Over-the-Counter (OTC) Medications and Products5290 Metamucil® Sugar-Free, Orange, 72 doses 1 ct....

Over-the-Counter (OTC) Medications and Products

H2962_OTC Catalog_v420_C

2020 Benefit Catalog and Order Form

OTC items delivered to your doorstep at no additional cost.

NationsOTC.com/ultimate

Keep this catalog

for future orders.

Save Money with Your OTC Benefit

Your over-the-counter benefit can save you money and help you stay well. Use your quarterly benefit allowance to purchase medications, health- and wellness-related items, first-aid supplies and other qualifying items, and have them shipped directly to your home.

Save Money with Your OTC Benefit

If you have any questions or need help placing your order, we’re here for you. Member Experience Advisors are available at 1-855-422-0039 (TTY: 711). We’re here to help you get the items you need.

SELECT PRODUCTSChoose from the list of available medications and products found on the following pages or online.

DETERMINE ORDERING METHOD Select which option is best for you:

RECEIVE YOUR ORDER Products will be shipped and delivered to your home. Products usually arrive within 7 to 10 days of when we receive your order.

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How to Place an OrderOrdering the items you need is simple by taking these steps.

ONLINE

Visit NationsOTC.com/ultimate to sign on using your login credentials. First-time users will need to register using your Ultimate Health Plans Member ID number.

MAIL ORDER

Complete and send in the mail order form included in this catalog. If the end of your benefit period is approaching and you’re not sure your order form will be received prior to the last business day of the month, please call or order online.

PHONE

Call 1-855-422-0039 (TTY: 711) to speak with a Member Experience Advisor Monday-Friday, between 8 a.m. and 8 p.m. EST. Language support services are available if needed.

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Please allow 7-10 business days after an order is placed for delivery. An order might take longer to arrive if a change is made or an item is not in stock.

Your order total will be applied to the benefit period in which the order is received. If you place your order using an order form, your order total will be applied to the quarter in which we receive your form. For example, if you mail your order form on June 29th, but we receive it on July 1st, your order total will be applied to your third quarter benefit, not your second quarter benefit. If you are getting close to the end of the quarter and you do not think your order form will be received in time, you can call in your order or order online.

We encourage you to use your full quarterly benefit amount in one order.

Your order total may not exceed your quarterly benefit amount. Cash, checks, credit cards or money orders are not accepted under this OTC benefit.

Orders may only be placed by the member, an authorized representative verbally approved by the member at time of the order, and/or the member’s authorized representative on file.

If you disenroll from Ultimate Health Plans, your OTC benefit will automatically terminate.

OTC products are intended for member use only. Ordering OTC items for friends and family is not allowed.

If an item is damaged during shipping, it will be exchanged or replaced for an identical item, at no cost, within 30 days from your order day or delivery day, whichever applies.

OTC items are available through home delivery only. Products may not be purchased at a local retail pharmacy or through any source other than the Ultimate OTC benefit channels described in this document.

Your benefit allows a set amount every three months as specified in your Summary of Benefits and Evidence of Coverage. The benefit amount does not roll over from quarter to quarter. You pay $0 copay for covered OTC items, medications and products up to the available benefit limit each quarter. You can check your available balance at any time by either logging on to NationsOTC.com/ultimate or calling NationsOTC.

Items in the 2020 OTC Catalog may change throughout the year. For the most up-to-date listing of products available, visit NationsOTC.com/ultimate or call NationsOTC.

OTC Benefit Guidelines

If you have questions about your OTC order, please call NationsOTC at 1-855-422-0039 (TTY: 711). Member Experience Advisors are available Monday-Friday between 8 a.m. and 8 p.m. EST. For all other questions, please contact Ultimate Health Plans Member Services at 1-888-657-4170 (TTY: 711), Monday - Sunday from 8 a.m - 8 p.m. EST. During certain times of the year we may use alternative technologies to answer your call on weekends and Federal holidays.

