OTC Product Catalog. Ordering is easy:

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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.

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 Care Agent can get someone on the call who speaks your language. The CVS/caremark OTC Customer Care 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, 4 th 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 $20 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 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 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 Card 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 Care 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. 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.

3 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 $20 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. Call CVS/caremark if a discontinued OTC item is out of stock. 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 extra items that you purchase. This includes taxes and shipping when they apply. Extra items not covered under your Plan s OTC benefit that you will have to pay for: o You can use your ExtraCare Health Card to get a 20% 1 ExtraCare ECHC discount on thousands of CVS/pharmacy brand health-related OTC items that you buy online at CVS.com or in a CVS/pharmacy. This is a CVS/pharmacy ExtraCare ECHC loyalty card discount that we pass on to our Members. You can use your ExtraCare Health Card to stretch your savings even further by buying these extra OTC items even if you have not used your monthly OTC benefit amount. This 20% 1 ExtraCare ECHC savings is not a Plan benefit, but a no-cost, CVS/pharmacy value-added loyalty card program. o You can also shop for and get other discounts on CVS.com and CVS/pharmacy promo items. This is not a Plan or ExtraCare ECHC 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% 1 ExtraCare ECHC discount should not be used to purchase OTC items for anyone else.

4 Shipping, Payments, and Refunds Allow 7-10 days for shipping. If your order does not arrive by this time please contact CVS/caremark at or call (888) , TTY (877) 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. Plan discounts will not be applied to refunds. A check will be mailed to your home address within 4 weeks. There are no refunds for any extra items that you buy. This includes, but is not limited to, extra items that you buy with your 20% 1 ExtraCare ECHC discount or for other CVS.com or CVS/pharmacy promo OTC items. 1 The 20% ExtraCare ECHC discount is restricted to items purchased for the health care of the member and applies to regular/non-sale priced CVS/pharmacy brand health-related items valued at $1 or more. Excludes alcohol, lottery, money orders, prescriptions and copays, postage stamps, pre-paid cards, gift cards, photo finishing, newspapers and magazines, milk, sale/promotional merchandise, bottle deposits, bus passes, hunting and fishing licenses, and are not valid on any items reimbursed by a governmental program. Members pay upfront out-of-pocket for these extra items. This includes taxes and shipping when they apply. The Plan will not refund members for these extra purchases. The ExtraCare ECHC products and services described above are neither offered nor guaranteed under our contract with Medicare. In addition, they are not subject to the Medicare appeals process. Purchases eligible for the ExtraCare ECHC discounts will not count toward your true out-of-pocket (TrOOP) costs under our Plan. Any disputes regarding these products and services may be subject to our grievance process. You cannot use the Plan s supplemental Part C OTC benefit to fill prescriptions at a CVS/pharmacy or any other pharmacy. The Plan s supplemental Part C OTC benefit is not a Part D or pharmacy benefit. If you need to fill a prescription you are not required to use a CVS/pharmacy. Other pharmacies are available in our network. Molina Dual Options Medicare-Medicaid Plan is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. You can get this information for free in other formats, such as large print, braille, or audio. Call (877) , TTY/TDD: 711, Monday Friday, 8 a.m. to 8 p.m., local time. The call is free.

5 You can get this document in Spanish, or speak with someone about this information in other languages for free. Call (877) , TTY/TDD: 711, Monday Friday, 8 a.m. to 8 p.m., local time. The call is free. Puede obtener este documento en inglés o hablar con una persona acerca de esta información en otros idiomas de manera gratuita. Llame al (877) , TTY/TDD al 711, de lunes a viernes de 8 a.m. a 8 p.m. hora local. La llamada es gratuita. Limitations, copays, and restrictions may apply. For more information, call Molina Dual Options Member Services or read the Molina Dual Options Member Handbook. Benefits, and/or copayments may change on January 1 of each year.

6 Eligible OTC Items Allergy & Asthma - Allergy & Sinus Medicine Category / Item Description CVS SKU Price* OTC items / pricing can change without notice CVS Maximum Strength Dye-Free Adult Allergy Liquid, Cherry Flavor (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 Non-Drowsy Daytime Multi-Symptom Cold/Flu Relief Softgels (24 ct.) $6.23 CVS AirShield Gummies (42 ct.) $5.99 CVS Medicated Cold Sore Treatment, Maximum Strength (.23 oz.) $4.39 CVS Nasal Decongestant Inhaler (.01 oz.) $4.23 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, 75 mg (30 ct.) $6.79 CVS Antacid Tablets, Extra Strength, Assorted Fruit (96 ct.) $3.99 CVS Health Stomach Relief Chewable Tablets, Original (48 ct.) $4.79 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.) $3.19 Digestive Health - Fiber & Laxatives / Constipation Relief CVS Disposable Enema, Latex Free (4.5 oz.) $1.34 CVS Epsom Salt (64 oz.) $3.67 CVS Easy Fiber (62 doses) $9.59 CVS Easy Fiber Chewable Tablets, Wild Berry (90 ct.) $8.39 CVS Milk of Magnesia Saline Laxative, Original Flavor (12 oz.) $4.39 CVS Health Magnesium Citrate Oral Solution, Grape (10 oz.) $2.06 CVS Health Senna Plus Laxative/Stool Softener Tablets, Value Size (180 ct.) $13.03 CVS Health Stool Softener Softgels 100 mg (30 ct.) $4.39 CVS Health Glycerin Suppositories, Adult Size (50 ct.) $3.51 Digestive Health - Gas Relief CVS Gas Relief ChewableTablets, Mint (100 ct.) $7.59

