Transcription
2021Over-the-Counter(OTC) CatalogKeep this booklet handy where you can easily get to it. You’llwant to reference this often and use it to help you order.
How to use your OTC benefitYour OTC benefit covers a wide range of items from toothpaste to vitamins.There are 3 ways you can use it.ONLINEwww.cvs.com/otchs/devoted Online orders must be submitted by 11:59pm Eastern to beprocessed that day Order includes free delivery Allow 14 days for delivery Call us if your order is latePHONE1-888-628-2770 (TTY 711)9am to 8pm local time, Monday to Friday You may experience high call volume the first and last weeks ofthe month Order includes free deliveryIN STORE Find a participating store on the online Store Locator:www.cvs.com/otchs/devoted/storelocator Regular retail price in-store may vary. Check this catalog for yourbenefit price2Home delivery only Limited to one per benefit period
Shop our OTC itemsYour benefit only works for the exact items listed here—no substitutions allowed.The most popular OTC items are shown on the next few pages, so you know what tolook for. The rest of this catalog is a complete list of what’s covered.A few helpful things to know Catalog prices cannot be combined with promotional offers orExtraBucks Rewards. You can only purchase 3 of a single item if you have a monthly benefit or 9of a single item if you have a quarterly benefit. Blood pressure monitors, thepulse oximeter, and the digital body scale are limited to 1 per year. OTC items may only be ordered for an enrolled member. What you order cannot exceed your monthly or quarterly benefit amount. No returns or exchanges allowed. If you receive a damaged item, call OTC Health Solutions within 30 days toget an identical replacement item. Some items may be not be available because of shortages related tothe pandemic.You will receive the generic equivalent of all items.3
MOST POPULAR ITEMSUnscented Wipes64 CT, Sku 571810Enteric Aspirin 81mg120 CT, Sku 230268Hand Sanitizer2 OZ, Sku 799023Sensitive Toothpaste3.4 OZ, Sku 368775Flushable Wipes42 CT, Sku 843837Sore Throat Lozenges18 CT, Sku 707032Airshield Berry Chew32 CT, Sku 889580Facial Tissue8 PK, Sku 265212Heavy Duty Fabric Bandages20 CT, Sku 875957 3.00 4.00 6.004 5.00 2.00 4.00 4.00 2.00Home delivery only 4.00Limited to one per benefit period
MOST POPULAR ITEMSRubbing Alcohol Wipes40 CT, Sku 444797Ibuprofen 200mg50 CT, Sku 371948Hot/Cold Patches5 CT, Sku 957604Clear Bandages45 CT, Sku 383505Flosser Picks90 CT, Sku 454381Denture Cleanser Tabs40 CT, Sku 213330Fish Oil Omega-3 1000mg120 CT, Sku 460962Vitamin D3 1000 IU120 CT, Sku 346754B-12 1000mcg60 CT, Sku 247321 5.00 4.00 10.00You will receive the generic equivalent of all items. 4.00 3.00 7.00 6.00 3.00 7.005
MOST POPULAR ITEMSAcetaminophen 500mg100 CT, Sku 371914Digital Thermometer1 CT, Sku 155912Muscle Rub3 OZ, Sku 200964Adult Daily Women’s 50 65 CT, Sku 448393Adult Daily Men’s 50 65 CT, Sku 448404Coenzyme Q-10 50mg45 CT, Sku 122869Tussin DM4 OZ, Sku 707516Epsom Salt22 OZ, Sku 482649Chewable Aspirin 81mg36 CT, Sku 547802 7.00 8.00 6.006 8.00 8.00 5.00Home delivery only 7.00 12.00 2.00Limited to one per benefit period