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Allergy Page 5

Antacids & Acid Reducers Page 5

Anticandidal (Yeast) Page 5

Anti-Diarrheal, Laxatives & Digestive Health Page 5

Bathroom Safety & Fall Prevention Page 5

Cold & Flu Page 6

Compression & Supportive Items Page 7

Dental & Denture Care Page 7

Diabetes Care Page 8

Diagnostics Page 8

Eye & Ear Care Page 9

First Aid Page 9

Foot Care Page 10

Health Supports Page 10

Hemorrhoidal Preparations Page 10

Home & Patient Aids for Daily Living Page 10

Incontinence Page 11

Pain Relief Aids Page 12

Pediculicide (Lice Treatment) Page 12

Skin & Sun Care Page 12

Smoking Deterrents Page 13

Vitamins & Dietary Supplements‡ Page 13

Wart Remover Page 14

Weight Loss‡ Page 14

Product Categories

The items listed in this catalog are shown by category, making it easier for you to locate what

you’re looking for. Available categories include:

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ITEM # DESCRIPTION QTY PRICE

ALLERGY

5052 Cetirizine Tablets, 10 mg. 30 ct. $6

5097 Chlorpheniramine Maleate, 4 mg. 24 ct. $3

5089 Cold & Allergy Children's Liquid, 4 oz. 1 ct. $4

5690 Cromolyn Sodium Allergy Nasal Spray, 1.5 oz. 1 ct. $13

5451 Diphenhydramine Caplets 24 ct. $3

5418 Loratadine Tablets, 10 mg. 30 ct. $4

5345 Nasacort® Allergy Relief 24 Hour, 10.8 ml. 1 ct. $22

5082 Nasal Decongestion PE Tablets 36 ct. $4

5081 Nasal Decongestion Spray, 1 oz. 1 ct. $4

ANTACIDS & ACID REDUCERS

5795 Milk of Magnesia, 12 oz. 1 ct. $3

5800 TUMS® Extra Strength 48 ct. $8

ANTICANDIDAL (YEAST)

5016 Miconazole Vaginal Cream, 3-Day, 0.32 oz. 1 ct. $13

5283 Monistat® Vaginal Cream, 3-Day 1 ct. $24

5142 Panty Liners, Universal 22 ct. $3

ANTI-DIARRHEAL, LAXATIVES & DIGESTIVE HEALTH

5214 Alka-Seltzer® Tablets 24 ct. $8

5304 Antacid Chewable 150 ct. $4

5060 Anti-Nausea Liquid, 4 oz. 1 ct. $5

5695 Beano 100 ct. $9

5213 Bisacodyl Tablets, 5 mg. 100 ct. $5

5696 ClearLax Unflavored Powder, 13 oz. 1 ct. $14

5254 Dramamine® Tablets 12 ct. $9

5554 Dulcolax® Tablets, 5 mg. 25 ct. $12

5167 Enema, Saline Laxative, 4.5 oz. 1 ct. $2

5021 Fibertab Caplet, 625 mg. 90 ct. $8

5280 Gas Relief Chewable Tablets 100 ct. $4

5188 Glycerin Adult Suppository 25 ct. $6

5077 Lactase Enzyme Caplet 60 ct. $8

5801 Magnesium Citrate, Saline Laxative, Lemon, 10 oz. 1 ct. $6

5290 Metamucil® Sugar-Free, Orange, 72 doses 1 ct. $26

5292 Metamucil®, Orange, 114 doses 1 ct. $26

5697 Methylcellulose Fiber Therapy, 16 oz. 1 ct. $12

5238 Motion Sickness Tablets 12 ct. $3

5287 Pepto-Bismol™, 16 oz. 1 ct. $12

5033 Psyllium Powder, Orange, 13 oz. 1 ct. $9

5212 Senna Plus Laxative Tablets 60 ct. $3

5062 Stomach Relief Liquid, 8 oz. 1 ct. $4

5336 Stomach Relief Tablets 30 ct. $5

BATHROOM SAFETY & FALL PREVENTION

5647 Bath Mat, 27" x 13" 1 ct. $8

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5802 Bed Assist Bar 1 ct. $55

