2021 OTC Catalog SCAN

1 2021 Over-The-Counter Benefit Catalog Your benefit amount is per quarter. Please see the letter inserted with this Catalog to confirm your amount. As a member of SCAN Health Plan, you have an over-the-counter (OTC) benefit every quarter. This benefit provides you with OTC medications and products you may need. Your order will be shipped directly to your door. REMEMBER Keep your Catalog to use each quarter. Information on how to place your order can be found in the front of the Catalog . Y0057_SCAN_12269_2020_C IA 11102020 ORDERING IS EASY Order online at Call 1-877-494-2892 (TTY: 711) Mail In your completed order for m ORDER GUIDELINES You can order your OTC products using the following methods: ORDER ONLINE ORDER BY MAIL ORDER BY PHONE You may place an order online using your SCAN Health Plan OTC website at You may place your order by mailing in the order form to the OTC servicing Center, PO Box 526266, Miami FL 33152-9819.

2 If the end of the benefit period is approaching and you do not think your order form will be received in time, you may order online or call us. If you have questions or would like to place an order over the phone, OTC Advocates are available Monday Friday from 5 to 8 (PST) at 1-877-494-2892 (TTY: 711). Remember to save your username and password to order again during your next benefit period. You can place up to 2 orders per quarter. If all of your OTC benefit amount is not used, the remaining balance will roll over from one quarter to the next, giving you more to spend the next quarter. Any unused benefit will expire on December 31st of the benefit year.

3 Your order total may not exceed your benefit amount. Cash, checks, credit cards, or money orders are not accepted under this OTC benefit. Your order total will be applied to the benefit period in which the order is received. OTC products are intended for member use only to help with a health or medical need. SCAN Health Plan prohibits the use of this benefit to order OTC items for family members and friends. Due to the personal nature of these products, returns are not accepted. Items in the OTC Catalog occasionally change during the year. For the most up-to-date listing of OTC products available, go to OTC items are available through home delivery only.

4 Products may not be purchased at a local retail pharmacy, submitted for reimbursement, or through any source other than the SCAN Health Plan OTC benefit channels listed above. Allow 5 7 business days from the time your order is placed for delivery. Orders for the benefit period must be placed prior to midnight Eastern Time of the last day of the period. The health information provided in the Catalog is general in nature and is not medical advice or a substitute for professional health care. All product and company names are trademarks or registered trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them.

5 3 4 Order Online: HOW TO USE YOUR OTC WEBSITE Online access to your OTC benefit is fast, easy, and secure! Your OTC benefit website offers you many convenient features. You are able Browse the OTC products that are available to you Access a digital copy of your OTC Catalog Monitor your available balance while you shop Track your order and view your order history Manage your account And more! If you have already created an account online, just log in to get started! If it s your first time ordering online, you will need to register and set up your account. Registration is easy and takes only a few minutes to complete. Access your SCAN Health Plan OTC website at , indicate that you are a first-time user by clicking on the Not Registered?

6 Sign Up Now button, and enter your information exactly as it appears on your Health Plan ID card. You will need the following: First and last name Health Plan Member ID number (if your ID number contains any special characters, such as a hyphen (-) or an asterisk (*), enter only the numbers) State Date of birth as MM/DD/YYYY Current email address You will then create a unique username and password for your account. You will be asked to choose and answer some security questions, so if you forget or misplace your username or password, we can help you recover your login information. Now you can log in and access your OTC benefit online, 24/7. If you need any assistance, please call the Order Fulfillment Center Monday Friday from 5 to 8 PST at 1-877-494-2892 (TTY: 711).

7 Our friendly and knowledgeable advocates are happy to help you take full advantage of your OTC benefit. Please Note: Orders for the benefit period must be placed prior to midnight Eastern Time of the last day of the period. If you place your order using an order form, your order total will be applied to the month 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 July benefit, not your June benefit. * See Page 335 AllergyItemProductPackagingStrength Price 1927 Benadryl Allergy Liqui-Gels Dye-Free24 ct25 mg$ HCL (Allergy Tablets)14 ct10 mg$ HCL (Allergy Tablets)45 ct10 mg$ Maleate Antihistamine (Allergy Tablets)100 ct4 mg$ Antihistamine (Allergy Tablets)24 ct25 mg$ Antihistamine (Allergy Tablets)100 ct25 mg$ Antihistamine (Allergy Tablets)400 ct25 mg$ (Allergy Tablets)30 ct180 mg$ Propionate (Allergy Nasal Spray, 24-hour)120 spray50 mcg$ (Allergy Tablets)10 ct10 mg$ (Allergy Tablets)100 ct10 mg$ (Allergy Tablets)