MOST POPULAR ITEMSDaytime Cold/Flu Soft Gels16 CT, Sku 890425Petroleum Jelly2.5 OZ, Sku 531343Anti-Diarrheal Tablets12 CT, Sku 672550Hemorrhoidal Wipes48 CT, Sku 401472Omeprazole Tablets14 CT, Sku 451300Lidocaine Cream2.7 OZ, Sku 977934Antacid Tablets96 CT, Sku 836320Allergy Relief Tablets24 CT, Sku 477066Anti Itch Cream1 OZ, Sku 550749 6.00 6.00 5.00 3.00 10.00You will receive the generic equivalent of all items. 4.00 6.00 7.00 5.007
CODESKUPRODUCTACTIVE INGREDIENTQUANTITYPRICEAdult CareI70830476Women’s Small/MediumUnderwear Max36 CT 18I71830475Women’s Large Underwear Max32 CT 18I72830474Women’s XL Underwear Max28 CT 18I73830473Men’s Small/Medium UnderwearMax36 CT 18I75842939Men’s LG/XL Underwear Max32 CT 18I76163094Unisex Extra Large Brief Max14 CT 11I77641431Unisex Large Brief Max16 CT 11I78240487Women’s Protective PadsModerate20 CT 5I79964701Overnight Women’s BladderControl Pads30 CT 12I80520577Adult Care Wipes48 CT 8I83383703Unisex Overnight Underwear XL12 CT 13I84383182Unisex Overnight Underwear L14 CT 13I86512509Underpads XL 23”X36”18 CT 9I87795728Women’s Bladder Control Pads,Long27 CT 11I88163093Men’s Bladder Control Pads52 CT 12A2477066Allergy Relief TabletsDiphenhydramine HCl25mg24 CT 4A3444238Cetirizine 10mg TabletsCetirizine 10mg30 CT 14A5232642Loratadine 10mg, 24 Hr RegularLoratadine 10mg30 CT 15Allergy8Home delivery only Limited to one per benefit period
CODESKUPRODUCTACTIVE INGREDIENTQUANTITYPRICEA6847260Fexofenadine Tablets 180mgFexofenadine 180mg30 CT 14A10232641Loratadine 10mgLoratadine 10mg10 CT 8A11389345Levocetirizine Allergy ReliefLevocetirizine 5mg35 CT 16A12922201Children’s Cetirizine SugarfreeGrapeCetirizine 1mg/mL8 OZ 13A16583518Loratadine 10mg TabletsLoratadine 10mg365 CT 40A20477072Child Allergy ElixirDiphenhydramine HCl12.5mg4 OZ 5A53444236Allergy Cetirizine 10mg TabletsCetirizine 10mg14 CT 11A59238246Fluticasone Nasal SprayFluticasone, 50mcg perspray0.34 OZ 13A61370783Fexofenadine 60mg TabletsFexofenadine 60mg24 CT 13Acetaminophen 650mg;Dextromethorphan HBr20mg; Guaifenesin 400mg;Phenylephrine HCl 10mg6 OZ 1142 CT 103.5 OZ 6Cold RemediesC3895139Cold Flu & Sore Throat MaxC5970454Airshield Adult GummiesC7587618Medicated Chest RubC8155912Thermometer Digital1 CT 8C9381791Airshield Twin Pack Orange20 CT 10C11707032Sore Throat Lozenges18 CT 4C12971824Tussin CF Max StrengthDextromethorphan HBr20mg; Guaifenesin 400mg;Phenylephrine HCI 10mg4 OZ 6C13707516Tussin DMDextromethorphan HBr20mg; Guaifenesin 400mg4 OZ 6You will receive the generic equivalent of all items.Camphor 4.8%; EucalyptusOil 1.2%; Menthol 2.6%9
CODESKUPRODUCTC15889580Airshield Berry ChewC16297625Nasal Decongestant TabsC17164963C18QUANTITYPRICE32 CT 6Phenylephrine HCl 10mg18 CT 4Sugar Free Honey Lemon CoughDropMenthol 7.6mg150 CT 5884883Sugar Free Cough Drop MentholMenthol 7.6mg150 CT 5C19297885Chest Congestion Relief 400mgGuaifenesin 400mg60 CT 9C21164183No Drip Nasal Mist1 OZ 6C22202227Micro Temple ThermometerEACH 23C23834800Temple ThermometerEACH 38C24890425Daytime Cold/Flu Soft Gels16 CT 6C25465804Cold Remedy Melts Citrus25 CT 9C26954407Severe Nighttime Cold & Flu ReliefBerry8 OZ 7C28953437Nasal Strips Clear Small30 CT 9C29159734Nasal Decongestant InhalerLevmetamfetamine 50mg0.07 OZ 