Fill - Free fillable Over-the-Counter Health & Wellness PDF form

Over-the-Counter

Health & Wellness

Products

This is the new 2020 catalog and

order form! Use this to submit your next order

if requesng by mail.

Your health and wellness allowance amount

may have changed for 2020. Please contact

your sales agent or check your 2020 Summary

of Benets to determine your benet amount.

This can be done by signing into

MyHumana and clicking “Documents and

Forms” under Member Support.

Please note: when ordering mulple products,

depending on the items you order, you may

receive your products in mulple shipments.

2020 Catalog and Order Form

Y0040_GHHKHD8EN _C

2020 Over-the-Counter (OTC)

Health and Wellness Product Order Form

Your current plan may have an over-the-counter benet that would allow you to

purchase OTC health and wellness products from Humana Pharmacy. To verify your

2020 Health and Wellness allowance, please contact your sales agent or check your

Summary of Benets.

Keep this catalog somewhere accessible. You’ll need this to look up the health and

wellness products you want to order.

How to order

If your order exceeds your plan’s allowance, please include your check, money order,

or enter your credit card informaon to pay the remaining amount due. Balances

higher than the allowance amount will have sales tax applied. Failure to submit

payment in full will lead to items being cancelled to bring your order total at or

below your benet allowance. Please be sure to provide your payment

informaon each me you order over your allowance amount. Any unused

allowance does not roll over.

• If you have a monthly allowance, submit your order by the 20th of each month.

• If you have a quarterly allowance, submit your order by the last week of your

allowance period. Last month of quarters are March, June, September, and

December.

Ordering your OTC products

• Online: Sign in to HumanaPharmacy.com and select “Over-the-Counter (OTC)

items” from the “Shop OTC & Supplies” drop-down at the top of the page.

• Mobile App: Order your OTC products whenever and wherever you’d like with the

Humana Pharmacy Mobile app, directly from your mobile device.

• Mail:

Fill out the OTC Health and Wellness Product Order Form and mail only the

order form pages to:

Humana Pharmacy

PO Box 1197

Cincinna, OH 45201-1197

• Fax: Fill out the OTC Health and Wellness Product Order Form and fax

only the order form pages to Humana Pharmacy at: 1-800-379-7617.

Call Humana Pharmacy at 1-855-211-8370 (TTY: 711) if you have quesons about

how to use this benet at Humana Pharmacy. Customer Care representaves are

available Monday - Friday, 8 a.m. - 11 p.m. and Saturday, 8 a.m. - 6:30 p.m.,

Eastern me.

Please note: This order form is for the 2020 benet year. Please do

not submit your rst order unl aer January 1, 2020.

2020 Humana Health and Wellness

Product Order Form

PAYMENT INFORMATION (if applicable)

If your total order is less than your plan’s allowance, you DO NOT need to include payment and you

will receive the items you ordered. If your order exceeds your plan’s allowance, please include your

check, money order, or enter your credit card information below to pay the remaining amount due.

Failure to submit payment in full will lead to items being cancelled to bring your order total at

or below your benet allowance.

Please be sure to provide your payment information each

time you order over your allowance amount.

Any unused balance does not roll over.

Please make checks payable to “Humana Pharmacy”. Please do not send cash.

To pay by credit card, please complete the following:

Credit/Debit Card # Exp. Date

M M Y Y

Cardholder First Name

Cardholder Last Name

Cardholder Signature:

Gender

Male

Female

Member ID (found on Humana ID card) Date of Birth

–

First Name Last Name MI

Street Number Street Name Apt/Suite #

Urbanization Code (for Puerto Rico addresses only)

City State Zip Code

–

Daytime Phone Evening Phone Please check

box

if this is a

new address:

M M D D Y Y Y Y

MEMBER INFORMATION

During which month would you like to receive this order?

If a month is not selected, your order will be processed the month your request is received.

M M

Orders will be shipped to your home by UPS or the US Postal Service at no extra charge to you.

Please allow 10 to 14 business days for processing from the time Humana Pharmacy receives

your order. Orders may be split into multiple shipments. You’ll receive a generic comparable to

the name-brand product. This product list is subject to change. If a product is unavailable or not

in stock, it may be substituted for a similar product at no additional charge. Humana Pharmacy

reserves the right to limit the quantities of OTC medications and supplies dispensed. Please check

with your healthcare provider before taking OTC medicines. Some items may vary depending on

manufacturer (for example: caplets, tablets, capsules or soft gels may be substituted for one

another).

Y0040_GHHKHD8EN _C

971

PRODUCT SELECTION

*Write in the quantity of the product you would like to receive, not the package size listed in catalog.

Product Code Product Name Quantity* Price

Example: 0 1 6 Aspirin Low Dose 81mg EC

1 $6

To order by mail, send the completed Humana Health

and Wellness Product Order Form page along with

payment (if applicable) to:

Humana Pharmacy

P.O. Box 1197

Cincinnati, OH 45201-1197

Your total order amount $ _______

Humana allowance $ _______

Total remaining amount due $ _______

1 OTC

2 OTC

3 OTC

4 OTC

5 OTC

6 OTC

7 OTC

8 OTC

9 OTC

10 OTC

11 OTC

12 OTC

13 OTC

14 OTC

15 OTC

Member ID (found on Humana ID card) Date of Birth

Balances higher than the allowance

amount will have sales tax applied.