5708 Bedside Commode* 1 ct. $75

5538 Cane, 1-Leg Folding Adjustable, 32" - 36"* 1 ct. $10

5539 Cane, Adjustable Quad Bariatric* 1 ct. $26

5315 Cane, Adjustable Quad Non-Bariatric* 1 ct. $18

5803 Gait Belt, 60" 1 ct. $16

5804 Gait Belt, 72" 1 ct. $17

5591 Handheld Shower Head 1 ct. $13

5218 Knurled Chrome Grab Bar, 12" 1 ct. $17



5556 ProBasics® Adjustable Transfer Bench without Back 1 ct. $74

5229 ProBasics® Bath Mat, 27" x 13" 1 ct. $16

5537 Shower Safety Bench without Back 1 ct. $25

5806 Slipper Socks, One Size Fits Most 1 ct. $7

5533 Toilet Safety Rails 1 ct. $29

5532 Toilet Seat, Raised 1 ct. $19

5534 Toilet Seat, Raised with Arms 1 ct. $35

5536 Transfer Bench, Adjustable 1 ct. $58

5637 Tub and Stair Safety Tread Tape 1 ct. $3

COLD & FLU

5252 Abreva® Cream, 2 g. 1 ct. $24

5790 Airborne® Chew 32 ct. $8

5606 Blistex® Ointment, 6 g. 1 ct. $4

5133 Cepacol 18 ct. $4

5460 Children's Cough & Cold, 4 oz. 1 ct. $5

5344 Cold Sore Treatment Lip Balm 1 ct. $5

5338 Cough & Cold for High Blood Pressure 16 ct. $4

5220 Cough Drop, Cherry 30 ct. $2

5545 Cough Drop, Honey Lemon 30 ct. $3

5126 Cough Drop, Menthol 30 ct. $2

5405 Cough/Throat Sugar-Free Drop 25 ct. $3

5399 Day/Nite Cold/Flu Caplet 20 ct. $6

5691 Guaifenesin Cough Expectorant, 200 mg. 100 ct. $9

5087 Mucus Relief DM Tablets 30 ct. $4

5799 Nasal Decongestant Inhaler, Levmetamfetamine, .007 oz. 1 ct. $8

5807 Nasal Rinse Kit, Saline 1 kit $18

5692 Personal Steam Inhaler 1 ct. $53

5072 Saline Nasal Spray, 1.5 oz. 1 ct. $3

5197 SinuCleanse Neti Pot 1 ct. $15

5453 Snoring Nose Strips 10 ct. $9

5693 Sore Throat Lozenges, Cherry 25 ct. $5

5694 Sore Throat Spray, Cherry, 6 oz. 1 ct. $8

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5007 Thera-Flu® Multi-Symptom, Lemon 6 ct. $14

