure of business secrets and other confidential information. The omissions are MERGER PROCEDURE shown thus […]. Where possible the information ARTICLE 6(1)(b) DECISION omitted has been replaced by ranges of figures or a general description. To the notifying party Dear Sir/Madam, Subject: Case No COMP/M.2192 – SmithKline Beecham/Block Drug Notification of 17.11.2000 pursuant to Article 4 of Council Regulation No 4064/89 1. On 17 November, the Commission received a notification of a proposed concentration pursuant to Article 4 of Council Regulation (EEC) No 4064/89 (“the Merger Regulation”), by which the UK company, SmithKline Beecham plc (“SB”) notified its intention to acquire sole control over the US company, Block Drug Company Inc. (“Block Drug”), through purchase of shares. 2. Following examination of the notification, the Commission has concluded that the notified operation falls within the scope of the said Council Regulation and does not raise serious doubts as to its compatibility with the common market and the EEA agreement.
    [Show full text]
  • Annual Report 2015
    Annual Report 2015 2015 saw substantial progress to accelerate new product sales growth and strengthen our Pharmaceuticals, Vaccines and Consumer Healthcare businesses Overview of 2015 Strategic report “ In 2015, we made substantial progress to accelerate new product sales growth, integrate new businesses in Vaccines and Consumer Healthcare and restructure our global Pharmaceuticals business. This progress means the Group is well positioned to return to core earnings growth in 2016.” Sir Andrew Witty, Chief Executive Officer Governance & remunerationPerformance Financial statements summary Investor information £23.9bn £10.3bn £5.7bn £3.9bn Group turnover Total operating profit Core operating profit Cash dividends paid (up 6% CER/up 1% CER (up >100% CER) a (down 9% CER/down 3% in 2015 pro-forma) a CER pro-forma)a £2.0bn 174.3p 75.7p 10 0 % New product sales b Total earnings per share Core earnings per share Markets now operating (up >100%) (up >100%, primarily (down 15% CER, primarily new commercial model reflecting impact of reflecting short-term dilution transaction gains) of the Novartis transaction)a ~40 20 ~13 % 1st Potential new medicines Potential to file up to Estimated internal In Access to Medicine and vaccines profiled at R&D 20 assets with regulators rate of return in R&D Index event, 80% of which have by 2020 in 2015 potential to be first-in-classc Footnotes a We use a number of adjusted measures to report the performance of our business, as described on page 54. These include core results, CER growth rates and pro-forma CER growth rates. A reconciliation of total results to core results is set out on page 62.
    [Show full text]
  • Annual Report 2015
    Annual Report 2015 2015 saw substantial progress to accelerate new product sales growth and strengthen our Pharmaceuticals, Vaccines and Consumer Healthcare businesses Overview of 2015 Strategic report “ In 2015, we made substantial progress to accelerate new product sales growth, integrate new businesses in Vaccines and Consumer Healthcare and restructure our global Pharmaceuticals business. This progress means the Group is well positioned to return to core earnings growth in 2016.” Sir Andrew Witty, Chief Executive Officer Governance & remunerationPerformance Financial statements summary Investor information £23.9bn £10.3bn £5.7bn £3.9bn Group turnover Total operating profit Core operating profit Cash dividends paid (up 6% CER/up 1% CER (up >100% CER) a (down 9% CER/down 3% in 2015 pro-forma) a CER pro-forma)a £2.0bn 174.3p 75.7p 10 0 % New product sales b Total earnings per share Core earnings per share Markets now operating (up >100%) (up >100%, primarily (down 15% CER, primarily new commercial model reflecting impact of reflecting short-term dilution transaction gains) of the Novartis transaction)a ~40 20 ~13 % 1st Potential new medicines Potential to file up to Estimated internal In Access to Medicine and vaccines profiled at R&D 20 assets with regulators rate of return in R&D Index event, 80% of which have by 2020 in 2015 potential to be first-in-classc Footnotes a We use a number of adjusted measures to report the performance of our business, as described on page 54. These include core results, CER growth rates and pro-forma CER growth rates. A reconciliation of total results to core results is set out on page 62.