M D D Y Y Y YM

/ /

971A

Product

code

Product name Compare to Package

count

Price

032 Antacid/Anti-Gas Liquid Mylanta

12 oz. $8.00

318 Anti-Diarrheal Caplets -

Loperamide 2 mg

Imodium

A-D 24 $7.00

031 Anti-Hemorrhoidal Ointment Preparation H

2 oz. $7.00

093 Bisacodyl 5 mg Dulcolax

25 $7.00

203 Calcium Carbonate Antacid -

Regular Strength

Tums

Regular Strength 150 $7.00

116 Dairy Digestive Supplement-

Lactase Enzyme

Lactaid

Tablets 60 $10.00

215 Effervescent Antacid & Pain Relief Alka-Seltzer

36 $7.00

323 Esomeprazole 20 mg Nexium

24HR 28 $17.00

320 Extra Strength Gas Relief Soft-Gels Gas-X

Extra Strength 48 $8.00

261 Famotidine 20 mg Pepcid

20 mg 25 $8.00

415 Fiber Gummies Vitafusion

Fiber Well Gummies 90 $15.00

208 Fiber Laxative Tablets FiberCon

90 $9.00

216 Hemorrhoidal Suppositories Preparation H

Suppositories 12 $7.00

358 Medicated Hemorrhoidal Pads Tucks

Pads 100 $8.00

033 Milk of Magnesia - Laxative/Antacid Phillips

Milk of Magnesia 12 oz. $7.00

120 Motion Sickness Tablets -

Dimenhydrinate 50 mg

Dramamine

12 $6.00

351 Nausea Relief Liquid Emetrol

4 oz. $7.00

112 Omeprazole 20 mg Prilosec OTC

14 $10.00

115 Pink Bismuth - Chewable Tablets Pepto-Bismol

Chewable Tablets 30 $7.00

264 Polyethylene Glycol 3350 MiraLAX

8.3 oz. $10.00

258 Psyllium Fiber Laxative Capsules Metamucil

Capsules 160 $11.00

359 Psyllium Fiber Supplement Orange

Smooth Texture Powder

Metamucil

13 oz. $10.00

360 Psyllium Fiber Supplement Orange

Smooth Texture Powder - Sugar Free

Metamucil

Sugar Free 10 oz. $9.00

233 Senna Laxative Tablets Senokot

100 $10.00

101 Stool Softener Capsules Colace

100 $7.00

Over-the-Counter (OTC) Health and Wellness Product Catalog

Note:

You will receive the generic equivalent of all items

Antacid, Anti-Diarrheal and Laxatives

Product

code

Product name Compare to Package

count

Price

416 Adjustable Transfer Bench** Drive Medical 1 $80.00

417 Bath Bench with Arms and Back** Essential Medical Supply Shower

Bench with Back

1 $60.00

418 Bath Bench with Arms, No Back** Essential Medical Supply Shower

Bench

1 $50.00

371 Bath Mat** Bath Mat 1 $12.00

372 Raised Toilet Seat - 250 lbs. capacity** Raised Toilet Seat - 250 lbs. capacity 1 $25.00

420 Toilet Safety Rails** Nova

Toilet Safety Rails 1 $40.00

373 Tub and Stair Safety Treads Tub and Stair Safety Treads 8 $8.00

421 Tub Safety Bar** Drive Medical Tub Safety Bar 1 $40.00

Bath Safety

Cough, Cold and Allergy

Product

code

Product name Compare to Package

count

Price

113 Cetirizine HCL 10 mg Zyrtec

10 mg 30 $12.00

260 Cough and Cold High Blood

Pressure Tablets*

Coricidin

HBP Cough and Cold 16 $7.00

422 Cough Drops, Black Cherry, Sugar Free Halls

Cough Drops Sugar Free 25 $2.00

423 Cough Drops, Honey Lemon Halls

Cough Drops 30 $2.00

321 Cough Formula Expectorant Robitussin

8 oz. $7.00

210 Cough Suppressant/Expectorant

(sugar free)*

Robitussin

Sugar Free DM 4 oz. $7.00

096 Cough Suppressant/Nasal

Decongestant/Expectorant*

Robitussin

CF 4 oz. $6.00

237 Daytime Cold and Flu Soft Gels* DayQuil™ 16 $7.00

111 Expectorant - Guaifenesin 400 mg Mucus Relief 400 mg 30 $9.00

291 Eye Itch Relief 0.025% Eye Drops Zaditor

0.17 oz. $13.00

361 Levocetirizine Xyzal

35 $9.00

110 Loratadine 10 mg Claritin

30 $10.00

290 Loratadine Liquid 5 mg/5 ml Children’s Claritin

4 oz. $9.00

043 Medicated Chest Rub Vicks VapoRub

100 gm $7.00

117 Menthol/Benzocaine Sore Throat

Lozenges

Cepacol

Lozenges 18 $6.00

228 Nasal Decongestant PE Max Strength Sudafed

PE Tablets 36 $6.00

095 Nasal Decongestant Spray Afrin

1 oz. $6.00

362 Nasal Strips - Medium Breathe Right

Nasal Strips 30 $12.00

220 Phenol/Oral Anesthetic Sore Throat

Spray

Chloraseptic

6 oz. $6.00

325

Saline Nasal Spray Ocean

Saline Nasal Spray 3 oz. $6.00

097 Sinus-Acetaminophen/

Phenylephrine HCI

Tylenol

Sinus 24 $6.00

Diabetes Management

Product

code

Product name Compare to Package

count

Price

265 Compression Stockings 15-20mmHg

Regular Beige Size A

(Ankle: 7” - 7 7/8”; Calf: 10” - 13”)

