BlueCare Plus (HMO SNP)SM Over-the-Counter Catalog

1 H3259_19_OTCCAT_C (09/18) BlueCare Plus (HMO SNP)SMOver-the-Counter to the BlueCare Plus Tennessee Over-the-Counter (OTC) Program! This program can help you save time and money. You can purchase products in this Catalog with your OTC benefit credits and get them shipped right to your are the four quarterly benefit periods in the year and the amount you get each quarter: + Quarter 1 (January March) $300 credit + Quarter 2 (April June) $300 credit + Quarter 3 (July September) $300 credit + Quarter 4 (October December) $300 creditHow to Use This CatalogProducts are organized alphabetically in each section. Every product has a description, item number, and price. You will need this information if you fill out the BlueCare Plus Over-the-Counter Order Easy Ways to Order1. Online. You can order online at By phone.

2 To place an order or check your order s status, call 1-800-400-6864 or (TTY: 711), toll free from 8:30 to 10 CT, Monday through By mail. Complete the BlueCare Plus Over-the-Counter Order Form and mail it to the address listed on the form. Keep in Mind + BlueCare Plus may limit the quantity you can order due to product restrictions. + Products shipped may appear differently than what is pictured. + Due to the personal nature of these products, returns will not be accepted. + The list of covered OTC products and prices may change at any time. For the most up-to-date information on OTC products, visit Plus Tennessee Over-the-Counter CatalogThese items are for your purchase and use only. BlueCare Plus Tennessee is not responsible for statements made in descriptions of items in the Catalog regarding use and effectiveness.

3 Remember to discuss all of your medications, including Over-the-Counter medications, with your doctor. How often can I place an order? You can place one order per month with a total of three orders per example: In Quarter 1 (January - March), you place one order that equals your benefit credit amount of $ You use $ on products in January, then spend $ in February, and $100 in March so that all three months orders add up to your Quarter 1 benefit credit amount of $ I use my OTC benefit for items not in the Catalog ? No, you can only use your OTC benefit for products in this Catalog or on the DrugSource website. We will not pay you back for any OTC products purchased outside of the BlueCare Plus Over-the-Counter Catalog or the DrugSource happens if I do not use all of my OTC benefit within the quarter? Your OTC benefit will not carry over from quarter to quarter.

4 Beginning each quarter, you will have $300 to spend each quarter on OTC items from this Catalog or from the DrugSource I use the OTC Order Form for prescription drugs?No, you do not use the OTC Order Form for your prescription drugs. You may only use your OTC benefit for items in this Catalog or on the do I return items? Due to the personal nature of these products, returns will not be accepted and no refund or credit will be given once items are ordered and mailed. Who do I contact with Benefit Questions? You can call BlueCare Plus member service at 1-800-332-5762 ( T T Y: 711). From Oct. 1 to March 31, you can call us 7 days a week from 8 to 9 ET. From April 1 to Sept. 30, you can call us Monday through Friday from 8 to 9 ET. If you call us outside these hours or on a holiday, our automated system will answer your call.

5 You can leave a message for us, and we will call you back the next business Asked Questions about Using Your OTC Benefit ACNE TREATMENT BENZOYL PEROXIDE GEL 10% 45GM Item# 540- 8570 Price $ CLEAN & CLEAR ADVANTAGE ACNE SPOT TREATMENT .75OZ Item# 148- 2967 Price $ For the treatment of acne. This treatment contains breakthrough technology that actually dissolves oil and allows the maximum strength acne medicine to penetrate into your pores. This formula works fast to reduce visible signs of acne. 100% of people showed clearer skin in just one day. Won't overdry skin. Oil-free. CLEAN & CLEAR ESSENTIAL FOAM FACIAL CLEANSER 8OZ Item# 410- 6050 Price $ Removes oil, dirt, and make-up impurities that can cause breakouts. This oil-free formula rinses clean, leaving no residue.

6 Won't over-dry. NEUTROGENA ACNE WASH OIL-FREE 6OZ Item# 645- 1330 Price $ For the treatment of acne. This #1 dermatologist recommended acne cleanser combines a powerful acne treatment and cleanser in one formula to treat and help prevent breakouts in one simple step. It eliminates oil and unclogs pores while its medicine treats breakouts, even blackheads. Effective yet gentle, it won't over-dry or irritate. Rinses clean, leaving no pore -clogging residue. NEUTROGENA CLEAR PORE OIL-ELIMINATING ASTRINGENT 8OZ Item# 113- 3560 Price $ For the treatment of acne. Clear skin starts with clear pores. Specifically formulated to instantly remove surface oil to control shine and to treat and help prevent breakouts. OXY DAILY CLEANSING PADS MAXIMUM 90CT Item# 464-7004 Price $ Treats and helps prevent acne.