    [Show full text]
  • Annual Report 2017
    Annual Report Image HIV virus 2 017 GSK Annual Report 2017 GSK is a science-led global healthcare company In the Strategic report Our new CEO discusses Measuring performance 2017 performance and our and managing risk new long-term priorities See pages 05–07 See pages 18–21 How we create Innovation and Performance long-term value in each of our three businesses See pages 08–09 See pages 22–41 Industry trends How our three businesses together contribute to our Trust priority See pages 10–11 See pages 42–51 Our new long-term priorities: Financial review Innovation, Performance and Trust See pages 12–17 See pages 52–78 Cover image Cautionary statement 30 years after developing the first HIV See the inside back cover of this document medicine, our research into treatment and for the cautionary statement regarding prevention of HIV continues. We remain forward-looking statements. at the forefront of helping people living with HIV, driving innovation and working with communities all over the world. 01 GSK Annual Report 2017 Strategic report Governance and remuneration Financial statements Investor information Our financial performance in 2017a £30.2bn AER +8% £6.7bn AER +51% Group turnover CER +3% New product salesb CER +44% £4.1bn AER +57% £8.6bn AER +12% Total operating profit CER +39% Adjusted operating profit CER +5% 31.4p AER +67% 111.8p AER +11% Total earnings per share CER +36% Adjusted earnings per share CER +4% £6.9bn £3.4bn £3.9bn 80p Net cash flow from Free cash flow Dividends declared 2017 dividend operating activities for 2017 per
    [Show full text]
  • GSK to Acquire Full Ownership of Consumer Healthcare Business
    Accelerating our strategy: GSK to acquire full ownership of Consumer Healthcare Business Buyout of Novartis’ stake Strategic review of Horlicks and other Consumer Healthcare Nutrition products Cautionary statement regarding forward-looking statements This presentation may contain forward-looking statements. Forward-looking statements give the Group’s current expectations or forecasts of future events. An investor can identify these statements by the fact that they do not relate strictly to historical or current facts. They use words such as ‘anticipate’, ‘estimate’, ‘expect’, ‘intend’, ‘will’, ‘project’, ‘plan’, ‘believe’, ‘target’ and other words and terms of similar meaning in connection with any discussion of future operating or financial performance. In particular, these include statements relating to future actions, prospective products or product approvals, future performance or results of current and anticipated products, sales efforts, expenses, the outcome of contingencies such as legal proceedings, and financial results. Other than in accordance with its legal or regulatory obligations (including under the Market Abuse Regulations, UK Listing Rules and the Disclosure Guidance and Transparency Rules of the Financial Conduct Authority), the Group undertakes no obligation to update any forward-looking statements, whether as a result of new information, future events or otherwise. Investors should, however, consult any additional disclosures that the Group may make in any documents which it publishes and/or files with the US Securities and Exchange Commission (SEC). All investors, wherever located, should take note of these disclosures. Accordingly, no assurance can be given that any particular expectation will be met and investors are cautioned not to place undue reliance on the forward-looking statements.
    [Show full text]
  • راتفرannual Report 2019
    THE BLUE DOT GlaxoSmithKline Consumer Healthcare Pakistan Limited 35 - Dockyard Road, West Wharf, Karachi - 74000 GlaxoSmithKline Consumer Healthcare Pakistan Limited REPORT 2019 رفتارis a member of GlaxoSmithKline group of companies. ANNUAL © GlaxoSmithKline Consumer Healthcare Pakistan Limited GLAXOSMITHKLINE CONSUMER HEALTHCARE PAKISTAN LIMITED GSK Consumer Healthcare Pakistan Limited is proud to present its Annual Report for the year 2019. This report focuses on Stakeholder Information, Corporate Governance, Directors’ Report and Financial Statements for the year ended December 31, 2019. For any feedback, suggestions or queries kindly contact the following: Talal Javed Ahmed Chief Financial Ocer E-mail: [email protected] Abdul Haseeb Pirzada Head of Corporate Aairs and Administration Email: [email protected] رفتار STRONGER, FEARLESS, AGILE Amongst many our ‘Raftaar – speed’ stands out alone - GSK Consumer Healthcare Pakistan Limited's (GSK CH's) identity is accounted for being undoubtedly the best fast-moving consumer healthcare company in Pakistan. We set foot in this journey back in 2017 when GSK CH took its Flight (Uraan) with relentless motivation and unwavering energy. We moved forward in 2018 and created our Identity (Pehchaan) when we had committed to deliver only the best to our consumers. Keeping our core values at heart, we remained patient focused, transparent, respectful and most importantly carried our integrity above all. These elements led us to this day where we excelled in this corporate race with a new profound strength; accelerating with a speed (Raftaar) not just to be the best but to be the number one choice for our consumers in Pakistan. This strength for speed was not easy in such economic times with currency devaluation, regulatory frameworks and a competitive landscape.
