Ordering is easy: Go online to Order 24/7 from any PC, Mac, tablet, or smartphone with online access

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Leona Warner
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1 OTC Product Catalog We want to make it easy for you to manage your health. To help you do that, we have partnered with CVS/ caremark to offer you an over-the-counter (OTC) benefit. Your OTC benefit covers the health and wellness items that you need most. Ordering is easy: Go online to Order 24/7 from any PC, Mac, tablet, or smartphone with online access Type Molina into the search box to see color photos of all Plan-approved OTC products Click on any image to read more about the item See if an item is in stock Select other items to order if it is out of stock You will need a valid address to order online, view your past orders, or get a tracking number so you know when your order shipped. OTC products are shipped right to your door. This means fewer trips to the store and the gas pump! To place an order by phone call CVS/caremark toll-free at (888) , TTY (877) If you need, a CVS/caremark OTC Customer Service Agent can get someone on the call who speaks your language. The CVS/caremark OTC Customer Service line is open Monday-Friday 8 a.m.-11 p.m. ET and on weekends from 8:30 a.m.-9 p.m. ET. The line is closed on New Year s Day, 4th of July, Labor Day, Memorial Day, Thanksgiving, and Christmas. You do not need a prescription to purchase any of the OTC items covered under this benefit. Whether you order online or call in your order, you pay nothing for Plan-approved OTC items as long as you stay within your $15 monthly OTC benefit amount and order once a month. No out-of-pocket costs. No waiting for refunds. No trips to the store. When you order once a month by phone or online at Make sure to spend your entire OTC benefit amount each month. What you don t use expires at the end of each month. If the entire amount is not used, the remaining balance does not carryover. You will not have a larger amount to spend the following month.

Key Things to Keep in Mind ID Cards and Ordering Once you become a Molina Dual Options MI Health Link (Medicare-Medicaid Plan) member, CVS/ caremark will mail you a CVS/caremark ExtraCare Health card.

2 Key Things to Keep in Mind ID Cards and Ordering Once you become a Molina Dual Options MI Health Link (Medicare-Medicaid Plan) member, CVS/ caremark will mail you a CVS/caremark ExtraCare Health card. Your card should arrive within 3-4 weeks. You will need your ExtraCare Health card number (found on the back of your ExtraCare Health card) to order OTC items covered under this benefit. If you have an ExtraCare card or an ExtraCare Health card because you purchased items from CVS/ caremark before becoming a member, you will receive a new ExtraCare Health card in the mail. This new card will reflect your current OTC benefit. Your card will also have your new ExtraCare Health number. It can take 7-10 days after you are enrolled in the Plan to show up as an active member in the CVS/ caremark system. Don t worry. Until you get your ExtraCare Health card, you can call CVS/caremark to place your order. The CVS/caremark OTC Customer Service Agent will simply ask you for your member number (found on your Plan ID card). The agent will call us to confirm that you are still enrolled in the Plan, then help you place your order. To make your order process as simple as possible please be sure to make a list of the items you would like to order prior to calling to place your order. Even though you can create an online account without your ExtraCare Health card number, you will not be able to order OTC items online without it. Once you receive your ExtraCare Health card, go back to the website, update your account with your ExtraCare Health card number, and you will be ready to place your next order online. If you have an existing CVS.com account because you ordered from CVS.com before becoming a member you do not need to setup a new account. You only have to setup an account once. Simply update your existing account with your new ExtraCare Health card number once your new card arrives. For online support or to place an order by phone call CVS/caremark for help. You can also choose to buy any of the covered Plan-approved OTC items at a store (retail, drugstore, or online store) and get a refund.

