Transcription of Covered OTC List - OptumRx
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Covered OTC List - OptumRx
TennCare Covered OTC List - Effective 8/1/2022 NDCL abel NameGen NamePackage SizeCovered- KidsPA only- KidsCovered- AdultsPA only- AdultsNot Covered -AdultsANTIHELMENTICP lease refer to TennCare's PDL for coverage of the following:PYRANTEL PAMOATEEMERGENCY CONTRACEPTIVESP lease refer to TennCare's PDL for coverage of the following:AFTERA OTCPLAN B ONE-STEP OTCTAKE ACTION OTCCOVID TEST KITSQ uantity Covered per member per month = 8 tests08337000158 INTELISWAB KIT COVID-19 COVID-19 AT HOME ANTIGEN TEST KIT2xx11877001140 BINAXNOW COV KIT HOME TESCOVID-19 AT HOME ANTIGEN TEST KIT2xx14613033972 QUICKVUE HOM KIT COVID-19 COVID-19 AT HOME ANTIGEN TEST KIT2xx50021086001 ELLUME COV19 KIT HOME TESCOVID-19 AT HOME ANTIGEN TEST KIT1xx56964000000 ELLUME COV19 KIT HOME TESCOVID-19 AT HOME ANTIGEN TEST KIT1xx60006019166ON/GO COVID KIT ANTIGENCOVID-19 AT HOME ANTIGEN TEST KIT2xx82607066026 FLOWFLEX KIT TESTCOVID-19 AT HOME ANTIGEN TEST KIT1xx82607066027 FLOWFLEX KIT TESTCOVID-19 AT HOME ANTIGEN TEST KIT2xxDIABETES
humulin 70/30 kwikpen humulin 70-30 vial humulin n vial humulin r vial novolin r vial novolin 70-30 vial novolin n vial 00169183702 relion novolin 70-30 vial insulin nph hum/reg insulin hm 70-30/ml 10 x x 00169183402 relion novolin n 100 unit/ml insulin nph human isophane 100/ml 10 x x
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