7 Digestive Health - Lactose Intolerance Category / Item Description CVS SKU Price* OTC items / pricing can change without notice CVS Fast Acting Dairy Relief Chewable Tablets, Vanilla Twist Flavor (60 ct.) $10.79 Feminine Care - Yeast Infections CVS Miconazole 7 Day Vaginal Treatment Cream (1.59 oz.) $9.59 First Aid - Antibiotic & Antiseptic CVS Triple Antibiotic Ointment (.26 oz.) $4.23 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 Elastic Bandage, 4" (1 ct.)** $5.03 CVS Liquid Bandage (.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 (6 ct.) $4.23 First Aid - Hemorrhoid Treatment CVS Hemorrhoidal Ointment, Medicated Formula (1 oz.) $5.19 CVS Medicated Pads (100 ct.) $7.19 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.) $3.75 CVS Jock Itch Spray (4.6 oz.) $7.43 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.) $14.79 CVS Antifungal Ringworm Cream (.5 oz.) $7.19 First Aid - Sterile Gloves & Masks CVS Durable Nitrile Exam Gloves, Powder Free (40 ct.) $7.99 CVS Procedural Face Masks with Earloops (50 ct.) $8.39 First Aid - Tape, Gauze, & Pads CVS Cotton Balls (130 ct.) $2.63 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.)** $2.39 CVS Non-Irritating Paper Tape for Sensitive Skin (1 ct.)** $2.63 First Aid - Wart Removal CVS Maximum Strength Invisible Wart Remover Strips (14 ct.) $6.63 Foot Care - Antifungal & Health CVS Clotrimazole Cream Usp 1% (1 oz.) $7.99 CVS Athlete's Foot Powder Spray (4.6 oz.) $7.19

8 Category / Item Description CVS SKU Price* OTC items / pricing can change without notice Health & Medicine - Compression Hosiery & Stockings CVS Crew Comfort Socks for Diabetics, White, Size S/M (2 pairs) $7.19 Health & Medicine - Diabetic CVS Glucose Tablets, Orange (10 ct.) $1.59 Health & Medicine - Medicine Accessories CVS Eye and Ear Medicine Droppers (2 ct.) $2.63 CVS Complete System for Needle Collection & Disposal (1 ct.) $5.59 CVS Weekly AM/PM Pill Case (1 ct.) $8.39 CVS Pill Crusher Plus Storage (1 ct.) $5.83 CVS Pill Splitter with Safety Shield (1 ct.) $3.99 Hot and Cold Therapy CVS Cold Pain Relief Pack, Reusable (1 ct.) $4.79 CVS Health Deluxe Reusable Hot Cold Pain Relief Compress, Small (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 Poise Moderate Absorbency Incontinence Pads (20 ct.) $5.43 Incontinence - Protective Underwear & Briefs CVS Premium Underpads (8 ct.) $10.39 CVS Smooth Shape Briefs for Woman Maximum Absorbency, L/XL (10 ct.) $8.79 Ophthalmic (eyes) CVS Eye Allergy Relief Eye Drops (.5 oz.) $5.43 CVS Artificial Tears Lubricant Eye Drops (1 oz.) $6.39 CVS Redness Relief Eye Drops (.5 oz.) $2.71 Oral Care (mouth) CVS Oral Anesthetic Gel, Maximum Strength (.25 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 Comfort Drops (.33 oz.) $6.63 CVS Earwax Removal Kit (1 ct.) $6.39 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

9 Category / Item Description CVS SKU Price* OTC items / pricing can change without notice 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.) $5.19 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 CVS Pain Relief Tablets, Extra Strength (60 ct.) $4.39 Pain & Fever - Thermometers & Accessories CVS Digital Flexible Tip Thermometer (1 ct.) $8.79 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-Taking Blood Pressure Monitor (1 ct.) $14.39 Vitamins - Minerals CVS Calcium 600 mg + D Tablets (120 ct.) $9.59 CVS Great Tasting Calcium 500 mg Gummy Vitamins (50 ct.) $9.03 CVS Iron 65 mg Tablets (200 ct.) $8.79 Vitamins - Supplements CVS Coenzyme Q10 50 mg Softgels (45 ct.) $10.39 CVS Natural Fish Oil 1000 mg Softgels (120 ct.) $7.99 CVS Folic Acid Tablets 800 mcg (100 ct.) $3.19 CVS Glucosamine Maximum Strength Tablets 1500 mg (60 ct.) $8.79 CVS Melatonin Timed Release Tablets 5 mg (90 ct.) $7.19 CVS Flush Free Niacin Capsules 500 mg (200 ct.) $11.19 Vitamins CVS Vitamin B1 Tablets 100 mg (100 ct.) $3.99 CVS Vitamin B mg Tablets (100 ct.) $5.59 CVS Vitamin B mcg Tablets (100 ct.) $5.99 CVS Vitamin C 500 mg Tablets (100 ct.) $4.39 CVS Vitamin C with Rose Hips Chewable 1000 mg Tablets (100 ct.) $8.79 CVS Vitamin E 400 IU Softgels (100 ct.) $7.59 CVS Spectravite Adult Multivitamin Tablets (130 ct.) $5.99

10 Category / Item Description CVS SKU Price* OTC items / pricing can change without notice Non-Eligible 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 * Price (what Member pays) reflects the Plan s 20% discount on OTC items at the time this OTC Product Catalog was published. Current CVS.com pricing can be found online at The Plan s 20% discount will be applied at checkout.

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

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