8 365 ct10 mg$ sprays-$ Decongestant Inhaler - oz50 mg$ Decongestant Spray, 12-Hour1 $ Spray, $ & Acid ReducersItemProductPackagingStrength Price 1313 Alka-Seltzer36 ct-$ Order Online: & Acid Reducers (continued)ItemProductPackagingStrength Price 1006 Antacid / Anti-Gas Liquid12 oz-$ Chewables150 ct500 mg$ ervescent Antacid & Pain Relief36 ct-$ Magnesium (Acid Reducer, Delayed Release) *194942 ct20 mg$ (Acid Reducer) *30 ct10 mg$ (Acid Reducer, Delayed Release) *42 ct20 mg$ (Acid Reducer, Delayed Release, Dissolvable) *196642 ct20 mg$ ct20 mg$ (Gas Relief)100 ct80 mg$ Extra Strength48 ct750 mg$ Ultra Strength72 ct1,000 mg$ (yeast)ItemProductPackagingStrength Price 1115 Clotrimazole (Vaginal Antifungal 7-Day Cream with Applicator)45 gm1%$ (Vaginal Antifungal 3-Day Cream with Applicator)

9 1 kit2%$ (Vaginal Antifungal 1-Day Cream with Applicator)1 $ * See Page 337 Anti-diarrheal, Laxatives & Digestive HealthItemProductPackagingStrength Price 1316 Beano30 ct-$ (Stimulant Laxative, Enteric Coated)100 ct5 mg$ Unfl avored Powder oz17 g$ Sodium (Stool Softener)100 ct100 mg$ Sodium plus Sennosides (Natural Vegetable Laxative)60 mg / 50 mg$ oz-$ ct15 mg$ Tablets 60 ct500 mg$ Suppository Laxative25 ct2 gm$ Capsules60 ct9,000 FCC Units$ HCL (Anti-Diarrheal Tablets) *12 ct2 mg$ Citrate (Saline Laxative, Lemon)10 oz-$ of Magnesia12 oz1,200 mg$ Cherry12 oz525 mg / 30 ml$ Bismuth Chewable Tablets30 ct262 mg$ Bismuth Liquid8 oz525 mg / 30 ml$ Order Online: Safety & Fall PreventionItemProductPackagingStrength Price 1464 Bed Rails1 ea-$ Bench without Back1 ct-$ Mat, Non-Skid1 ct-$ Tub Safety Rail1 ct-$ Cane Ergonomic Handle *1 ct-$ Belt - 60"1 ct-$ Belt - 72"1 ct-$ Shower Head1 ct-$ Chrome Grab Bar - 12"1 ct-$ Chrome Grab Bar - 24"1 ct-$ ct-$ Cane, Small Base *1 ct-$ Price 1047 Clotrimazole (Athlete's Foot Cream) oz1%$ Nitrate (Anti-fungal Cream)1 oz2%$ Nitrate (Athlete's Foot Spray) oz2%$ ne HCL (Athlete's Foot Cream).

10 5 oz1%$ (Anti-fungal Cream) oz1%$ * See Page 339 Bathroom Safety & Fall Prevention (continued)ItemProductPackagingStrength Price 1776 Quad Cane, Large Base *1 ct-$ Toilet Seat1 ct-$ Treads, Tub & Stair1 pack-$ Mat, Non-Skid1 ct-$ Safety Rails1 set-$ Slipper Socks, One Size Fits Most1 pair-$ & FluItemProductPackagingStrength Price 1360 Cepacol Sore Throat Lozenges16 ct-$ & Cold for High Blood Pressure16 ct-$ Drops, Cherry30 mg$ Drops, Honey Lemon30 ct-$ Drops, Menthol30 ct-$ Drops, Sugar Free, Cherry25 mg$ Syrup, Expectorant4 oz200 mg / 10 ml$ Tussin DM4 oz-$ (Cough Expectorant)100 ct200 mg$ Mentho-Lyptus Drops Cherry30 ct-$ ct600 mg$ Relief DM Expectorant & Cough Suppressant (Guaifenesin 400 mg / Dextromethorphan HBr 20 mg)30 ct400 mg / 20 mg$ Relief DM Expectorant & Cough Suppressant, Extended Release14 ct1,200 mg / 60 mg$ Order Online.