JOBST

Compression Stockings

15-20mmHg Regular Beige Size A

(Ankle: 7” - 7 7/8”; Calf: 10” - 13”)

1 pair $15.00

266 Compression Stockings 15-20mmHg

Regular Beige Size B

(Ankle: 8” - 8 7/8”; Calf: 12” - 15”)

JOBST

Compression Stockings

15-20mmHg Regular Beige Size B

(Ankle: 8” - 8 7/8”; Calf: 12” - 15”)

1 pair $15.00

267 Compression Stockings 15-20mmHg

Regular Beige Size C

(Ankle: 9” - 9 7/8”; Calf: 14” - 17”)

JOBST

Compression Stockings

15-20mmHg Regular Beige Size C

(Ankle: 9” - 9 7/8”; Calf: 14” - 17”)

1 pair $15.00

268 Compression Stockings 15-20mmHg

Regular Beige Size D

(Ankle: 10” - 10 7/8”; Calf: 16” - 19”)

JOBST

Compression Stockings

15-20mmHg Regular Beige Size D

(Ankle: 10” - 10 7/8”; Calf: 16” - 19”)

1 pair $15.00

269 Compression Stockings 15-20mmHg

Regular Beige Size E

(Ankle: 11” - 11 7/8”; Calf: 18” - 21”)

JOBST

Compression Stockings

15-20mmHg Regular Beige Size E

(Ankle: 11” - 11 7/8”; Calf: 18” - 21”)

1 pair $15.00

270 Compression Stockings 15-20mmHg

Regular Beige Size F

(Ankle: 12” - 12 7/8”; Calf: 20” - 23”)

JOBST

Compression Stockings

15-20mmHg Regular Beige Size F

(Ankle: 12” - 12 7/8”; Calf: 20” - 23”)

1 pair $15.00

271 Compression Stockings 15-20mmHg

Regular Beige Size G

(Ankle: 13” - 13 7/8”; Calf: 22” - 26”)

JOBST

Compression Stockings

15-20mmHg Regular Beige Size G

(Ankle: 13” - 13 7/8”; Calf: 22” - 26”)

1 pair $15.00

329 Compression Stockings 15-20mmHg

Regular Black Size A

(Ankle: 7” - 7 7/8”; Calf: 10” - 13”)

JOBST

Compression Stockings

15-20mmHg Regular Black Size A

(Ankle: 7” - 7 7/8”; Calf: 10” - 13”)

1 pair $15.00

330 Compression Stockings 15-20mmHg

Regular Black Size B

(Ankle: 8” - 8 7/8”; Calf: 12” - 15”)

JOBST

Compression Stockings

15-20mmHg Regular Black Size B

(Ankle: 8” - 8 7/8”; Calf: 12” - 15”)

1 pair $15.00

331 Compression Stockings 15-20mmHg

Regular Black Size C

(Ankle: 9” - 9 7/8”; Calf: 14” - 17”)

JOBST

Compression Stockings

15-20mmHg Regular Black Size C

(Ankle: 9” - 9 7/8”; Calf: 14” - 17”)

1 pair $15.00

332 Compression Stockings 15-20mmHg

Regular Black Size D

(Ankle: 10” - 10 7/8”; Calf: 16” - 19”)

JOBST

Compression Stockings

15-20mmHg Regular Black Size D

(Ankle: 10” - 10 7/8”; Calf: 16” - 19”)

1 pair $15.00

333 Compression Stockings 15-20mmHg

Regular Black Size E

(Ankle: 11” - 11 7/8”; Calf: 18” - 21”)

JOBST

Compression Stockings

15-20mmHg Regular Black Size E

(Ankle: 11” - 11 7/8”; Calf: 18” - 21”)

1 pair $15.00

334 Compression Stockings 15-20mmHg

Regular Black Size F

(Ankle: 12” - 12 7/8”; Calf: 20” - 23”)

JOBST

Compression Stockings

15-20mmHg Regular Black Size F

(Ankle: 12” - 12 7/8”; Calf: 20” - 23”)

1 pair $15.00

335 Compression Stockings 15-20mmHg

Regular Black Size G

(Ankle: 13” - 13 7/8”; Calf: 22” - 26”)

JOBST

Compression Stockings

15-20mmHg Regular Black Size G

(Ankle: 13” - 13 7/8”; Calf: 22” - 26”)