5C31972801Sore Throat & Cough LozengesMixed BerryBenzocaine 7.5mg;Dextromethorphan HBr5mg18 CT 4C32896024Sinus Cleanser Wash KitEACH 10C33173270Mucus ER DM Max StrengthDextromethorphan HBr60mg; Guaifenesin 1200mg14 CT 13C34277898Medicated Chest RubCamphor 4.8%; EucalyptusOil 1.2%; Menthol 2.6%1.76 OZ 4C36277790Nasal Spray Saline 2 PackTwinpack1.5 OZ 510ACTIVE INGREDIENTAcetaminophen 325mg;Dextromethorphan HBr10mg; Phenylephrine HCl5mgAcetaminophen 650mg;DextromethorphanHBr 20mg; DoxylamineSuccinate 12.5mg;Phenylephrine 10mgHome delivery only Limited to one per benefit period
CODESKUPRODUCTACTIVE INGREDIENTQUANTITYPRICEC40477060Tussin DM Sugar FreeDextromethorphan HBrUSP 20mg; Guaifenesin200mg8 OZ 7C41688783Cold Remedy Sugar Free25 CT 10C52891465Saline Nasal SpraySodium chloride 0.65%1.5 OZ 4C54890411Nighttime Cold/Flu Soft GelsAcetaminophen 325mg;DextromethorphanHBr 15mg; DoxylamineSuccinate 6.25mg16 CT 6C56408566Sinus AcetaminophenAcetaminophen 325mg;Phenylephrine HCl 5mg24 CT 6C57316620Sore Throat SprayPhenol 1.4%6 OZ 4C58181059Child’s Cold Cough & Sore ThroatAcetaminophen 325mg;Dextromethorphan HBr10mg; Guaifenesin 200mg;Phenylephrine HCl 5mg4 OZ 10C60244956Cough & Cold HBPChlorpheniramine Maleate4mg; DextromethorphanHBr 30mg16 CT 7C64320711Airshield Orange Tablets10 CT 6C66858828Nasal Mist0.5 OZ 78 CT 7OxymetazolineHydrochloride 0.05%Digestive HealthB17966747Oral Electrolyte Adult OrangeD2310425Stool SoftenerDocusate sodium 100mg100 CT 12D4206805Gas Relief E/S Soft GelSimethicone 125mg30 CT 5D5878020Beanaid CapsulesAlpha galactosidase300 GaIU30 CT 5D6108530Glycerin Suppositories Adult25 CT 3You will receive the generic equivalent of all items.11
12CODESKUPRODUCTACTIVE INGREDIENTQUANTITYPRICED8860849Heartburn Relief TabletsAluminum Hydroxide160mg; MagnesiumCarbonate 105mg100 CT 8D9451300Omeprazole TabsOmeprazole 20mg tablet14 CT 10D11348639Bisacodyl Laxative TabsBisacodyl 5mg25 CT 6D12672550Anti-Diarrheal TabletsLoperamide HCl 2mg12 CT 6D13703368Pink Bismuth Chewable TabsBismuth Subsalicylate262mg (Total Salicylate102mg Per Tablet)30 CT 5D14690256Acid Controller TabsFamotidine 10mg30 CT 7D15139139Motion Sickness TabsDimenhydrinate 50mg12 CT 6D16690260Easy FiberCorn Dextrin8.6 OZ 13D17252794Fiber CapsulesPsyllium Husk (Approx.0.52 G)160 CT 12D18272722Esomeprazole MagnesiumCapsulesEsomeprazole 20mg42 CT 24D20689598Stomach Relief CapletsBismuth Subsalicylate262mg24 CT 3D21401472Medicated Hemorrhoidal WipesWitch hazel 50%48 CT 6D22961468Hemorrhoidal SuppositoriesIn Each Suppository:Cocoa Butter 85.39%;Phenylephrine HCl 0.25%12 CT 6D23144212Hemorrhoidal OintmentMineral Oil (14%);Petrolatum (71.9%);Phenylephrine HCl (0.25%)2 OZ 9D24305623Milk of MagnesiaMagnesium hydroxide1200mg12 OZ 6D25480996Laxative Bisacodyl SuppositoriesUSP 10mgBisacodyl 10mg4 CT 6Home delivery only Limited to one per benefit period