    [Show full text]
  • Investor Information Information Investor Information
    Strategic report report Governance and and remuneration remuneration Financial statements statements Investor information information Investor information In this section Quarterly trend 244 Pharmaceuticals turnover 246 Vaccines turnover 248 Five year record 249 Product development pipeline 255 Products, competition and intellectual property 258 Principal risks and uncertainties 261 Share capital and control 276 Dividends 278 Financial calendar 2021 279 Annual General Meeting 2021 279 Tax information for shareholders 280 Shareholder services and contacts 282 US law and regulation 284 Group companies 287 Glossary of terms 299 GSK Annual Report 2020 243 Financial record Quarterly trend An unaudited analysis of the Group results is provided by quarter in Sterling for the financial year 2020. Income statement – Total 12 months 2020 Q4 2020 Q3 2020 Q2 2020 Q1 2020 Reported Pro-forma Reported Reported Reported Reported £m £% CER% CER% £m £% CER% £m £% CER% £m £% CER% £m £% CER% Turnover Pharmaceuticals 17,056 (3) (1) (1) 4,366 (4) (3) 4,192 (7) (3) 4,102 (5) (5) 4,396 6 6 Vaccines 6,982 (2) (1) (1) 2,012 15 16 2,032 (12) (9) 1,133 (29) (29) 1,805 19 19 Consumer Healthcare 10,033 12 14 (2) 2,360 (8) (7) 2,422 (4) 2 2,389 25 25 2,862 44 46 34,071 1 3 (2) 8,738 (1) – 8,646 (8) (3) 7,624 (2) (3) 9,063 18 19 Corporate and other unallocated turnover 28 1 – – 27 Total turnover 34,099 1 3 (2) 8,739 (2) (1) 8,646 (8) (3) 7,624 (2) (3) 9,090 19 19 Cost of sales (11,704) (1) – (3,171) (2) (2) (2,885) (11) (8) (2,449) (7) (7) (3,199) 17 18 Selling, general
    [Show full text]
  • Annual Report 2016
    Annual Report 2016 2016 saw good sales momentum across Pharmaceuticals, Vaccines and Consumer Healthcare and further pipeline progress We are a global science-led healthcare company. Our three world-leading businesses research and deliver innovative medicines, vaccines and consumer healthcare products. Front cover case study At GSK, innovation underpins each of our three businesses We are using next generation technology return on R&D investment and accelerate to develop new approaches to disease the development of new products that can management and control. In addition to improve patients’ lives. our own research and development, We have an active pipeline of innovative we gain insights through our network of products across six core areas: respiratory, collaborations with biotechs, other HIV and infectious diseases, vaccines, companies and academic institutions. immuno-inflammation, oncology and This enables more efficient trial design rare diseases. and greater use of software, analytics and new technology, all of which is helping to increase our productivity, maximise our Arthur works at our Upper Providence R&D lab Cautionary statement regarding forward-looking statements The Group’s reports filed with or furnished to the US Securities and Exchange Commission (SEC), including this document and written information released, or oral statements made, to the public in the future by or on behalf of the Group, may contain forward-looking statements. Forward-looking statements give the Group’s current expectations or forecasts of future events. An investor can identify these statements by the fact that they do not relate strictly to historical or current facts. They use words such as ‘anticipate’, ‘estimate’, ‘expect’, ‘intend’, ‘will’, ‘project’, ‘plan’, ‘believe’ and other words and terms of similar meaning in connection with any discussion of future operating or financial performance.