3 We do not suggest that you choose this option for a number of reasons. You will have to pay the full retail price charged by the store upfront out-of-pocket. This also applies to any Plan-approved OTC items that you buy at a CVS/pharmacy drugstore. Plan pricing is only applied to the Plan-approved OTC items you order online or by phone from CVS/caremark. Claims for all OTC products are not paid. We will only refund your out-of-pocket costs for Plan-approved OTC items up to your monthly benefit amount. Plan discounts are not applied to refunds. After you purchase your Plan-approved items you will have to call us to get a Direct Member OTC Refund Form. You will have to pay the postage to mail the completed form along with a copy of your receipts. You will have to wait for a refund check. Once you get your check you will then have to get in the car again to cash your check. Benefit Amount You have a fixed amount of $15 to spend each month on Plan-approved OTC items. Make sure to spend your entire OTC benefit amount each month. What you don t use expires at the end of each month. If the entire amount is not used, the remaining balance does not carryover. You will not have a larger amount to spend the following month. Refer to the list of covered OTC items below or go online to find the items that you want to order. Visit and type Molina into the search box. This will pull up a list of all Plan-approved OTC products. Click on any image to read more about the item. OTC items and prices can change without notice. Total the cost of all your items and be sure to stay within your monthly OTC benefit amount. Your monthly OTC benefit amount can only be used to buy Plan-approved OTC items. You will have to pay upfront out-of-pocket for any other items that you purchase. This includes taxes and shipping when they apply. o Our Members get a 20% discount on any CVS/pharmacy brand health-related OTC item they buy online at CVS.com or in a CVS/pharmacy. This is a Plan benefit. o You can also get other discounts on CVS.com and CVS/pharmacy promo items. This is not a Plan benefit. Anyone can buy these items. Promo deals are not limited to health-related items. You may find savings and specials on shampoo, soaps, and other items you need. Promo offers and pricing vary. This OTC benefit is for Plan members only. Your monthly OTC benefit amount and 20% Plan discount should not be used to purchase OTC items for anyone else. Shipping, Payments, and Refunds Allow 7-10 days for shipping. If your order does not arrive by this time please contact CVS/caremark at customercare@cvs.com or call (888) , TTY (877)

4 Shipping is free when you order once a month. When you order more than once a month you will have to pay a $5.49 flat shipping charge for each extra order. Surcharges for heavy items may apply. American Express, MasterCard, Discover Card, and Visa are accepted when you buy online. Should you receive a damaged item, please contact CVS/caremark within 72 hours at customercare@cvs.com or call (888) , TTY (877) If you purchased your OTC items at a store call us to get a Direct Member OTC Refund Form. You will find our Member Services phone number on the back of your Plan ID card. Follow the steps on the form and mail your completed form and receipts to the address on the form. Your claim will be reviewed. You will get a refund for any Plan-approved OTC items you purchased up to your monthly benefit amount. There are no refunds for 20% discounted or other promo OTC items. A check will be mailed to your home address within 4 weeks.

5 Molina Dual Options MI Health Link (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Michigan Medicaid to provide benefits of both programs to enrollees. This information is available in other formats, such as Braille, large print, and audio. You can speak with someone about this information in other languages for free. Call (855) The call is free. Usted puede hablar con una persona gratuitamente acerca de esta información en otros idiomas. Llame al (855) La llamada es gratuita. Limitations, restrictions, and patient pay amounts may apply. For more information, call Molina Dual Options Member Services or read the Molina Dual Options Member Handbook. Benefits, List of Covered Drugs, pharmacy, and provider networks may change from time to time throughout the year and on January 1 of each year.