CODESKUPRODUCTACTIVE INGREDIENTQUANTITYPRICED26452277Hemorrhoidal CreamGlycerin 14.4%;Phenylephrine HCI 0.25%;Pramoxine HCI 1%;White Petrolatum 15%1.8 OZ 11D27689614Stool SoftenerDocusate sodium 100mg30 CT 4D30451305Omeprazole TabletsOmeprazole 20mg42 CT 20D31267635Dairy ReliefLactase60 CT 13D40836320Antacid Calcium ES TabletsCalcium carbonate 750mg96 CT 5D46272739Esomeprazole Magnesium TabEsomeprazole 20mg14 CT 10D47883055Lansoprazole 15mg CapsLansoprazole 15mg14 CT 10D49713639Purelax PowderPolyethylene Glycol3350 (17 gram)8.3 OZ 11Eye & Ear CareE5014332Visine Dry Eye ReliefGlycerin 0.2%;Hypormellos 0.2%;Polyethylene glycol 400 1%0.5 OZ 9E7110973Earwax Removal DropsCarbamide peroxide 6.5%0.5 OZ 4E8941579Earwax Care KitCarbamide peroxide 6.5%EACH 10E14171322Artificial TearsGlycerin 0.3%; PropyleneGlycol 1.0%1 OZ 9E17337097Eye Wash4 OZ 6E18695753Contact Solution4 OZ 5E19976354Eye Health 50 Vitamins90 CT 20E20457496Swimmers Ear SolutionIsopropyl Alcohol 95%;Anhydrous Glycerin 5%1 OZ 4E21973866Ear Wax Removal KitCarbamide peroxide 6.5%1 KIT 8You will receive the generic equivalent of all items.13
CODESKUPRODUCTACTIVE INGREDIENTQUANTITYPRICEFeminine CareG1927025Maxi Super Long Pads42 CT 5G2692443Maxi Regular Pads48 CT 5G3872912Ultra Thin Long Pads40 CT 5G4836891Ultra Thin Pads Regular WithWings36 CT 5G5167765Feminine Cleansing Wash12 OZ 7G6234554Urinary Pain Relief Tablets30 CT 6G7692424Plastic Tampon Unscented Regular40 CT 6G8416639Tampon Unscented Multipack36 CT 6G9721062Miconazole Vaginal Insertand CreamMiconazole nitrate 2%EACH 13G30333336Miconazole 7 Day Vaginal CreamMiconazole nitrate 2%7 CT 10G37418121Personal Lubricant5.6 OZ 10G38326808Pregnancy Test1 CT 10G40842800Overnight Maxi Pads36 CT 8G41289061Feminine Wipe Fragrance Free32 CT 5First Aid14F3875957Heavy Duty Fabric Anti-BacterialBandages20 CT 4F4109405Calamine Lotion Plus6 OZ 6F6322430Triple Antibiotic & Pain ReliefOintment0.5 OZ 4Bacitracin zinc USP 500units; Neomycin 3.5mg;Polymyxin B sulfate USP10,000 units; PramoxineHCl USP 10mgHome delivery only Limited to one per benefit period
CODESKUPRODUCTACTIVE INGREDIENTQUANTITYPRICEF8618348Triple Antibiotic OintmentPain & ScarBacitracin zinc USP 500units; Neomycin 3.5mg;Polymyxin B sulfate USP10,000 units; PramoxineHCl USP 10mg0.5 OZ 7F9383505Clear Bandages45 CT 4F11550749Anti Itch Cream1 OZ 5F13955322Calamine Plus Spray4.1 OZ 8F14875952Flex Fabric Antibacterial FingertipKnuckle Bndgs20 CT 4F15241483Antibacterial BandagesAssortment120 CT 12F16488598Bandages Assortment Value Pack200 CT 10F17894077Transparent Dressing WoundCover8 CT 7F18832864Freeze Wart RemoverKIT 14F19330703Lidocaine Burn Relief Gel8 OZ 6F20717967Sensitive Skin Adhesive Bandages20 CT 5F21602441IodineIodine 2%1 OZ 4F22311533MerthiolateBenzalkonium Chloride0.13%2 OZ 5F23405572First Aid KitEACH 6F28270304Waterproof Large TransparentDressing4 CT 15F31864765Antiseptic Skin Cleanser8 OZ 10F32482649Epsom Salt22 OZ 5F33351170Wart Removal0.5 OZ 8You will receive the generic equivalent of all items.DiphenhydramineHydrochloride 2%; ZincAcetate 0.1%Lidocaine HCl 0.5%Salicylic Acid 17% w/w15