    [Show full text]
  • Alphabetical Listing by Name Dod UNIFORM OUTPATIENT
    DoD UNIFORM OUTPATIENTFORMULARY Alphabetical Listing by Name This document is current as of July 14, 2021 The availability of formulary items is subject to change. Basic Core Formulary: MTF must have on formulary Uniform Formulary: MTF may have on formulary Nonformulary: MTF must not have on formulary Extended Core Formulary: MTF must be on formulary if includes any drugs from that drug class 1 ABACAVIR Abacavir Capsule, Oral: DoD Uniform Formulary Outpatient Dosage Forms Mapap Extra Strength: 500 mg UNIFORM FORMULARY Elixir, Oral: Solution, Oral: Mapap Children's: 160 mg/5 mL (118 mL, 480 mL) [ethanol free; contains Ziagen: 20 mg/mL (240 mL) [contains methylparaben, propylene glycol, benzoic acid, propylene glycol, sodium benzoate; cherry flavor] propylparaben, saccharin sodium; strawberry-banana flavor] Injection, Solution [preservative free]: Tablet, Oral: Ofirmev: 10 mg/mL (100 mL) Generic: 300 mg Liquid, Oral: Generic: 160 mg/5 mL (120 mL, 473 mL); 500 mg/5 mL (240 mL) Abacavir and Lamivudine Solution, Oral: DoD Uniform Formulary Outpatient Dosage Forms Generic: 160 mg/5 mL (5 mL, 10 mL, 20 mL) UNIFORM FORMULARY Suppository, Rectal: Tablet, Oral: Generic: 120 mg (12s); 325 mg (12s) Generic: Abacavir 600 mg and lamivudine 300 mg Suspension, Oral: Generic: 160 mg/5 mL (5 mL, 10.15 mL, 20.3 mL) Abacavir, Dolutegravir, and Lamivudine Syrup, Oral: DoD Uniform Formulary Outpatient Dosage Forms Triaminic Children's Fever Reducer Pain Reliever: 160 mg/5 mL (118 mL) UNIFORM FORMULARY Tablet, Oral: Tablet, Oral: Generic: 325 mg, 500 mg Triumeq:
    [Show full text]
  • Press Release First Quarter 2018
    Press release First quarter 2018 Issued: Wednesday, 25 April 2018, London U.K. GSK delivers Q1 sales of £7.2 billion, -2% AER, +4% CER Total EPS 11.2p, -48% AER, -33% CER; Adjusted EPS 24.6p, -2% AER, +11% CER Significant currency impact in the quarter reflecting movements in Sterling F inancial highlights • CER sales growth across all 3 businesses. Pharmaceuticals sales £4.0 billion -4% AER, +2% CER; Vaccines £1.2 billion +7% AER, +13% CER; Consumer Healthcare £2.0 billion -3% AER, +2% CER • Adjusted Group operating margin of 26.6%, down 0.2 percentage points AER, up 1.3 percentage points CER. Pharmaceuticals 33.2%; Vaccines 27.4%; Consumer Healthcare 19.4% • Total EPS 11.2p, -48% AER, -33% CER, reflecting revaluation of Consumer Healthcare business following agreement to acquire full ownership • Adjusted EPS 24.6p, -2% AER, +11% CER driven by continued operating and financial efficiencies • Q1 free cash flow £324 million -50% primarily reflecting impact of £317 million Vaccine sales milestone payment to Novartis • 19p dividend declared for quarter. Continue to expect 80p for FY 2018 • Guidance for CER growth in Adjusted EPS for 2018 maintained Novartis transaction • Agreement reached with Novartis to acquire full ownership of Consumer Healthcare business for $13 billion, subject to shareholder approval P roduct and pipeline highlights • Sales of Ellipta Respiratory products, £386 million +25% AER, +34% CER and Nucala £104 million +76% AER, +86% CER. Landmark IMPACT data for Trelegy Ellipta published in NEJM. sNDA approved in US and data submitted to European Medicines Agency to support expanded label.
    [Show full text]
  • Medallion 4.0 Formulary (Current)
    VIRGINIA PREMIER HEALTH PLAN MEDICAID FORMULARY PLEASE NOTE: Check your benefit materials for the specific drugs covered and the copayments for your prescription drug program. For specific questions about your coverage, please call the phone number printed on your ID card. The list may not be all- inclusive. THIS LIST IS SUBJECT TO CHANGE. For the member: Generic medications contain the same active ingredients as their corresponding brand-name medications, although they may look different in color or shape. They have been FDA-approved under strict standards. For the physician: Please prescribe preferred products and allow generic substitutions when medically appropriate. Thank you. CURRENT AS OF 9/1/2021 Requirements/Limits AGE = Age limit requirement Custom = Drug has unique restrictions OTC = Over the Counter PA = Prior Authorization required QL = Quantity Level Limit lowercase italics = Generic Formulary SP = Specialty Drug. Preferred Specialty drugs Pharmacy will be listed if applicable UPPERCASE = Brand name Formulary Formulary Status ST = Step Therapy may apply to some or all drugs Formulary = Covered strengths of the drug Drug Name Formulary Status Requirements/Limits 1st relief spray external liquid 4-1 % Formulary OTC 1st tier unifine pentips 29g x 12mm , 31g x 5 mm , 31g x 6 Formulary OTC; QL (200 EA per 30 days) mm , 31g x 8 mm , 32g x 4 mm 1st tier unilet comfortouch Formulary OTC; QL (150 EA per 30 days) 50+ adult eye health oral capsule Formulary OTC A & D ZINC OXIDE EXTERNAL CREAM Formulary OTC a thru z advanced oral tablet
    [Show full text]