1 pair $15.00

424 Steam Inhaler** Vicks

Steam Inhaler 1 $50.00

293 Triamcinolone Allergy Nasal Spray Nasacort

Allergy 24 hour 0.57 oz. $18.00

376 Diabetes Circulatory Crew Socks

8-15mmHg Black - Small

Diabetes Circulatory Crew Socks

8-15mmHg Black - Small

1 pair $10.00

375 Diabetes Circulatory Crew Socks

8-15mmHg Black - Medium

Diabetes Circulatory Crew Socks

8-15mmHg Black - Medium

1 pair $10.00

374 Diabetes Circulatory Crew Socks

8-15mmHg Black - Large

Diabetes Circulatory Crew Socks

8-15mmHg Black - Large

1 pair $10.00

377 Diabetes Circulatory Crew Socks

8-15mmHg Black - XL

Diabetes Circulatory Crew Socks

8-15mmHg Black - XL

1 pair $10.00

381 Diabetes Circulatory Crew Socks

8-15mmHg White - Small

Diabetes Circulatory Crew Socks

8-15mmHg White - Small

1 pair $10.00

380 Diabetes Circulatory Crew Socks

8-15mmHg White - Medium

Diabetes Circulatory Crew Socks

8-15mmHg White - Medium

1 pair $10.00

379 Diabetes Circulatory Crew Socks

8-15mmHg White - Large

Diabetes Circulatory Crew Socks

8-15mmHg White - Large

1 pair $10.00

382 Diabetes Circulatory Crew Socks

8-15mmHg White - XL

Diabetes Circulatory Crew Socks

8-15mmHg White - XL

1 pair $10.00

368 Diabetic Foot Care Telescoping

Inspection Mirror

Telescoping Mirror 1 $12.00

272 Diabetic Skin Relief Foot Cream Gold Bond® Diabetic Skin Relief

Foot Cream

3.4 oz. $10.00

305 Glucose Tablets (6 pack of 10 tablets) DEX4® Glucose Tablets 60 $11.00

274 Sharps Container BD™ Home Sharps Container 1 $6.00

First Aid

Product

code

Product name Compare to Package

count

Price

035 Alcohol Prep Pads Curad

Alcohol Swabs 100 $4.00

226 Elastic Bandage Ace

Bandage 1 $5.00

425 Elastic Bandage 6” Ace

Bandage 1 $8.00

385 First Aid Kit - 175 Pieces Curad

First Aid Kit - 175 pcs. 1 kit $12.00

426 Gauze Roll 4.5” x 4.1 Yards Curad

Gauze Roll 1 $3.00

427 Hand Sanitizer Purell

8 oz. $4.00

428 Hot Water Bottle Hot Water Bottle 1 $10.00

429 Hydrogen Peroxide Hydrogen Peroxide 16 oz. $3.00

430 Ice Bag Ice Bag 1 $6.00

431 Paper Tape 2” x 10 Yards Curad

Paper Tape 1 $9.00

432 Petroleum Jelly Vaseline

4 oz. $4.00

324 Plastic Bandages Band-Aids

200 $9.00

433 Rubbing Alcohol Rubbing Alcohol 16 oz. $3.00

231 Triple Antibiotic Ointment Plus Neosporin

+ Pain Relief 1 oz. $7.00

384 Waterproof Adhesive Bandages Waterproof Adhesive Bandages 100 $10.00

Fitness Devices

Product

code

Product name Compare to Package

count

Price

434 Fitbit

Charge** Fitbit

Charge 1

$150.00

435 Fitbit

Inspire** Fitbit

Inspire 1

$70.00

436 Fitbit

Inspire HR** Fitbit

Inspire HR 1

$100.00

437 Fitbit

Versa Lite** Fitbit

Versa Lite 1

$160.00

438 Garmin

Vivot** Garmin

Vivot 1

$80.00

440 Garmin

Vivosmart** Garmin

Vivosmart 1

$130.00

441 Pedometer Pedometer 1

$25.00

Home Medical

Product

code

Product name Compare to Package

count

Price

257 7-Day Pill Box 7-Day Pill Box 1 $8.00

242 Blood Pressure Home Kit (manual

pump w/stethoscope)**

Blood Pressure Home Kit (manual

pump w/stethoscope)

1 $17.00

443 CPAP Memory Foam Pillow** CPAP Memory Foam Pillow 1 $60.00

444 CPAP Pillow - Fiber Filled** CPAP Pillow - Fiber Filled 1 $45.00

247 Digital Bathroom Scale** Digital Bathroom Scale 1 $24.00

245 Digital Blood Pressure Monitor** Digital Blood Pressure Monitor 1 $50.00

445 Digital Hearing Amplier Clearon Hearing Amplier 1 $50.00

244 Electric Heating Pad - Standard** Sunbeam

Electric Heating Pad 1 $30.00

447 Foam Ring Cushion Carex

1 $21.00

448 Heating Pad Wrap for Shoulder &

Neck**

Sunbeam

1 $40.00

449 Humidier, Ultra-Sonic Cool Mist** Honeywell

Humidier - Ultrasonic 1 $50.00

450 Hypoallergenic Pillow Hypoallergenic Pillow 1 $25.00

451 Lumbar Cushion Carex

1 $23.00

446 Magnifying Glass Magnifying Glass 1 $13.00

452 Medical Bracelet - Diabetes Medical Bracelet 1 $21.00

453 Medical Bracelet - Heart Patient Medical Bracelet 1 $21.00

370 Medication Disposal Powder DisposeRx™ 3 $9.00

458 Medication Lock Pillpod 1 $25.00

454 No-Touch Forehead Thermometer** Braun No Touch + Forehead

Thermometer

1 $40.00

048 Oral Thermometer B-D

Oral Thermometer 1 $6.00

455 Peak Flow Meter Peak Flow Meter 1 $18.00

456 Pill Bottle Opener Pill Bottle Opener 1 $7.00

457 Pill Splitter & Crusher Pill Splitter & Crusher 1

$9.00

419 Plug-In LED Night Lights Plug-In LED Night Lights 2 $8.00

386 Quad Cane Large Base-300lbs

capacity**

Quad Cane Large Base-300lbs

capacity

1 $25.00

Incontinence

Product

code

Product name Compare to Package

count

Price

256 Absorbent Underpads (Disposable

Chux Pads) 23”x36”

Protection Plus

Disposable

Underpads 23”x36”

20 $20.00

253 Adult Incontinence Pull On Underwear

Large

Protection Plus

Classic Protective

Underwear Large 40”-56”

18 $16.00

252 Adult Incontinence Pull On Underwear

Medium

Protection Plus

Classic Protective

Underwear Medium 28”-40”