CODESKUPRODUCTF38270351F39ACTIVE INGREDIENTQUANTITYPRICEWaterproof Assorted TransparentDressing10 CT 9998839Wound Care Kit S/M30 PC 15F45219642Zinc Oxide Ointment1 OZ 4F47337274Finger Injury KitKIT 7F48444797Rubbing Alcohol Wipes40 CT 5F49946095Witch Hazel Spray6 OZ 7F50935683Gauze Pad Non Stick 2X325 CT 6F51893121Gauze Pad 4X425 CT 7F52893120Gauze Pad 3X325 CT 6F53894104Gauze Roll 4” 2 yards1 CT 4F62964606First Aid Tape1 CT 2F68531343Pertroleum Jelly2.5 OZ 3F69259370Butterfly Closures12 CT 3F72882127Sharps ContainerEACH 13F73373092Hydrocortisone Ointment 1%1 OZ 5F74219634Bacitracin1 OZ 79 CT 21 OZ 80.5 OZ 74 OZ 62 CT 4Bacitracin Zinc USP500 UnitsFoot CareT1337956Corn CushionsT2521682Tolnaftate Antifungal CreamT3211003Clotrimazole Cream, USP 1%T4334566Odor Control Spray PowderT5894580Moleskin Padding16Tolnaftate 1%Tolnaftate 1%Home delivery only Limited to one per benefit period
CODESKUPRODUCTT7102294T9ACTIVE INGREDIENTQUANTITYPRICEHeel Liner 1 Size1 PAIR 5314468Medicated Corn Cushion9 CT 2T12894776Plantar Fasciitis Gel Sleeve1 PAIR 12T35139231Liquid Corn & Callous Remover0.5 OZ 6T36893272Diabetic Socks S/M2 CT 9T37893270Diabetic Socks L/XL2 CT 9T38658593Firm Compression Socks S/MBlack1 PAIR 12T39658582Firm Compression Socks L/XLBlack1 PAIR 12T40229790Foot Powder10 OZ 9Salicylic Acid 17% w/wHome DiagnosticsH19130344Alcohol Prep Swabs100 CT 3H20149650Glucose Chewable Tablets10 CT 1H21149647Glucose Tablets Orange50 CT 6H22149616Glucose Tablets Raspberry50 CT 6H23235152Glucose Tablets Grape50 CT 6H24732550Micro-Thin Lancets, 33 Gauge100 CT 4H25235157Ultra Thin Lancets, 30 Gauge100 CT 4H26149668Thin Lancets, 26 Gauge100 CT 4H27343477Lancing DeviceEACH 6H70375224Test for Colon Cancer,Diverticulitis, ColitisEACH 35H71708884BP Monitor Upper Arm Semi Auto8.7” x 16.5”EACH 40You will receive the generic equivalent of all items.17
CODESKUPRODUCTH72800232H73ACTIVE INGREDIENTQUANTITYPRICEBP Monitor Upper Arm Manual8.7” x 12.6”EACH 18800824Auto Wrist Blood Pressure MonitorEACH 52H74800231Advanced Auto Blood PressureMonitorEACH 52H75800230Premium Blood Pressure MonitorUpper ArmEACH 70H76800229Premium Auto Blood PressureMonitor Upper ArmEACH 90H77814854Pulse OximeterEACH 40Home HealthJ1861900Drive Medical Bath MatEACH 17J2792495Suction Grab BarEACH 10J3868921Shoe HornEACH 9J4741739ReacherEACH 22J5741741Raised Toilet Seat 4”EACH 45J6741727Quad Cane BlackEACH 26J7741731Grip Cane GoldEACH 18J8980705Black Cane Tip 3/4EACH 4MiscellaneousM49460696Tablet CutterEACH 7M517151237 Day Pill BoxEACH 3M75135615Mosquito Repellent w/30% Deet6 OZ 7M77864739Digital Body ScaleEACH 12Nicotine Replacement18Home delivery only Limited to one per benefit period
CODESKUPRODUCTK1133190K2ACTIVE INGREDIENTQUANTITYPRICENicotine Transdermal 21mg PatchStep 17 CT 24173013Nicotine Transdermal 14mg PatchStep 214 CT 40K3338618Nicotine Transdermal 7mg PatchStep 314 CT 40K4971444Mini Mint Lozenge 4mgNicotine polacrilex 4mg20 CT 12K5971448Mini Mint Lozenge 2mgNicotine polacrilex 2mg20 CT 12K6720035Uncoated Gum 4mgNicotine polacrilex 4mg20 CT 12Oral CareO6307117Sensitive Tooth Paste ExtraWhitening4 OZ 4O7808698Pro Clean Power Toothbrush w/Replacement HeadsEACH 9O8978931Sensitive Flosspicks90 CT 3O9469085Extra Comfort Floss Mint 40mEACH 3O10230196Denture Adhesive Regular2.4 OZ 4O12910693Toothbrush (Soft)EACH 1O13933844Extra Comfort Floss Mint 43.7YD2 PK 6O14122340Effervescent Denture CleanserTablets84 CT 5O15933823Interdental Brushes Tight Spaces16 CT 5O16572131Tongue Brush2 CT 6O17902457Comfort Dental Night Guard2 CT 20O18809800Lower Dental Guard2 CT 30O19956360Clear Pro Toothbrush - Medium3 CT 3O20897755Toothbrush Medium2 CT 5You will receive the generic equivalent of all items.19