5023 Tussin DM Sugar-Free Syrup, 4 oz. 1 ct. $4

5015 Tussin Syrup, 4 oz. 1 ct. $3

5511 Vapor Rub, 3.53 oz. 1 ct. $3

COMPRESSION & SUPPORTIVE ITEMS

5148 Anti-Embolism Stockings, Medium 1 ct. $7

5560 Anti-Embolism Stockings, Large 1 ct. $7

5895 Compression Knee-High Socks, 15-20 mmHg, Men's Black, Medium (Shoe Size 6-8)

1 ct. $16

5896 Compression Knee-High Socks, 15-20 mmHg, Men's Black, Large (Shoe Size 7.5-11)

1 ct. $16

5897 Compression Knee-High Socks, 15-20 mmHg, Men's White, Medium (Shoe Size 6-8)

1 ct. $16

5898 Compression Knee-High Socks, 15-20 mmHg, Men's White, Large (Shoe Size 7.5-11)

1 ct. $16

5728 Compression Knee-High Socks, 8-15 mmHg, Women's Black, Small (Shoe Size 4-5)

1 ct. $16

5901 Compression Knee-High Socks, 8-15 mmHg, Women's Black, Medium (Shoe Size 5.5-7.5)

1 ct. $16

5902 Compression Knee-High Socks, 8-15 mmHg, Women's Black, Large (Shoe Size 8-10.5)

1 ct. $16

5729 Compression Knee-High Socks, 8-15 mmHg, Women's Nude, Small (Shoe Size 4-5)

1 ct. $16

5899 Compression Knee-High Socks, 8-15 mmHg, Women's Nude, Medium (Shoe Size 5.5-7.5)

1 ct. $16

5900 Compression Knee-High Socks, 8-15 mmHg, Women's Nude, Large (Shoe Size 8-10.5)

1 ct. $16

5732 Hip Protector, Small 1 ct. $37

5731 Hip Protector, Medium 1 ct. $37

5730 Hip Protector, Large 1 ct. $37

5733 Hip Protector, X-Large 1 ct. $37

5734 Knee Stabilizer, Medium 1 ct. $21

5736 Knee Support Elastic with Stays, Small 1 ct. $15

5735 Knee Support Elastic, Small 1 ct. $10

5737 Rib Belt, Female, One Size Fits Most 1 ct. $21

5738 Rib Belt, Male, One Size Fits Most 1 ct. $21

DENTAL & DENTURE CARE

5510 Adult Toothbrush 1 ct. $2

5700 Biotene® Dry Mouth Oral Rinse, 16 oz. 1 ct. $14

5505 Colgate® Toothbrush Soft, Adult 1 ct. $2

5047 Colgate® Toothpaste, 4 oz. 1 ct. $3

5811 Crest® Sensi-Relief Toothpaste, 4.1 oz. 1 ct. $10

5626 Denture Brush 1 ct. $2

5546 Denture Cleanser Tablets 42 ct. $4

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5808 Efferdent® Plus Mint Tablets 36 ct. $9