6 Category / Item Description OTC items / pricing can change without notice CVS SKU Eligible OTC Items Allergy & Asthma - Allergy & Sinus Medicine CVS Dye-Free Allergy Liquid, Cherry (4 oz.) $5.59 CVS Small Size Allergy Tablets (24 ct.) $3.59 CVS Non-Drowsy Sinus Relief Daytime and Multi-Symptom Nighttime Softgels (48 ct.) $10.23 CVS Nasal Spray Sinus (1 oz.) $5.99 Cough, Cold, & Flu CVS Medicated Chest Rub (3.53 oz.) $5.83 CVS Non-Drowsy Daytime & Multi-Symptom Cold & Flu Relief, Combo Pack (24 oz.) $10.63 CVS Cold Remedy Fast Melting Quick Dissolving Tablets, Cherry (25 ct.) $8.39 CVS Maximum Strength Sore Throat Lozenges, Cherry (18 ct.) $3.19 CVS Sore Throat Spray, Cherry (6 oz.) $4.63 CVS All Natural Flu Relief Quick Dissolving Pellets (12 ct.) $15.99 CVS AirShield Gummies (42 ct.) $5.59 CVS Medicated Cold Sore Treatment Maximum Strength (.23 oz.) $4.39 CVS Nasal Decongestant Inhaler (.01 oz.) $3.99 CVS No-Drip Maximum Strength Nasal Mist (.5 oz.) $4.39 CVS Saline Nasal Spray (3 oz.) 6205 $4.39 CVS Nasal Strips Large, Tan (30 ct.) $8.79 Digestive Health - Antacid / Heartburn Relief CVS Omeprazole Magnesium Acid Reducer 20.6 mg Delayed Release Capsules (14 ct.) $8.39 CVS Acid Reducer Tablets 75mg (30 ct.) $6.79 CVS Antacid Tablets Extra Strength, Assorted Fruit (96 ct.) $3.99 CVS Stomach Relief ChewableTablets ( 48 ct.) $4.39 CVS Antacid & Pain Reliever Tablets Effervescent, Original (36 ct.) $3.59 Digestive Health - Anti-Diarrhea CVS Anti-Diarrheal Caplets (12 ct.) $4.63 CVS Bismuth Liquid (8 oz.) $3.18 Digestive Health - Fiber & Laxitives / Constipation Relief CVS Disposable Enema, Latex Free (4.5 oz.) $1.26 CVS Epsom Salt, Unscented (16 oz.) $1.59 CVS Easy Fiber (62 doses) $9.43 CVS Easy Fiber Chewable Tablets, Wild Berry (90 ct.) $7.99 CVS Milk of Magnesia Saline Laxative, Original Flavor (12 oz.) $4.39 CVS Oral Solution Magnesium Citrate, Lemon (10 oz.) $1.99 CVS Senna Plus Laxative/Stool Softener Tablets Value Size (180 ct.) $13.03 CVS Stool Softener Capsules, Original (30 ct.) $4.39 CVS Glycerin Suppositories, Adult Size (50 ct.) $3.51 Price

7 Digestive Health - Gas Relief CVS Gas Relief Chew Tablets, Mint (100 ct.) $7.19 Digestive Health - Lactose Intolerance CVS Fast Acting Dairy Relief Chewable Tablets, Vanilla Twist Flavor (60 ct.) $10.79 Feminine Care - Yeast Infections CVS Miconazole Nitrate Vaginal Cream 2% Disposable Applicators (1.59 oz.) $9.59 First Aid - Antibiotic & Antiseptic CVS Antibiotic Ointment, Original (.5 oz.) $3.99 CVS Hydrogen Peroxide Solution (16 oz.) $1.42 CVS 70% Isopropyl Rubbing Alcohol (16 oz.) $1.82 First Aid - Bandages CVS Clear Bandages, Assorted Sizes (45 ct.)* $2.87 CVS Liquid Bandage (0.3 oz.) $4.39 First Aid - Burn Treatment CVS Medicated Instant First Aid Spray (3 oz.) $5.19 First Aid - Corn Removal CVS One Step Medicated Corn Removers, Maximum Strength $4.23 First Aid - Hemorrhoid Treatment CVS Hemorrhoidal Ointment (1 oz.) $5.19 CVS Medicated Pads for Hemorrhoidal Relief (100 ct.) $5.99 CVS Hemorrhoidal Suppositories (12 ct.) $5.59 First Aid - Itch & Rash Treatment CVS No-Rub Calamine Plus Spray (6 oz.) $6.39 CVS Maximum Strength Cortisone Intense Healing Anti-Itch Cream (1 oz.) $4.39 CVS Jock Itch Spray (4.6 oz.) $7.19 First Aid - Medical ID Bracelets CVS Medical ID Bracelet (1 ct.) $11.19 First Aid - Pinworm & Lice Treatment CVS Lice Solution Kit, Maximum Strength (1 ct.) $14.63 CVS Antifungal Ringworm Cream (.5 oz.) $7.19 First Aid - Sterile Gloves & Masks CVS Latex-Free Super-Soft Vinyl Gloves, One Size Fits Most, Mega Pack (120 ct.) $12.79 CVS Procedural Face Masks with Earloops (50 ct.) $8.47 First Aid - Tape, Gauze, & Pads CVS Cotton Balls (130 ct.) $2.39 CVS Sterile Latex-Free Gauze Pads, 2 x 2 (25 ct.)* $3.59 CVS Sterile Latex-Free Non-Stick Pads, 2 x 3 (10 ct.)* $2.55 CVS Alcohol Prep Swabs (120 ct.)* $2.22 CVS All Purpose Cloth Tape 7.5 x 6 yards (6 yds.)* $2.95 First Aid - Wart Removal CVS Maximum Strength Invisible Wart Remover Strips (14 ct.) $6.63

