MCS Classicare

MA (HMO), Premium A (HMO),

Premium B (HMO POS), Medicare Platino (HMO SNP),
Especial (HMO SNP) and Ideal D (HMO SNP)

OVER THE COUNTER (OTC)

MEDICATION GUIDE
2011

This is a guide that includes the most commonly used over the counter (OTC)
medications. The list does not represent the entire list of OTC covered medications and
it is effective from January 1st, 2011 thru December 31, 2011. You may contact our
Service Call Center at (787) 620-2530 (Metro Area) or 1-866-627-8183, Monday
through Sunday from 8:00 a.m. to 8:00 p.m. for more details about whether your over
the counter prescription is covered. TTY/TDD users may call 1-866-627-8182. After
March 2, 2011, your call will go to our Automated Answering System, after 4:30 p.m. on
Saturdays, all day Sundays and holidays. When you leave your message, please,
include your name, phone number, and the time you called. A representative will return
your call no later than one (1) working day after the date you called.
If you know the name of the medication you are looking for, please refer to the
Index on page 10 which has drug names listed in alphabetical order.
A Medicare Advantage organization with a Medicare contract.

Y0077_9000_E_011 CMS Approved 09232010

OVER THE COUNTER MEDICATION GUIDE

MCS Classicare has developed an Over the Counter Medication Guide. This Guide
contains a list of covered drugs selected by MCS Classicare in consultation with a team
of health care providers, which represents the non-prescription therapies believed to be
important in supplementing your treatment program with prescription drugs.
Over the counter drugs are usually obtained at pharmacies. You can find these drugs
outside the pharmacy department.
MCS Classicare will generally cover the drugs listed in our Over-the-Counter Medication
Guide as long as a prescriber has written a prescription for the drug, and the
prescription is filled at a MCS Classicare network pharmacy, and other plan rules are
followed.
1. What are over the counter (OTC) drugs?
OTC drugs are non-prescription drugs that are not normally covered by a Medicare
Prescription Drug Plan. OTC drugs are used for the treatment of medical conditions
such as cough and cold, pain, diarrhea and stomach discomfort, among others. MCS
Classicare requires you to obtain a prescription in order for these medications to be
covered.
2. Do I have a cost share for OTC drugs covered by MCS Classicare?
MCS Classicare pays for a specific list of OTC drugs as an enhanced benefit. MCS
Classicare will provide these OTC drugs at no cost to you. The cost to MCS Classicare
of these OTC drugs will not count toward your total drug costs and does not count
towards qualifying you for the Catastrophic Coverage Stage.
3. Are there any restrictions on my coverage of OTC drugs?
Covered OTC drugs may have limits on coverage as follows:
a. Maximum quarterly dollar benefit: MCS Classicare will cover up to a maximum
dollar amount for OTC drugs in a given QUARTER. After the maximum dollar
limit is reached within the specified time limit, MCS Classicare will no longer
cover these drugs.
b. You may contact our Service Call Center at (787) 620-2530 (Metro Area) or 1866-627-8183, Monday through Sunday from 8:00 a.m. to 8:00 p.m. for more
details about your over the counter coverage. TTY/TDD users may call 1-866627-8182.

4. What are the advantages of using over the counter drugs?

The use of over the counter drugs allows the patient to have greater access to a variety
of drugs available in the market to treat some medical conditions. In addition, it allows
the patient to save money, because they usually cost less than other drugs.
5. Are over the counter drugs safe and effective?
Yes. Over the counter drugs are drugs approved by the United States Food and Drug
Administration (FDA) and have proven to be safe and effective. However, inappropriate
use of them can lead to harmful effects. Always remember to read package labeling for
specific instructions on how to take them, and warnings and precautions you should
consider when taking them.
6. How do I use this Over the Counter Medication Guide?
This Guide classifies over the counter drugs by category according to the condition they
are used for. For example, drugs to treat cough and congestion are classified under the
category Cough / Cold / Allergy Combinations. If you know what your drug is used for,
look for the category name in the table of contents starting on page 4. Then look for
your drug under this category. You can also look for the name of the drug in the
alphabetical index starting on page 10.
7. How do I obtain over the counter drugs?
Over the counter drugs can be obtained in pharmacies. Even though these drugs do not
require a prescription, MCS Classicare requires a prescription in order for you to obtain
them. These drugs may only be purchased for the plan enrollee.
8. Which medical conditions can be treated with over the counter drugs?
Some examples of medical conditions that can be treated with over the counter drugs
are:
Nasal Allergies Claritin, Benadryl
Athlete Foot - Clotrimazole, Lamisil
Cough and Cold - Guaifenesin DM, Mucinex DM
Fever - Acetaminophen, Ibuprofen
Migraine - Ibuprofen, Excedrin
Pain and Inflammation - Ibuprofen, Naproxen
Stomach Reflux - Ranitidine, Omeprazole

9. Who should you consult for advice about whether an over the counter drug is
appropriate for you?
You can ask your physician and/or pharmacist if an over the counter drug is appropriate
for you. Your physician and/or pharmacist will help you select an over the counter drug
that is adequate to treat your condition and symptoms.
Always remember that in order to obtain coverage for over the counter drugs, you
should ask your physician for a prescription, so that the pharmacy will electronically
process the over the counter medication through their pharmacy payment system.