5504 Fixodent® Cream, 0.75 oz. 1 ct. $4

5379 Fixodent® Cream, 2.4 oz. 1 ct. $8

5102 Fluoride Toothpaste, 6.4 oz. 1 ct. $3

5200 Interdental Flossups 1 ct. $3

5195 Oral Pain Relief Gels, 0.33 oz. 1 ct. $3

5701 Polident® Denture Cream, 3.9 oz. 1 ct. $7

5809 Polident® Overnight 84 ct. $12

5130 Reach® Dental Floss 1 ct. $4

5160 Rechargeable Toothbrush 1 ct. $28

5421 Sensitive Toothpaste, 4.3 oz. 1 ct. $3

5810 Tongue Cleaner 1 ct. $6

5702 Toothbrush, Soft, 2-Pack 1 ct. $7

5241 Toothpaste Squeezer 1 ct. $3

5530 Toothpaste, 0.85 oz. 1 ct. $2

5294 Ultrabright Toothpaste, 6 oz. 1 ct. $4

5703 Water Jet Replacement Tips 5 ct. $17

5654 Water Jet, Battery Operated 1 ct. $41

DIABETES CARE

5812 Diabetic Skin Relief Foot Cream, 3.4 oz. 1 ct. $12

5313 Glucose Tablets 50 ct. $6

5574 Lancing Device 1 ct. $4

5225 Diabetic Socks, Unisex Medium, Black 3 ct. $6

5223 Diabetic Socks, Unisex Large, Black 3 ct. $6

5860 Diabetic Socks, Unisex X-Large, Black 3 ct. $6

5224 Diabetic Socks, Unisex Medium, White 3 ct. $6

5222 Diabetic Socks, Unisex Large, White 3 ct. $6

5861 Diabetic Socks, Unisex X- Large, White 3 ct. $6

DIAGNOSTICS

5813 Activity Tracker 1 ct. $52

5814 Bathroom Scale, Talking‡§ 1 ct. $60

5573 Blood Pressure Monitor, Audio‡ 1 ct. $32

5602 Dial Bath Scale, 300 lbs.‡§ 1 ct. $9

5723 EZ Detect Colon Cancer Test Kit‡ 1 kit $24

5778 HIV Test‡ 1 ct. $45

5724 Home Access® Cholesterol Test Kit‡ 1 kit $30

5201 Heart Rate Monitor Watch‡ 1 ct. $16

5491 Peak Flow Meter‡ 1 ct. $11

5482 Pregnancy Test‡ 1 ct. $4

5096 Pulse Oximeter‡ 1 ct. $20

5371 Surelife BPM Fully Auto Cuff, Large‡ 1 ct. $22

5370 Surelife BPM Wrist Unit‡ 1 ct. $20

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EYE & EAR CARE

5385 Cotton Swabs 300 ct. $4

5815 Ear Pain Relief Ear Drops, 10 ml. 1 ct. $13

5189 Ear Wax Drops, 0.5 oz. 1 ct. $3

5704 Ear Wax Removal System with Rubber Bulb, 5 ml. 1 ct. $11

5004 Eye Artificial Tears, 0.5 oz. 1 ct. $4

5048 Eye Redness Relief, 0.5 oz. 1 ct. $3

5138 Eye Wash, 3.9 oz. 1 ct. $9

5705 Multi-Purpose Contact Lens Solution, 4 oz. 1 ct. $8

5473 Pain Relief Mask 1 ct. $3

5706 Stye Eye Compress 1 ct. $18

5707 Stye Eye Ointment, 3.5 mg. 1 ct. $13

5494 Visine® Drops for Red Eyes, 0.5 oz. 1 ct. $12

FIRST AID

5375 After Bite Relief, 0.05 oz. 1 ct. $6

5295 Alcohol Pad* 100 ct. $3

5816 Antiseptic Skin Cleanser, 4 oz. 1 ct. $11

5796 Bacitracin Ointment, 0.5 oz. 1 ct. $3

5798 Bacitracin Ointment, 1 oz. 1 ct. $4

5698 Bactine Solution, 5 oz. 1 ct. $10

5173 Bandages Generic, Assorted* 100 ct. $3

5203 Benadryl® Cream, 1 oz. 1 ct. $8

5547 Burn Gel Liquid, 4 oz. 1 ct. $6