7 Formulated to minimize dryness and irritation for healthy looking skin. Continues to work between uses. Great for home or on-the -go. Sales Tax Applies 1 ANTI -FUNGALS ATHLETE'S FOOT ANTIFUNGAL C REAM 15GM Item# 221- 5952 Price $ Generic for Lamisil CLOTRIMAZOLE 1% CREAM 1OZ Item# 148- 1258 Price $ Generic for Lotrimin CLOTRIMAZOLE 1% CREAM Item# 904- 1955 Price $ Generic for Lotrimin FUNGI NAIL TINCTURE 30ML Item# 316- 0017 Price $ Proven effective in the treatment of most athlete's foot (tinea pedis) and ringworm (tinea corporis). For effective relief of itching, burning and cracking. Maximum strength. Moisturizing solution with pinpoint applicator. Kills fungus on contact and restores skin. Stops the spread of fungus. LAMISIL AT ATHELETE'S FOOT CREAM 1% 12GM Item# 102- 3407 Price $ Cures most athlete s foot (tinea pedis).

8 Cures most jock itch (tinea cruris) and ringworm (tinea corporis). Relieves itching, burning, cracking and scaling which accompany these conditions. Full prescription strength. LOTRIMIN AF CREAM Item# 550- 3818 Price $ Cures most athlete's foot, jock itch, and ringworm. Relieves itching, burning, cracking, scaling and discomfort which accompany these conditions. Clinically proven. LOTRIMIN AF CREAM 30GM Item# 19150 Price $ Cures most athlete's foot, jock itch, and ringworm. Relieves itching, burning, cracking, scaling and discomfort which accompany these conditions. Clinically proven. MICONAZOLE NITRATE CREAM 2% 30GM Item# 099- 1265 Price $ Generic for Micatin TOLNAFTATE 1% CREAM 1OZ Item# 105- 4352 Price $ Generic for Tinactin 2 Sales Tax Applies TOLNAFTATE 1% CREAM Item# 354- 0051 Price $ Generic for Tinactin TOLNAFTATE 1% POWDER Item# 536- 3387 Price $ Generic for Tinactin ANTI -ITCH OINTMENTS & CREAMS AFTER BITE EXTRA GEL Item# 376- 1616 Price $ For temporary relief of pain and itching caused by: insect bites ; minor burns; minor skin irritation; minor cuts and scrapes.

9 This is a powerful gel that provides instant relief. This extra strength itch erasing formula contains antihistamine and tea tree oil to help soothe the skin and stop discomfort. Don't let insect bites and stings ruin your outdoor fun! New & improved formula. BENADRYL EXTRA STRENGTH ITCH STOPPING 2% CREAM 1OZ Item# 735- 7791 Price $ Temporarily relieves pain and itching associated with: insect bites , minor burns, sunburn, minor skin irritations, minor cuts, scrapes, rashes due to poison ivy, poison oak, and poison sumac. Dries the oozing and weeping of poison ivy, poison oak, and poison sumac. Extra strength. Relief from most outdoor itches. BENADRYL REGULAR STRENGTH ITCH RELIEF 1% CREAM 1OZ Item# 735- 7783 Price $ Temporarily relieves pain and itching associated with: insect bites ; minor burns; sunburn; minor skin irritations; minor cuts; scrapes; rashes due to poison ivy, poison oak, and poison sumac.

10 Dries the oozing and weeping of poison ivy, poison oak, and poison sumac. For ages 2 & up. Relief from most outdoor itches. CALAMINE LOTION 6OZ Item# 359- 1146 Price $ 4 .10 Generic for Caladryl CORTAID ANTI-ITCH MAXIMUM STRENGTH CREAM 1% 1OZ Item# 241- 1668 Price $ Temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema; insect bites ; poison ivy, oak, or sumac; soaps; detergents; cosmetics; jewelry; seborrheic dermatitis; psoriasis. Temporarily relieves external anal and genital itching. Other uses of this product should only be under advice and supervision of a doctor. Sales Tax Applies 3 CORTIZONE 10 CREME 1OZ Item# 455- 5561 Price $ Temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema; psoriasis; poison ivy, oak, sumac; insect bites ; detergents; jewelry; cosmetics; soaps; seborrheic dermatitis.