8 Foot Care - Antifungal & Health CVS Clotrimazole Cream Usp 1% (1 oz.) $7.99 CVS Athlete s Foot Powder Spray (4.6 oz.) $6.63 Health & Medicine - Compression Hosiery & Stockings CVS Men s Over-the-Calf Length Compression Socks, Size 7-12 (1 pair) $7.19 CVS Ladie s Non-Binding Crew Socks, Size 6-10 (3 pairs) $5.59 Health & Medicine - Diabetic CVS Glucose Liquid Shot, Berry Blast (2 oz.) $2.39 CVS Glucose Tablets Orange (10 ct.) $1.59 Health & Medicine - Medicine Accessories CVS Eye Droppers and Ear Medicine (1 ct.) $2.63 CVS Medicine Bottle Magnifier (1 ct.) $4.79 CVS Weekly AM/PM Pill Case (1 ct.) $8.39 CVS Pill Splitter (1 ct.) $3.99 Hot and Cold Therapy CVS Cold Pain Relief Pack, Reusable (1 ct.) $4.79 CVS Reusable Hot Cold Pain Relief Compress (1 ct.) $11.99 CVS Extra Strength Cold & Hot Medicated Patch XL (3 ct.) $5.83 CVS Arthritis Heatwraps, Hand & Wrist (2 ct.) $5.59 CVS Heatwraps, Neck, Shoulder, & Wrist (3 ct.) $4.39 Incontinence - Cleaners, Cloths, & Creams Total Home by CVS Flushable Moist Wipes Tub (42 ct.) $2.79 Incontinence - Pads & Liners CVS Maximum Absorbency Protective Pads, Long (12 ct.) $4.63 Incontinence - Protective Underwear & Briefs CVS Men s 4-Piece Maximum Absorbency Sizing Kit (4 ct.) $2.39 CVS Women s 4-Piece Maximum Absorbency Lifestyle Kit, L/XL (4 ct.) $2.39 CVS Women s 4-Piece Maximum Absorbency Lifestyle Kit, S/M (4 ct.) $2.39 Opthalmic (eyes) CVS Eye Allergy Relief Eye Drops (15 ml) $5.19 CVS Artificial Tears Lubricant Eye Drops (1 oz.) $6.39 CVS Redness Relief Eye Drops (0.5 oz) $2.55 Oral Care (mouth) CVS Oral Anesthetic Gel Maximum Strength (2 oz.) $4.63 CVS Extra Strength Denture Adhesive Cream (2.4 oz.) $3.43 CVS Denture Cleanser Anti-Bacterial Tablets (40 ct.) $2.55 CVS Dental Floss, Waxed (100 yd.) $2.14 CVS Dry Mouth Mouthwash, Mint (16 oz.) $6.23 CVS Maximum Strength Oral Pain Reliever for Severe Toothaches (45 oz.) $5.59 Otic (ears) CVS Ear Pain Relief Ear Drops (.33 oz.) $7.03 CVS Earwax Removal Kit (1 ct.) $6.39