CODESKUPRODUCTO21377971O23QUANTITYPRICETri Clean Soft Picks60 CT 6378381Smilesonic Replacement Heads2 CT 32O24454376Flosser Picks Mint90 CT 3O25695108Temporary Lost Filling and CrownRepairEACH 4O26341166Easy Flex Replacement BrushHeads3 PK 19O28246932Ease Between Soft Picks120 CT 7O29378314Cordless Water Flossing SystemEACH 55O30371107UV Dental SanitizerEACH 15O31227508Ultra Tight Interdental Brush32 CT 6O333481183 in 1 Interdental Cleaners16 CT 11O34276596Sensodyne Extra WhiteningSensitive Toothpaste6 OZ 11O36485907Sensodyne Pro Namel WhiteningToothpaste4 OZ 8O37705527Crest Whitening Toothpaste5.8 OZ 4O39357891Toothbrush Protector2 CT 7O46873493Dry Mouth Spray1.5 OZ 7O52933834Oral Pain Relief0.33 OZ 6O71454381Flosser Picks90 CT 3O72368775Sensitive Tooth Paste3.4 OZ 4O73213330Denture Cleanser Tabs40 CT 3O74422345Easyflex Pro PremiumRechargeable ToothbrushEACH 5520ACTIVE INGREDIENTBenzocaine 20%Potassium nitrate 5%;Sodium fluoride 0.24%(0.15% w/v fluoride ion)Home delivery only Limited to one per benefit period
CODESKUPRODUCTO75415475ACTIVE INGREDIENTQUANTITYPRICEReplacement Brushheads5 CT 2550 CT 43 OZ 7Pain RelieversP1371948Ibuprofen 200mgP2200964Muscle RubP4230268Enteric Aspirin 81mg120 CT 5P5215314Heating Pad Extra LongEACH 33P6371914Acetaminophen 500mg100 CT 7P7844209Icebag LargeEACH 13P8547802Chewable Aspirin 81mg36 CT 2P12261925Children Ibuprofen SuspensionIbuprofen 100mg per 5mL4 OZ 6P13207688Children Non Aspirin SuspensionCherryAcetaminophen 160mgper 5mL4 OZ 6P14957604Hot/Cold PatchesMethol 5%5 CT 6P15215313Heating Pad StandardEACH 22P16371271Lidocaine PatchLidocaine6 CT 11P17109017Headache Relief CapletsAcetaminophen 250mg;Aspirin 250mg; Caffeine65mg100 CT 9P18695905Cold & Hot Pain Relieving CreamMenthol 10%; Methylsalicylate 30%3 OZ 6P19299470Naproxen 220mg24 CT 4P21444770Medicated Heat PatchEACH 2P22152116Knee Support Sleeve L1 CT 12P23902106Wrist Support Strap1 CT 9P24151571Ankle Support Sleeve L1 CT 11You will receive the generic equivalent of all items.Menthol 10%; Methylsalicylate 15%Capsaicin 0.025%21
CODESKUPRODUCTP25453866Compression Sleeve Elbow LP26977934Lidocaine CreamP28459974P29QUANTITYPRICE1 CT 152.7 OZ 7Tens Targeted Muscle TherapyEACH 53459917Tens Replacement Pads4 CT 15P30942453Knee High Hosiery ModerateCompress L1 PAIR 20P31342829Knee High Hosiery ModerateCompress M1 PAIR 20P32524660Anti-Embolism Stocking KneeLength L1 PAIR 20P33524694Anti-Embolism Stocking KneeLength M1 PAIR 20P34318180Hot/Cold Multi Compress1 CT 11P35340744Naproxen Muscle & Back Tablets24 CT 4P36324111Reusable Ice Pack1 CT 6P37185226Migraine Relief CapletsAcetaminophen 250mg;Aspirin 250mg; Caffeine65mg24 CT 4P38864199Sleep Aid 50mg SoftgelsDiphenhydramine HCl50mg32 CT 6P39933380Sleep-Aid LiquidDiphenhydramine HCl50mg per 30mL6 OZ 5P40866534Melatonin 5mg Tablets90 CT 9P41475817Ibuprofen PM Caplets20 CT 5P42317581Acetaminophen 500mg RapidRelease Gels100 CT 9P43879536Acetaminophen 500mg Caplets225 CT 13P46738694Urinary Relief Max Strength12 CT 622ACTIVE INGREDIENTLidocaine HCI 4%Naproxen sodium 220mgDiphenhydramine citrate38mg; Ibuprofen 200mgPhenazopyridine HCl97.5mgHome delivery only Limited to one per benefit period