5066 Calamine Lotion, 6 oz. 1 ct. $4

5699 Caldyphen Clear Lotion Local Analgesic 1%, 7.65 oz. 1 ct. $9

5192 Cotton Balls 100 ct. $3

5709 Cushion, Foam Ring 1 ct. $20

5710 Cushion, Gel/Foam Seat 1 ct. $28

5194 Disposable Gloves, Small 50 ct. $5

5193 Disposable Gloves, Medium 50 ct. $5

5191 Disposable Gloves, Large 50 ct. $5

5612 First Aid Kit, 1 kit 75 ct. $6

5711 First Aid Kit, 1 kit 175 ct. $15

5462 Gauze Roll, 3-Pack 1 ct. $2

5400 Hydrocortisone 1% Cream, 1 oz. 1 ct. $3

5116 Hydrogen Peroxide Spray, 4 oz. 1 ct. $4

5227 Hydrogen Peroxide, 8 oz. 1 ct. $3

5045 Liquid Bandage, 0.0225 oz. 1 ct. $5

5250 Neosporin® Plus, 0.5 oz. 1 ct. $9

5437 Petroleum Jelly, 4 oz. 1 ct. $2

5712 Povidone Iodine Solution Antiseptic, 4 oz. 1 ct. $6

5817 Procedural Face Masks with Earloops 50 ct. $12

5541 Rubbing Alcohol, 16 oz. 1 ct. $3

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5131 Surgical Tape* 1 ct. $2

5149 Thermometer, 60 Second 1 ct. $3

5627 Thermometer, Audio 1 ct. $33

5172 Thermometer, Flex Tip 1 ct. $7

5415 Thermometer, Probe Covers 30 ct. $3

5262 Vitacilina® Antibiotic Ointment, 1 oz. 1 ct. $6

FOOT CARE

5818 Bunion Guard 1 ct. $10

5497 Compound W® Gel, 0.25 oz. 1 ct. $14

5196 Corn & Callus Remover, 0.5 oz. 1 ct. $6

5819 Hammer Toe Crest 1 ct. $12

5667 Lamb's Wool Padding 1 ct. $4

5158 Medicated Callus Removers 6 ct. $4

5543 Medicated Foot Powder, 4 oz. 1 ct. $6

5431 Miconazole Nitrate 2% Cream 1 ct. $9

5159 Moleskin Sheets Plus, 4 Sheets 1 ct. $4

5544 Toe Separator 1 ct. $5

5165 Tolnaftate 1% Cream, 1.25 oz. 1 ct. $4

HEALTH SUPPORTS

5395 Ankle Support 1 ct. $2

5604 Back Support, Curad 1 ct. $25

5261 Back Support, Generic with Suspenders 1 ct. $10

5398 Bandage Elastic, 3"* 1 ct. $2

5561 Brace, Thumb 1 ct. $8

5407 Carpal Tunnel Gloves, Small 1 ct. $30

5408 Carpal Tunnel Gloves, Medium 1 ct. $30

5409 Carpal Tunnel Gloves, Large 1 ct. $31

5394 Elbow Support 1 ct. $3

5472 Heating Pad, Dry Heat‡ 1 ct. $18

5526 Hot Cold Reusable Pack, 4" x 6" 1 ct. $2

5651 Inflatable Neck Cushion 1 ct. $3

5391 Knee Support with U-Buttress, Medium 1 ct. $31

5392 Knee Support with U-Buttress, Large 1 ct. $31

5393 Knee Support, Medium, Assorted 1 ct. $3

5389 Wrist Support 1 ct. $3

HEMORRHOIDAL PREPARATIONS

5414 Hemorrhoid Ointment, 2 oz. 1 ct. $5

5076 Hemorrhoid Pad 100 ct. $7

5351 Hemorrhoid Suppository 12 ct. $7

5820 Preparation H® Medicated Wipes 48 ct. $11

5057 Preparation H® Ointment, 2 oz. 1 ct. $21

HOME & PATIENT AIDS FOR DAILY LIVING

5100 Button and Zipper Puller 1 ct. $3

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5503 Humidifier, Ultrasonic Cool 1 ct. $42