20 $16.00

251 Adult Incontinence Pull On Underwear

Small

Protection Plus

Classic Protective

Underwear Small 20”-28”

22 $16.00

254 Adult Incontinence Pull On Underwear

X-Large

Protection Plus

Classic Protective

Underwear X-Large 56”-68”

14 $16.00

255 Adult Incontinence Pull On Underwear

XX-Large

Protection Plus

Classic Protective

Underwear XX-Large 68”-80”

12 $16.00

396 Adult Incontinence Tab-Style

Disposable Briefs, Extra Absorbency, S

FitRight

Disposable Briefs

Extra Absorbency - Small

20 $17.00

395 Adult Incontinence Tab-Style

Disposable Briefs, Extra Absorbency, M

FitRight

Disposable Briefs

Extra Absorbency - Medium

20 $17.00

394 Adult Incontinence Tab-Style

Disposable Briefs, Extra Absorbency, L

FitRight

Disposable Briefs

Extra Absorbency - Large

20 $17.00

397 Adult Incontinence Tab-Style

Disposable Briefs, Extra Absorbency,

FitRight

Disposable Briefs

Extra Absorbency - XL

20 $17.00

398 Adult Incontinence Tab-Style

Disposable Briefs, Extra Absorbency,

XXL

FitRight

Disposable Briefs

Extra Absorbency - XXL

20 $17.00

401 Adult Incontinence Tab-Style

Disposable Briefs, Ultra Absorbency, S

FitRight

Disposable Briefs

Ultra Absorbency - Small

20 $17.00

400 Adult Incontinence Tab-Style

Disposable Briefs, Ultra Absorbency, M

FitRight

Disposable Briefs

Ultra Absorbency - Medium

20 $17.00

399 Adult Incontinence Tab-Style

Disposable Briefs, Ultra Absorbency, L

FitRight

Disposable Briefs

Ultra Absorbency - Large

20 $17.00

402 Adult Incontinence Tab-Style

Disposable Briefs, Ultra Absorbency, XL

FitRight

Disposable Briefs

Ultra Absorbency - XL

20 $17.00

403 Adult Incontinence Tab-Style

Disposable Briefs, Ultra Absorbency,

XXL

FitRight

Disposable Briefs

Ultra Absorbency - XXL

20 $17.00

387 Quad Cane Small Base-300lbs

capacity**

Quad Cane Small Base-300lbs

capacity

1 $25.00

460 Talking Blood Pressure Monitor** Omron

1 $75.00

461 Talking Digital Bathroom Scale** Talking Digital Bathroom Scale 1 $35.00

462 Talking Ear and Forehead

Thermometer

DualScan

Thermometer, Audio 1 $27.00

463 Weighted Utensil Set Weighted Utensil Set 1 $40.00

Product

code

Product name Compare to Package

count

Price

294 Acetaminophen 325 mg Tylenol

Regular Strength 100 $7.00

002 Acetaminophen 500 mg Tylenol

Extra Strength 100 $6.00

020 Acetaminophen 80 mg chewable Tylenol

Children’s Chewable 30 $6.00

016 Aspirin Low Dose 81 mg EC Bayer

Adult Low Strength EC 120 $6.00

353 Children’s Acetaminophen Liquid Children’s Tylenol

4 oz. $7.00

213 Cold and Hot Patches Icy Hot

Patch 5 $8.00

229 Enteric Coated Aspirin 325 mg Ecotrin

100 $6.00

125 Headache Formula -

Aspirin/Acetaminophen/Caffeine

Excedrin

100 $8.00

019 Ibuprofen 200 mg Tablets Advil

50 $7.00

094 Ibuprofen Suspension (Children’s) Children’s Motrin

4 oz. $8.00

365 Lidocaine Patches Salonpas

Lidocaine Patches 6 $9.00

046 Muscle Rub BenGay

4 oz. $8.00

283 Naproxen Sodium 220 mg Aleve

100 $9.00

344 Roll-on Muscle Relief Biofreeze

2.5 oz. $15.00

464 Spray-On Muscle Relief BioFreeze

Spray 4 oz. $15.00

119 Topical Analgesic - Capsaicin Cream

0.025%

Zostrix

Cream 2 oz. $8.00

Pain Relievers

Personal Care

366 Bladder Control Guards for Men FitRight

Active Bladder Guards

for Men

52 $15.00

243 Bladder control pads (regular) Poise

Moderate Pads 20 $9.00

307 Diaper Rash Ointment Desitin

Ointment 2 oz. $6.00

369 Flushable Cleansing Cloths Cottonelle

40 $5.00

Product

code

Product name Compare to Package

count

Price

471 Battery-Operated Water Jet** Interplak

Battery-Operated Water Jet 1 $35.00

472 Battery-Operated Water Jet Tips Interplak

Battery-Opearted Water Jet

Tips

5 $9.00

390 Battery-Powered Toothbrush** Battery-Powered Toothbrush 1 $14.00

389 Battery-Powered Toothbrush

Replacement Heads

Battery-Powered Toothbrush

Replacement Heads

2 $10.00

465 Bunion Guard Bunion Guard 1 $9.00

036 Cotton Swabs Q-Tips

Cotton Swabs 300 $5.00

224 Dental Floss, Waxed Dental Floss, Waxed 100

yards

$5.00

391 Dental Flossers Dental Flossers 90 $7.00

225 Denture Adhesive Fixodent

1.5 oz. $6.00

392 Denture Brush GUM

Denture Brush 1 $6.00