CODESKUPRODUCTP47923748P48QUANTITYPRICEIbuprofen 200mg Tablets500 CT 18306397Ibuprofen 200mg Softgels80 CT 8P49263652Naproxen Sodium 220mg Caplets100 CT 8P50456231Menstrual Pain Relief Max24 CT 6P51140897Aspirin Enteric Coated 325mg125 CT 8P52729759Elastic Bandage 6”EACH 8P53124886Acetaminophen PM 500mgCapletsAcetaminophen 500mg;Diphenhydramine HCl25mg100 CT 9P54193588Arthritis Pain Relief 650mgAcetaminophen 650mg100 CT 10P55472994Knee Support S1 CT 12P56151894Knee Support M1 CT 12P57482556Knee Support XL1 CT 12P58245414Acetaminophen PM 500mgCaplets24 CT 5P59343538Melatonin Gummy 5mg Strawberry60 CT 11P60191238Childrens Ibuprofen SuspensionBubblegumIbuprofen 100mg per 5mL4 OZ 6P63521351Children Pain & FeverAcetaminophen BubblegumAcetaminophen 160mgper 5mL4 OZ 6P64271541Jr Strength Ibuprofen OrangeChew TabsIbuprofen 100mg24 CT 5P65291741Children’s Pain Relief ChewableTabs GrapeAcetaminophen 160mg24 CT 6P66155756Sleep Aid24 CT 4P68126623Low Dose Aspirin 81mg, CoatedTablets300 CT 11You will receive the generic equivalent of all items.ACTIVE INGREDIENTAcetaminophen 500mg;Caffeine 60mg; PyrilamineMaleate 15mgAcetaminophen 500mg;Diphenhydramine HCl25mg23
CODESKUPRODUCTACTIVE INGREDIENTQUANTITYPRICEP69441099Pain Reliever GelDiclofenac 1%3.5 OZ 17P70256563Lidocaine Roll On Pain ReliefLidocaine2.5 OZ 8Zinc oxide 40%2 OZ 4Personal CareB10803987Diaper Rash OintmentB33571810Unscented Wipes64 CT 3S2985326Aftersun Aloe Vera, Green Gel20 OZ 6S3447703Skin Therapy Lotion5.5 OZ 6S4428504Acne Treatment 10%1 OZ 5S6478041Sheer Dry Sunblock Lotion Spf 553 OZ 8S7992500Eczema Relief8 OZ 9S8246784Scar Gel1.76 OZ 20S10193503Gold Bond Diabetic Dry Skin Lotion4.5 OZ 9S23799023Hand Sanitizer2 OZ 2S34227230Medicated Body Powder10 OZ 7S36843837Flushable Wipes42 CT 4S42478284Sunblock SPF 455 OZ 9S43265212Facial Tissue8 PK 2S45697545Acne Wash5 OZ 645 CT 12120 CT 32100 CT 13Benzoyl peroxide 10%Colloidal Oatmeal 1.0%Menthol; Zinc oxideBenzoyl peroxide 10%Vitamins & MineralsV5122869Coenzyme Q-10 50mgV13247303Glucosamine Chondroitin TripleStrength CapletsV16240515Vitamin E 400 IU Soft Gel24Glucosamine HCl 1,500mg(1.5g)Home delivery only Limited to one per benefit period
CODESKUPRODUCTV17300258Folic Acid 800mcg TabletV18350480Iron Supplement 65mgV19460962V25QUANTITYPRICE100 CT 490 CT 6Fish Oil Omega-3 1000mg120 CT 10252577Prenatal Vitamin Tablets100 CT 10V27232025Vitamin C 1000mg200 CT 14V28166595Chewable Vitamin C 500mg,Orange Flavor100 CT 9V29378592Men’s Multivitamin120 CT 9V30378615Women’s Multivitamin120 CT 9V31711999B12 Vitamin 1000mcg200 CT 10V32346754Vitamin D3 1000 IU120 CT 7V35850942Magnesium 500mg100 CT 5V36247239Zinc Gluconate 50mg100 CT 5V37717911Vitamin D3 5000 IU100 CT 14V42710787Vitamin D3 2000 IU Softgels100 CT 8V43308785Coq-10 100mg60 CT 30V48965747Biotin 10,000mcg Soft Gel60 CT 12V53870668Omega-3 Krill Oil 500mg45 CT 26V54889908Calcium Supplement Gummy500mg 800 IU D-350 CT 10V56199216Vitamin A 8000 IU (2400mcg)100 CT 5V59250191Potassium Gluconate 595mg100CT 5V62448393Adult Daily Women’s 50 Adv65 CT 8V63448404Adult Daily Men’s 50 Adv65 CT 8You will receive the generic equivalent of all items.ACTIVE INGREDIENTFerrous Sulfate 325mg(65mg elemental iron)25