5791 Jar Opener/Faucet Gripper 1 ct. $3

5792 Key Turner 1 ct. $5

5821 Kitchen Scale, Digital‡ 1 ct. $25

5793 Lamp Switch Turner 1 ct. $5

5794 Letter Opener 1 ct. $5

5512 Medical Appointment Calendar 1 ct. $3

5822 Medicine Bottle Opener with Magnifier 1 ct. $10

5246 Pill Bottle Opener Aid 1 ct. $3

5242 Pill Box, 7 Day (1 Time a Day) 1 ct. $4

5456 Pill Box, 7 Day (3 Times a Day) 1 ct. $3

5210 Pill Box, 7 Day (4 Times a Day) 1 ct. $3

5508 Pill Box, 7 Day (AM & PM) 1 ct. $9

5123 Pill Crusher 1 ct. $3

5823 Pill Crusher with Storage 1 ct. $11

5824 Pill Cutter with Safety Shield 1 ct. $10

5190 Pill Splitter 1 ct. $3

5098 Reaching Aid Device 1 ct. $13

5656 Shoe Horn 1 ct. $2

5642 Travel Health Folder 1 ct. $6

INCONTINENCE

5525 A+D Ointment, 1 oz. 1 ct. $2

5150 Adult Bladder Control Pads* 12 ct. $7

5422 Adult Protective Briefs, Large* 20 ct. $13

5419 Adult Protective Briefs, Medium* 20 ct. $11

5416 Adult Protective Briefs, X-Large* 20 ct. $16

5447 Adult Washcloths, Disposable* 48 ct. $4

5714 Attends Discreet Men’s Guards, Large/X-Large* 52 ct. $14

5715 Attends Discreet Women’s Ultimate Bladder Control Pads* 28 ct. $21

5716 Attends Discreet Women’s Ultrathin Pads* 28 ct. $14

5717 Barrier Cream, 4 oz. 1 ct. $9

5825 Bathing Wipes 8 ct. $8

5718 Bladder Control Shaped Pads, Heavy Absorbency* 28 ct. $12

5719 Bladder Control Shaped Pads, Maximum Absorbency* 28 ct. $12

5720 Bladder Control Shaped Pads, Moderate Absorbency* 28 ct. $12

5170 Disposable Bed Underpads* 5 ct. $5

5883 Disposable Underwear, Medium - 34” to 44”* 20 ct. $15

5882 Disposable Underwear, Large - 44” to 58”* 18 ct. $15

5884 Disposable Underwear, X-Large - 58” to 68”* 14 ct. $15

5529 ReadyFlush Wipes* 24 ct. $4

5721 Underpads, Disposable, 23” x 36”* 25 ct. $12

5722 Underpads, Disposable, 30” x 30”* 10 ct. $11

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PAIN RELIEF AIDS

5022 Acetaminophen Arthritis Caplet, 650 mg. 24 ct. $3

5430 Acetaminophen Arthritis, 650 mg. 100 ct. $11

5038 Acetaminophen Chewables, 80 mg. 30 ct. $4

5039 Acetaminophen Children's Chewables, 160 mg. 24 ct. $7

5303 Acetaminophen Extra Strength Tablets, 500 mg. 100 ct. $3

5428 Acetaminophen PM Caplet, 500 mg. 50 ct. $3

5302 Acetaminophen Tablets, 325 mg. 100 ct. $3

5054 Advil® Liquidgels, 200 mg. 20 ct. $8

5053 Advil® Tablets, 200 mg. 50 ct. $12

5243 Aleve® Caplets, 220 mg. 24 ct. $8

5256 Aleve® Caplets, 220 mg. 100 ct. $10

5343 Aspercreme® 4% Cream 1 ct. $13

5073 Aspirin Chewables, 81 mg. 36 ct. $2

5064 Aspirin EC Tablets, 325 mg. 100 ct. $4

5297 Aspirin Tablets, 325 mg. 100 ct. $3

5090 Aspirin-NWI-EC Tablets, 81 mg. 120 ct. $3

5251 Capsaicin 0.025% Cream, 2 oz. 1 ct. $3

5074 Diphenhydramine Sleep Tablets 50 ct. $5

5314 Fast Freeze Pain Relief Spray, 4 oz. 1 ct. $9

5018 Headache Relief Tablets 50 ct. $3

5725 Heating Pad Wrap for Shoulder, Neck & Back, 25” x 26” 1 ct. $55

5726 Heating Pad, X-Large, 12” x 24”* 1 ct. $35

5080 Hot/Cold Patch 5 ct. $4

5020 Ibuprofen Chewables, 100 mg. 24 ct. $7

5401 Ibuprofen Liquidgels, 200 mg. 20 ct. $5

5093 Ibuprofen Tablets, 200 mg. 50 ct. $3

5485 Ibuprofen Tablets, 200 mg. 100 ct. $4

5317 Ice Bag 1 ct. $5

5341 Icy Hot® Patch 5 ct. $8

5826 Menthol Gel, 8 oz. 1 ct. $9

5457 Muscle Rub Cream, 1.25 oz. 1 ct. $3

5017 Naproxen Caplet, 220 mg. 50 ct. $6

5383 Salonpas® Patch 5 ct. $12

5365 Tens Unit, Digital 1 ct. $49

5121 Warm/Cold Water Bottle 1 ct. $5

5727 WellPatch® Migraine 4 ct. $7

PEDICULICIDE (LICE TREATMENT)

5827 Lice Elimination Kit 1 kit $27

5024 Lice Treatment Shampoo, 4 oz. 1 ct. $3

5035 LiceMD® Lice Shampoo, 4 oz. 1 ct. $18

SKIN & SUN CARE

5169 Anti-Bacterial Wet Wipes 24 ct. $3

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5397 Benzoyl Peroxide 10% Gel, 42.5 g. 1 ct. $5