345 Disposable Gloves - Non-Latex Curad

100 $10.00

393 Dry Mouth Oral Rinse Biotene

Dry Mouth Oral Rinse 16  oz. $9.00

118 Earwax Removal Drops Debrox

Earwax Removal Drops 0.5 oz. $7.00

319 Effervescent Denture Tabs Efferdent

90 $8.00

219 Eye Drops - Redness Reliever Visine

Original 0.5 oz. $6.00

466 Folding Reading Glasses +1.50 Folding Reading Glasses +1.50 1 $20.00

467 Folding Reading Glasses +1.75 Folding Reading Glasses +1.75 1 $20.00

468 Folding Reading Glasses +2.00 Folding Reading Glasses +2.00 1 $20.00

469 Folding Reading Glasses +2.25 Folding Reading Glasses +2.25 1 $20.00

470 Folding Reading Glasses +2.50 Folding Reading Glasses +2.50 1 $20.00

388 Insect Bite Relief After Bite

0.5 oz. $9.00

327 Insect Repellent Off

Deep Woods

Insect Repellent 6 oz. $9.00

356 Lubricant Eye Drops Refresh Optive

Lubricant Eye Drops 0.5 oz. $14.00

114 Lubricant Eye Drops (Sterile) Lubricant Eye Drops (Sterile) 0.5 oz. $7.00

346 Lubricant Eye Gel GenTeal

0.34 oz. $12.00

404 Medicated Foot Powder Gold Bond

Medicated Foot Powder 4 oz. $6.00

414 Medicated Lip Treatment

Squeeze Tube - 2 Pack

Carmex

2 $6.00

473 Moleskin Moleskin 3 strips $6.00

295 Oral Pain Relief - Benzocaine 20% Orajel™ Maximum 0.5 oz. $7.00

405 Preservative Free Lubricant Eye Drops Refresh Optive

30 $15.00

407 Rechargeable Power Toothbrush** Rechargeable Power Toothbrush 1 $35.00

406 Rechargeable Power Toothbrush

Replacement Heads

Rechargeable Power Toothbrush

Replacement Heads

2 $20.00

310 Reusable Cold Compress ACE™ Cold Compress 1 $7.00

284 Toothbrush Toothbrush 3 $7.00

285 Toothpaste Toothpaste 2 $8.00

296 Wart Remover Liquid 17% Compound W

Max Strength 0.31 oz. $9.00

Skin Care

Product

code

Product name Compare to Package

count

Price

217 Allergy Cream - Itch and Pain Relief Benadryl

Extra Strength Cream 1 oz. $6.00

037 Calamine Lotion Calamine 6 oz. $6.00

038 Clotrimazole Cream 1% Lotrimin AF

0.5 oz. $6.00

408 Diabetic Skin Relief Gold Bond

Ultimate Diabetics’ Dry

Skin Relief Hydrating Lotion

4.5 oz. $10.00

409 Eczema Moisturizing Cream Aveeno

Active Naturals

Eczema

Therapy Moisturizing Cream

5 oz. $12.00

322 Hydrocortisone Cream 1% Cortaid

2 oz. $7.00

241 Medicated Callus Remover Dr. Scholl’s

6 $7.00

410 Psoriasis Medicated Ointment Psoriasis Medicated Ointment 3.8 oz. $12.00

411 Soothing Oatmeal Bath Treatment Aveeno

Soothing Bath Treatment 8 $10.00

306 Sunblock SPF 30 Coppertone

SPF 30 8 oz. $8.00

218 Tolnaftate 1% Antifungal Tinactin

Cream 1 oz. $8.00

308 Vitamin A&D Ointment A&D

Original Ointment 4 oz. $8.00

Smoking Cessation

Product

code

Product name Compare to Package

count

Price

313 Nicotine Transdermal 14 mg Patch Nicotine Transdermal Patch 7 $25.00

314 Nicotine Transdermal 21 mg Patch Nicotine Transdermal Patch 7 $25.00

315 Nicotine Transdermal 7 mg Patch Nicotine Transdermal Patch 7 $25.00

123 Stop Smoking Gum - 2 mg Nicorette

2 mg gum 50 $20.00

124 Stop Smoking Gum - 4 mg Nicorette

4 mg gum 50 $20.00

Product

code

Product name Compare to Package

count

Price

336 Ankle Support Futuro

1 $10.00

363 Arthritis Gloves, Large Vive Arthritis Gloves 1 pair $18.00

364 Arthritis Gloves, Medium Vive Arthritis Gloves 1 pair $18.00

337 Back Support Elastic - one size ts

most

Futuro

1 $25.00

442 Carpal Tunnel Night Brace Futuro

Carpal Tunnel Night Brace 1 $23.00

339 Elbow Support Futuro

Elbow Support 1 $10.00

357 Knee Support w/Stays XL Futuro

Knee Support w/Stays - XL 1 $15.00

340 Knee Support w/Stays L Futuro

Knee Support w/Stays - L 1 $15.00

341 Knee Support w/Stays M Futuro

Knee Support w/Stays - M 1 $15.00

342 Knee Support w/Stays S Futuro

Knee Support w/Stays - S 1 $15.00

459 Plantar Fascitis Relief Sleeve Plantar Fascitis Relief Sleeve 1 pair $12.00

343 Wrist Support Futuro

1 $15.00

Supports

Vitamins, Minerals and Supplements

Product

code

Product name Compare to Package

count

Price

250 Almebex Plus B-12 Almebex Plus B-12® 473 ml $27.00

297 Antioxidant Tablets Antioxidant Tablets 60 $8.00

475 Biotin Gummies Vitafusion

100 $11.00

476 Calcium + Vitamin D Gummies Nature’s Way

Alive!