CODESKUPRODUCTV64797751V65QUANTITYPRICELutein 40mg30 CT 197108005-HTP 100mg Capsules30 CT 12V70184707Flaxseed 1000mg100 CT 14V71901330Calcium 600Mg Vitamin D3120 CT 10V72145626Super B Complex w/Vitamin C100 CT 10V73965746Melatonin 10mg60 CT 13V74452271Menopause Support Caplets28 CT 18V76247321B-12 1000mcg60 CT 7V77222901Vitamin C With Rosehips100 CT 8V78325394Cranberry 500mg100 CT 14V79307300Ginkgo Biloba60 CT 9V80451093Glucosamine Chondroitin TripleStrength Caplets240 CT 6626ACTIVE INGREDIENTGlucosamine HCl 1,500mg(1.5g)Home delivery only Limited to one per benefit period
Frequently Asked Questions (FAQs)Where can I find my member ID number?It can be found on the front of your health plan ID card.What is the Over-the-Counter (OTC) benefit?The OTC benefit offers you an easy way to get generic over-the-counter health andwellness products by going to any OTC Health Solutions-enabled CVS Pharmacy ,CVS Pharmacy y mas , or Navarro store.How much is my OTC benefit?The amount depends on your benefit plan. Check your plan documents or callOTC Health Solutions at 1-888-628-2770 (TTY: 711).How often can I use my OTC benefit?Your OTC benefit can be utilized multiple times throughout the benefit period,not to exceed your allowance.Can I carry over unused benefit amount to the next benefit period?Unused benefit amounts do not roll over to the next benefit period.Can I order more than my benefit amount?You cannot exceed your benefit amount online or by phone. However, you mayexceed your benefit amount at an OTC Health Solutions-enabled CVS Pharmacy ,CVS Pharmacy y mas , or Navarro store and pay the difference out of pocket.Are all items available at the stores?Not all items are available in stores.Is there a limit on the number of items I can order?There is no limit on the number of items you may order. There is, however, aquantity limit of 3 per any single item for monthly benefits or 9 per any single itemfor quarterly benefits. There are some select products that have special limits andthese are marked with a in the catalog.How long will it take to receive my order?You will receive your order within 14 days after it was placed.Is there a return policy?Due to the personal nature of the products, no returns or exchanges are allowed.If you haven’t received your order or if you received a defective or damaged item,please call OTC Health Solutions at 1-888-628-2770 (TTY: 711) within 30 days ofplacing your order to receive a replacement item.You will receive the generic equivalent of all items.27
Questions? Call us.1-800-385-0916 TTY 711If you’re a Devoted Health Member, call:1-800-338-6833 TTY 711Devoted Health is an HMO plan with a Medicare contract. Enrollment in Devoted Health depends on contract renewal. DevotedHealth complies with applicable Federal civil rights laws and does not discriminate on the basis of race,color, national origin,age, disability, or sex. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos deasistencia lingüística. Llame al1-800-338-6833 (TTY 711). Y0142 21S337 M
CODE SKU PRODUCT ACTIVE INREDIENT UANTITY PRICE Adult Care I70 830476 Women’s Small/Medium Underwear Max 36 CT 18 I71 830475 Women’s Large Underwear Max