5479 Bug X Repellent, 4 oz. 1 ct. $7

5091 Dry Skin Cream, 10 oz. 1 ct. $3

5333 Hand Sanitizer Spray, 2-Pack 2 ct. $4

5665 Sunscreen, SPF 30, 4 oz. 1 ct. $5

SMOKING DETERRENTS

5285 Nicotine Gum, 4 mg. 50 ct. $25

5689 Nicotine Lozenge, 4 mg. 20 ct. $39

5686 Nicotine Patches, Step 1 14 ct. $40



VITAMINS & DIETARY SUPPLEMENTS‡

5306 Adult Multi-Vitamin‡ 100 ct. $3

5359 Biotin Gummy, 5,000 mcg.‡ 60 ct. $8

5739 Calcium Chew, Chocolate, 650 mg.‡ 60 ct. $10

5300 Calcium, 600 mg.‡ 60 ct. $6

5001 Centrum® Silver Vitamins‡ 125 ct. $17

5000 Centrum® Vitamins‡ 130 ct. $17

5156 Coenzyme Q10 Caplet, 100 mg.‡ 30 ct. $7

5713 DHEA, 50 mg.‡ 100 ct. $11

5619 Estroven®‡ 30 ct. $17

5740 Ferrous Gluconate Iron Supplement, 240 mg.‡ 100 ct. $7

5299 Ferrous Sulfate, 325 mg.‡ 100 ct. $3

5337 Fish Oil Softgels, 1,000 mg.‡ 30 ct. $3

5668 Folic Acid, 800 mcg.‡ 100 ct. $3

5176 Glucosamine & Chondroitin, 1,500 mg.‡ 30 ct. $12

5450 Glucosamine & Chondroitin, 1,500 mg.‡ 60 ct. $14

5741 Iron, 27 mg.‡ 100 ct. $7

5742 Magnesium Oxide, 250 mg.‡ 100 ct. $6

5328 Magnesium, 500 mg.‡ 100 ct. $5

5358 Melatonin Gummy‡ 60 ct. $12

5221 Melatonin, 3 mg.‡ 60 ct. $5

5920 Men’s Multi-Vitamin‡ 100 ct. $6

5354 Multi-Vitamin Gummy‡ 60 ct. $8

5255 Niacin Flush Free, 500 mg.‡ 60 ct. $7

5743 Niacin, 100 mg.‡ 100 ct. $5

5184 Niacin, 500 mg.‡ 60 ct. $6

5307 Prenatal Vitamins‡ 100 ct. $6

5744 Rena-Vite‡ 100 ct. $10

5132 Senior Multi-Vitamin‡ 90 ct. $7

5065 Vitamin A, 10,000 iu.‡ 100 ct. $4

5745 Vitamin B-1, 100 mg.‡ 100 ct. $6

5308 Vitamin B-12, 100 mcg.‡ 100 ct. $4

13


5746 Vitamin B-12, 500 mg.‡ 100 ct. $6

5747 Vitamin B-6, 100 mg.‡ 100 ct. $6

5248 Vitamin B-Complex Gummy‡ 70 ct. $8

5305 Vitamin B-Complex‡ 100 ct. $4

5492 Vitamin C Gummy‡ 60 ct. $8

5748 Vitamin C, 1,000 mg.‡ 100 ct. $3

5301 Vitamin C, 500 mg.‡ 100 ct. $3

5355 Vitamin D + Calcium Gummy, 500 mg.‡ 60 ct. $11

5183 Vitamin D, 1,000 iu.‡ 100 ct. $7

5175 Vitamin D, 400 iu.‡ 100 ct. $4

5749 Vitamin D, 5,000 iu.‡ 100 ct. $4

5750 Vitamin E Softgels, 100 iu.‡ 100 ct. $7

5269 Windmill® Vitamin E, 400 iu.‡ 90 ct. $9

5274 Windmill® Zinc Tablet, 50 mg.‡ 90 ct. $6

5186 Women's Multi-Vitamin‡ 90 ct. $6

5070 Zinc, 50 mg.‡ 100 ct. $4

Wart Remover

5164 Liquid Wart Remover, 0.31 oz. 1 ct. $5

5751 Wart Removal System 20 ct. $10

Weight Loss‡

5124 Dial Kitchen Scale‡ 1 ct. $6

5247 Vitafusion Fiber Gummy‡ 90 ct. $17

* Part B/D - Under certain circumstances some items may be covered under either Part B or Part D. Whenyou are eligible to receive these items under Part B or Part D you may not purchase these items through your Part C supplemental OTC benefit. For your convenience, we’ve marked these items with an (*).

‡ Dual-purpose items are medicines and products that can be used for either a medical condition or for general health and well-being. In order to purchase these items under your plan, your personal

physician must recommend them to you for a specific diagnosed condition. Please speak to your physician before ordering these items.

§ Scales are only available to members with congestive heart failure or liver disease in order to monitorweight changes. Scales are not allowable for other conditions or diseases. Please discuss with yourhealthcare provider before ordering.

This product list is subject to change. Items, quantities, sizes and values may change depending onavailability. If a product is unavailable or not in stock, it may be substituted for a similar product at noadditional charge. Some items may vary depending on manufacturer.

NationsOTC and Ultimate Health Plans comply with applicable Federal civil rights laws and does notdiscriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: Si hablaespañol, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-241-0303(TTY: 711). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou.1-877-241-0303 (TTY: 711).

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Member ID (found on member ID card) Date of Birth (MM/DD/YY)

First Name Last Name

Street # Street Name Apt/Suite #

City State ZIP Code

Phone Email

Use the form on the reverse side to enter your product information.

NOTE: If you place your order using an order form, your order total will be applied to the quarter in which we receive your form. For example, if you mail your order form on June 29th, but we receive it on July 1st, your order total will be applied to your third quarter benefit, not your second quarter benefit.

Send the completed order form to:

NationsOTC P.O. BOX 8930West State Rd. 84, Suite 187Davie, FL 33324

If you have any questions or need assistance placing your order, please call NationsOTC at 1-855-422-0039 (TTY: 711). Member Experience Advisors are available Monday - Friday, between8 a.m. and 8 p.m. EST. Language support services are available.

SEE REVERSE SIDE FOR PRODUCT SELECTION

Make Your Product Selection

Mail Completed Form

Complete Your Personal Information

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Select the products you want to order by writing in the product information below.

ITEM # DESCRIPTION QTY PRICE TOTAL

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25. _______ ________________________________________ ________ $________ $________

Total Order $________

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Over-the-Counter (OTC) Medications and Products5290 Metamucil® Sugar-Free, Orange, 72 doses 1 ct....

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Transcript of Over-the-Counter (OTC) Medications and Products5290 Metamucil® Sugar-Free, Orange, 72 doses 1 ct....