60 $12.00

109 Calcium Citrate + Vitamin D Citracal

Caplets + D 60 $7.00

248 Chewable Calcium with Vitamin D

Plus Minerals

Caltrate

600 + D Plus Minerals

Chewable

60 $9.00

367 Co-Enzyme Q-10 100 mg Co-Enzyme Q-10 100 mg 30 $12.00

902 Co-Enzyme Q-10 30 mg Co-Enzyme Q-10 30 mg 30 $10.00

063 Complete Senior Vitamins and

Minerals

Centrum

Silver 60 $10.00

011 Daily Multivitamin and Mineral Centrum

130 $8.00

907 Eye Care Vitamins Ocuvite

Extra 36 $9.00

298 Ferrous Sulfate 5 gr Feosol

100 100 $8.00

477 Flax Seed Oil 1000 mg Softgels Flax Seed Oil 90 $10.00

240 Folic Acid 800 mcg Folic Acid 800 mcg 100 $6.00

412 Glucosamine Chondroitin Triple

Strength

Glucosamine Chondroitin Triple

Strength

100 $25.00

299 Gummy Multi-Vitamin Multi-Vitamin Gummy 120 $11.00

300 Gummy Vitamin C 250 mg Vitamin C 250 mg Gummy 100 $11.00

301 Gummy Vitamin D 2000 IU Vitamin D 2000 IU Gummy 120 $11.00

474 Immune Support Chewable Tablets Airborne

32 $9.00

246 Liquid Iron Formulation 220mg/5ml Liquid Iron 16 oz. $9.00

302 Magnesium Oxide 400 mg Mag-Ox

400 mg 120 $9.00

278 Melatonin 5 mg Melatonin 5 mg 100 $8.00

479 Melatonin Gummies, 5 mg Vitajoy

120 $12.00

413 Omega-3 Fish Oil 1000 mg Omega-3 Fish Oil 1000 mg 90 $10.00

107 One Daily Women’s Multivitamin One-A-Day Women’s

60 $8.00

316 One Daily Men’s Multivitamin One-A-Day Men’s

60 $8.00

317 Organic Sulfur MSM 1000 mg Organic Sulfur MSM 1000 mg 90 $9.00

303 Potassium Gluconate 595 mg Potassium Gluconate 595 mg 100 $6.00

481 Rena-vite Vitamins Rena-vite Vitamins 100 $15.00

909 Timed Release Niacin 500 mg Timed Release Niacin 500 mg 100 $9.00

238 Vitamin B-12 1000 mcg Vitamin B-12 1000 mcg 100 $7.00

279 Vitamin B-12 5000 mcg Sublingual Vitamin B-12 5000 mcg Sublingual

30 $8.00

482 VitaminB-Complex Gummies VitaFusion

70 $10.00

280 Vitamin B-Complex Sublingual Vitamin B-Complex Sublingual 60 $7.00

903 Vitamin B-Complex with B-12 Vitamin B-Complex with B-12 100 $8.00

010 Vitamin C 500 mg Vitamin C 500 mg 100 $6.00

209 Vitamin D 1000 IU Vitamin D 1000 IU 100 $8.00

483 Vitamin D 50,000 IU Vitamin D 50,000 IU 12 $20.00

239 Vitamin D 5000 IU Vitamin D 5000 IU 100 $9.00

012 Vitamin E 400 IU Vitamin E 400 IU 100 $8.00

Women’s Health

Product

code

Product name Compare to Package

count

Price

041 Clotrimazole 1% Vaginal Cream Gyne-Lotrimin

Cream 1.5 oz. $8.00

304 Miconazole 3 Combo Pack Monistat

3 Combo Pack 3 day

supply

$13.00

326 Urinary Pain Relief AZO Urinary Pain Relief

30 $8.00

484 Urinary Tract Infection Test Strips AZO Urinary Tract Infection Test

Strips

3 $14.00

IMPORTANT!

______________________________________________________________________

At Humana, it is important you are treated fairly.

Humana Inc. and its subsidiaries do not discriminate or exclude people because of their race, color, national

origin, age, disability, sex, sexual orientation, gender identity, or religion. Discrimination is against the law.

Humana and its subsidiaries comply with applicable Federal Civil Rights laws. If you believe that you

have been discriminated against by Humana or its subsidiaries, there are ways to get help.

• You may ﬁle a complaint, also known as a grievance:

Discrimination Grievances, P.O. Box 14618, Lexington, KY 40512-4618

If you need help ﬁling a grievance, call 1-877-320-1235 or if you use a TTY, call 711.

• You can also ﬁle a civil rights complaint with the U.S. Department of Health and Human Services,

Ofﬁce for Civil Rights electronically through the Ofﬁce for Civil Rights Complaint Portal, available at

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at U.S. Department of Health

and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, DC 20201,

1-800-368-1019, 800-537-7697 (TDD).

Complaint forms are available at https://www.hhs.gov/ocr/ofﬁce/ﬁle/index.html.

Auxiliary aids and services, free of charge, are available to you.

1-877-320-1235 (TTY: 711)

Humana provides free auxiliary aids and services, such as qualiﬁed sign language interpreters, video remote

interpretation, and written information in other formats to people with disabilities when such auxiliary aids

and services are necessary to ensure an equal opportunity to participate.