9 Pain & Fever - Arthritis Pain Relief CVS Menthol Gel (8 oz.) $5.99 CVS Arthricream Cream Rub (3 oz.) $5.03 CVS Muscle Rub (3 oz.) $5.03 Pain & Fever - Aspirin Relief CVS Adult Low Dose Aspirin 81 mg Chewable Tablets, Orange (36 ct.) $2.14 CVS Enteric Aspirin 81 mg Tablets (120 ct.) $5.19 CVS Aspirin 81 mg Tablets Low Dose (32 ct.) $2.06 CVS Aspirin 325 mg Coated Tablets, Regular Strength (100 ct.) $1.99 Pain & Fever - Migraine Relief CVS Migraine Relief Caplets (24 ct.) $3.83 Pain & Fever - Non-Aspirin Relief CVS Backache Relief Caplets, Extra Strength (24 ct.) $4.79 CVS Ibuprofen Tablets (200 ct.) $9.03 CVS Leg Cramps Pain Relief Caplets (40 ct.) $5.59 CVS All Day Pain Relief Tablets (50 ct.) $5.03 Pain & Fever - Thermometers & Accessories CVS Digital Flexible Tip Thermometer (1 ct.) $7.99 CVS Thermometer Probe Covers (30 ct.) $2.22 Under certain circumstances some items may be covered under either Part B or Part D. When you receive these items under Part B or 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 OTC Items All Items listed below are Dual Purpose items. You should only order these products after discussing them with your health care provider to see if s/he recommends the item for a specific diagnosed condition. Please speak to your physician before ordering these items. Health & Medicine - Blood Pressure Monitor CVS Self-Talking Blood Pressure Monitor (1 ct.) $14.39 Vitamins - Minerals CVS Calcium D Tablets (120 ct.) $9.83 CVS Great Tasting Calcium 500 mg Gummy Vitamins (50 ct.) $9.03 CVS Iron 65 mg Tablets (200 ct.) $8.39 Vitamins - Supplements CVS Coenzyme Q10 50 mg Softgels (30 ct.) $11.19 CVS Natural Fish Oil 1000 mg Softgels (120 ct.) $8.79 CVS Folic Acid 800 mcg Heart & Reproductive Health Tablets (100 ct.) $3.19 CVS Glucosamine 1500 mg Tablets (60 ct.) $7.99 CVS Melatonin Sleep Aid Tablets 5 mg (90 ct.) $7.19 CVS Niacin Capsules 500 mg (200 ct.) $11.19 Vitamins CVS B mg Tablets (100 ct.) $3.99 CVS Vitamin B mg Tablets (100 ct.) $5.19

10 CVS Vitamin B mcg Tablets (100 ct.) $5.99 CVS Vitamin C 500 mg Tablets (100 ct.) $3.59 CVS Vitamin C 1000 mg Chewable Tablets (100 ct.) $8.39 CVS Vitamin E 400 Iu Softgels (100 ct.) $5.99 CVS Spectravite Adult Multivitamin Tablets (130 ct.) $5.99 Non-Eligiblel OTC Items Non-Eligible OTC items, if purchased, will not be covered by the Plan. Alternative Medicines Baby Items Contraceptives Convenience (Non-Medical) Items Cosmetics Food Product or Supplements Replacement Items, Attachments, Peripherals

OTC Product Catalog. Ordering is easy:

OTC Product Catalog. Ordering is easy: OTC Product Catalog We want to make it easy for you to manage your health. To help you do that, we have partnered with CVS/caremark to offer you an over-the-counter (OTC) benefit. Your OTC benefit covers