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1CC FL Over the Counter (OTC) Benefit: List of Covered Products 081814

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1CC FL Over the Counter (OTC) Benefit: List of Covered Products 081814 ANTACIDS MAST CELL STABILIZER Maalox-generic tablets, liquid Nasalcrom spray-generic Mylanta DS-generic liquid MINERALS ANTIBIOTICS Citracal – generic (calcium citrate) - tablets Bacitracin ointment-generic Citracal + D – generic (calcium citrate + D) – tablets Clotrimazole – cream, vaginal cream/inserts-generic Magnesium oxide-generic Miconazole – cream, vaginal cream/inserts - generic Neutra-phos/K powder-generic Tolnaftate – cream, gel, solution, aerosol - generic Oscal 500 + Vit D – generic (calcium carbonate + D) - tablets ANTI-DIARRHEALS Tums Chew Tabs – generic (calcium carbonate) Imodium A-D-generic (loperamide) capsules Pepto-Bismol-generic (pink bismuth) liquid 262mg/15ml MOSQUITO REPELLENT OFF! Family Care ANTI-EMETIC OFF! Deep Woods Antivert-generic (meclizine) OFF! Active Cutter Skinsations ANTI-FLATULENTS Cutter Backwoods Gas-X chewables – generic simethicone 80mg Repel Insect Sportsmen Mylicon drops** – generic simethicone 40 mg/0.6ml Repel Sportsmen Max Formula ANTI-HISTAMINES NASAL DECONGESTANT Benadryl-generic (diphenhydramine)-capsules, liquid Sudafed-generic (pseudoephedrine)-tablets, liquid Chlor-Trimeton-generic (chlorpheniramine)-tablets, liquid NSAIDS Claritin - generic (loratadine) – tablets, syrup Ibuprofen-generic tablets, chewable, liquid, drops Claritin-D- generic (loratadine/ pseudoephedrine) - Naproxen – generic tablets tablets NUTRITIONAL SUPPLEMENTS ANTITUSSIVE Ensure Robitussin DM -generic (guaifenesin DM) syrup Pediasure COUGH SUPPRESSANT/DECONGESTANT OPHTHALMIC PREPARATIONS Triaminic AM, Night, soft chewable tablets-generic Alaway – (ketotifen 0.025%) Artificial tears – generic drops COUNTERIRRITANTS Naphcon-A-generic (naphazoline/pheniramine Capzasin-P cream-generic 0.025/0.3) Zaditor-OTC (ketotifen 0.025%) DILUENTS Sodium chloride-generic PEDICULICIDES NIX – generic (permethrin) DME PRODUCTS RID-generic (pyrethrins/piperonyl butoxide) Diabetic testing supplies Peak Flow Meters POISON IVY Spacers Calamine-generic Hydrocortisone cream, lotion, ointment, solution - DRY SKIN PREPARATIONS generic AmLactin-generic 1CC FL Over the Counter (OTC) Benefit: List of Covered Products 081814 PROTECTANTS Zinc oxide ointment-generic SMOKING DETERRENTS Commit Lozenges PROTON PUMP INHIBITORS (PPIS) NicoDerm CQ transdermal patch-generic Prilosec OTC tablets Nicorette DS gum-generic Nicorette gum-generic SALICYLATES & Nicotrol transdermal patch-generic ANTIPYRETICS Acetaminophen- TRACE ELEMENTS generic tablets, elixir, Ferrous gluconate – generic tablets drops, suppositories Ferrous sulfate-generic tablets, elixir, drops Aspirin-generic tablets VITAMINS EAR PREPARATIONS Folic acid-generic Debrox drops-generic Multi-vitamins with iron-generic tablets, liquid, Star Otic drops chewable Multi-vitamins-generic tablets, liquid, chewable ELECTROLYTES Nicotinic acid-generic Electrolyte solutions-generic Prenatal vitamins-generic tablets EXPECTORANT Robitussin - generic (guaifenesin) syrup H2-RECEPTOR ANTAGONISTS Pepcid 10mg tablets – generic (famotidine) Zantac 75mg tablets-generic (ranitidine) LAXATIVES Citrate of magnesium-generic Colace-generic (docusate sodium) capsules Dulcolax-generic (bisacodyl) tablets, suppositories Fleet enema-generic Milk Of Magnesium-generic MOM Miralax OTC Pediatric glycerin suppositories-generic 2CC FL Over the Counter (OTC) Benefit: List of Covered Products 081814 .
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