Language assistance services, free of charge, are available to you.

1-877-320-1235 (TTY: 711)

Español (Spanish):/ODPHDOQ¼PHURDUULEDLQGLFDGRSDUDUHFLELUVHUYLFLRVJUDWXLWRVGHDVLVWHQFLDbOLQJ¾¯VWLFD

籗넓⚥俒

(Chinese)



丸䩧♳꬗涸ꨶ鑨贫焺⽰〳栽䖤⯝顥铃鎊䴂⸔剪⹡

7L̹QJ9ĹW9LHWQDPHVH;LQJ͇LV͋ÓĹQWKR̛LWU¬QÓ¤\Ó̽QĶQÓɟ͝FF£FGͅFKY͟K͑WU͝QJ¶QQJͩPL̿QSK¯

묻펂

(Korean)



줂욚펆펂힎풞컪찒큲읊짩픊엲졂퓒픦쩖옪헒킻킪폲 

7DJDORJ7DJDORJȂ)LOLSLQR7DZDJDQDQJQXPHURVDLWDDVXSDQJPDNDWDQJJDSQJPJDVHUELV\RQJbWXORQJ

VDZLNDQDQJZDODQJED\DG

ƺǝǛǛǔǒǓ5XVVLDQƹǘǑǌǘǗǒǜǏǙǘǗǘǖǏǚǝǝǔǊǑǊǗǗǘǖǝǌǥǢǏǡǜǘǋǥǙǘǕǝǡǒǜǦǋǏǛǙǕǊǜǗǥǏ

ǝǛǕǝǍǒbǙǏǚǏǌǘǎǊ

.UH\´O$\LV\HQ)UHQFK&UHROH5HOHQLPHZRNLSLZRODDSRXUHVHYZDVªYLVªGSRXODQJNLbJUDWLV

Polski (Polish):$E\VNRU]\VWDÉ]EH]SĄDWQHMSRPRF\MÛ]\NRZHMSURV]Û]DG]ZRQLÉSRGZ\ľHMSRGDQ\QXPHU

,WDOLDQR,WDOLDQ&KLDPDUHLOQXPHURVRSUDSHUULFHYHUHVHUYL]LGLDVVLVWHQ]DOLQJXLVWLFDbJUDWXLWL

'HXWVFK*HUPDQ:¦KOHQ6LHGLHREHQDQJHJHEHQH1XPPHUXPNRVWHQORVHVSUDFKOLFKH

+LOIVGLHQVWOHLVWXQJHQ]XHUKDOWHQ

傈劤铂

(Japanese)



搀俱ך鎉铂佄䴂؟٦ؽأ׾׀銲劄ך㜥さכծ♳鎸ך殢〾תדֶꨵ鑧ֻ׌ְׁկ

ƖǊ1ƱǢ )DUVL

ǅƗǇƘŦƳ3ƱǯƷBǶǢG1ƱǯǍƱƳFƱŦƗ'1*1ǶǑƳƖǱƱƳ2*ȂƘǵǋƷƶǢƱƗ1/Ì'ǇƳ

/TYl-TeLLOß9LaLUZà%

W0dah7 b44sh bee hani’7 bee wolta’7g77 bich’9’ h0d77lnih 47 bee t’11 jiik’eh saad

bee 1k1’1n7da’1wo’d66 nik1’adoowo[.

ƵǺƳǇǝǫ' $UDELF

ǧƸǠǬƳ)ǅǜƱǋǯǬǫƵǺǱƱƾǮ*ƱǮǅǃǷǬǜDǶǑǁǬǫGȂǜ#ǰǺƴǯǫ'ǭǥǇǫƱƳDƱǑƷȁ'!ƱƽǇǫ'

Get your questions answered

Call Humana Pharmacy:

1-855-211-8370 (for TTY, dial 711)

Online:

Humana.com

Remember! Keep this catalog.

You’ll need this catalog to look up the health and wellness products you

want to order.

Please note: when ordering multiple products, depending on the items you order, you may receive

your products in multiple shipments.

OTC items may only be purchased for the plan enrollee. It is prohibited to purchase OTC items for

family members and friends. Purchase of covered OTC products made under emergency

circumstances may be eligible for reimbursement when the benet allowance is available.

*Sale of products containing Dextromethorphan are prohibited to members under the age of 18. Limit

quanty of two per <order><allowance period>.

**Limit one per plan year. Prior to purchase, the enrollee is strongly encouraged to have a conversaon

with their personal provider about the appropriateness of this OTC item.

The following items are not covered under this OTC benet (non-eligible items): Baby items,

Contraceptives, Convenience (non-medical items), Cosmetics, and Food Supplements.

An allowance amount is only available if your plan offers the over-the-counter (OTC) service as a

benet. Call Humana Pharmacy at 1-855-211-8370 (TTY: 711) if you have questions about your

order, or about how to use this benet at Humana Pharmacy, Monday- Friday, 8 a.m.—11 p.m., and

Saturday, 8 a.m.— 6:30 p.m. Eastern time.

Humana is a Medicare Advantage HMO, PPO, PFFS organization and a stand-alone prescription drug

plan with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.

Other pharmacies are available in our network.

Y0040_GHHKHD8EN _C

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Over-the-Counter Health & Wellness

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Over-the-Counter Health & Wellness Form

Related forms

Fillable Over-the-Counter Health & Wellness

Fill Online, Printable, Fillable, Blank Over-the-Counter Health & Wellness Form

Related forms

First 20 documents completely FREE!