TABLE OF CONTENTS
Antacids............................................................................................................ 5
Cough Suppresant............................................................................................ 5
Cough / Cold / Allergy Combinations ................................................................ 5
Corn / Callus Remover ..................................................................................... 6
Diarrhea............................................................................................................ 6
Expectorants..................................................................................................... 6
Gas Relief......................................................................................................... 6
Hemorrhoids ..................................................................................................... 6
Lactose Intolerance .......................................................................................... 6
Laxatives .......................................................................................................... 6
Migraine............................................................................................................ 7
Nasal Allergy Agents ........................................................................................ 7
Nasal Decongestant ......................................................................................... 7
Nausea ............................................................................................................. 7
Ophtalmic Agents ............................................................................................. 7
Otic Agents ....................................................................................................... 7
Pain and Fever ................................................................................................. 7
Pain and Inflammation ...................................................................................... 8
Proteins ............................................................................................................ 8
Scabicides ........................................................................................................ 8
Topical Analgesics............................................................................................ 8
Topical Antibiotics............................................................................................. 8
Topical Antifungal ............................................................................................. 8
Topical Anti-histamines..................................................................................... 9
Topical Anti-Inflammatory ................................................................................. 9
Urinary Analgesics............................................................................................ 9
Vitamins and Minerals ...................................................................................... 9
INDEX............................................................................................................. 10

Antacids
Axid AR
Gaviscon chew tab & liquid
Gaviscon Extra Strength
Maalox
Mylanta
Pepcid
Pepcid AC
Prevacid 24hr OTC
Prilosec OTC
Rolaid
Tagamet
Tums
Zantac
Zegerid OTC

Cough Suppresant
Delsym
Pediacare
Robitussin
Triaminic
Tussin

Cough / Cold / Allergy Combinations

Advil Cold & Sinus
Advil Multi-Symptom
Alavert Allergy & Sinus
Aleve Cold and Sinus
All-Nite Cold Formula
Benadryl-D Allergy & Sinus
Claritin-D
Coricidin HBP Chest Congestion
Day-Time Cold / Flu Relief
Diabetic Tussin Cold/Flu
Guaifenesin-DM
Iophen DM-NR
Iophen-NR
Mucinex-DM
Robitussin-DM, Robitussin Cough & Cold
Tussin-DM
Tylenol Cold Relief, Tylenol Cold Multi-Symptom
Note: All over the counter drugs included in this guide are also covered in their generic
5
version.

Vicks Formula 44
Vicks Nyquil Multi-Symptoms
Zyrtec-D

Corn / Callus Remover

Corn & Callus remover
Salicylic Acid Solution

Diarrhea
Imodium AD
Kaopectate
Pepto-Bismol

Expectorants
Diabetic Tussin Ex
Mucinex
Robitussin Chest Congestion
Vicks

Gas Relief
Beano
Gas-X
Mylanta Gas
Mylicon
Phazyme
Simethicone

Hemorrhoids
Anusol
Preparation H
Tucks

Lactose Intolerance
Lactaid

Laxatives
Benefiber
Bisacodyl
Citrucel
Colace
Fiber Choice
Note: All over the counter drugs included in this guide are also covered in their generic
6
version.

Metamucil
Senokot
Surfak

Migraine
Advil Migraine
Excedrin Migraine
Motrin Migraine

Nasal Allergy Agents

Alavert
Benadryl
Claritin
Chlor-trimetron
Nasalcrom
Zyrtec

Nasal Decongestant
Afrin
Neo-Synephrine
Pseudoephedrine

Sudafed

Nausea
Emetrol

Ophtalmic Agents
Artificial tears
Genteal
Lacri-lube
Murine
Naphcon
Opcon
Visine

Otic Agents
Auro-Dri
Debrox
Ear Dry
Murine Ear Drops

Pain and Fever

Note: All over the counter drugs included in this guide are also covered in their generic
7
version.

Aspirin
Tylenol (Acetaminophen)

Pain and Inflammation

Advil
Aleve
Aspirin
Ibuprofen
Motrin
Naproxen

Proteins
Pre-Protein
Proteinex

Scabicides
Permethrine

Topical Analgesics
Benzocaine
Capsaicin
Dermoplast
Lanacane

Topical Antibiotics
Bacitracin
Neosporin
Polysporin
Triple Antibiotic

Topical Antifungal
Clotrimazole
Desenex
Lamisil
Lotrimin
Micatin
Myco-Nail
Nizoral
Tinactin

Note: All over the counter drugs included in this guide are also covered in their generic
8
version.

Topical Anti-histamines
Anti-Itch
Benadryl

Topical Anti-Inflammatory
Cortizone-10
Hydrocortisone
Lanacort 10

Urinary Analgesics
Azo Tabs
Phenazopyridine

Vitamins and Minerals

B-Complex
Bioflavonoids
Biotin
Caltrate
Centrum
Electrolytes
Folic Acid
Iron
Magnesium
Niacin
One-A-Day
Potassium
Vasoflex
Vitamin A
Vitamin B
Vitamin C
Vitamin D
Vitamin E
Vitamin K
Zinc

Note: All over the counter drugs included in this guide are also covered in their generic
9
version.

INDEX
Advil ................................................................................................................................ 8
Advil Cold & Sinus........................................................................................................... 5
Advil Migraine.................................................................................................................. 7
Advil Multi-Symptom ....................................................................................................... 5
Afrin................................................................................................................................. 7
Alavert ............................................................................................................................. 7
Alavert Allergy & Sinus.................................................................................................... 5
Aleve ............................................................................................................................... 8
Aleve Cold and Sinus...................................................................................................... 5
All-Nite Cold Formula ...................................................................................................... 5
Anti-Itch ........................................................................................................................... 9
Anusol ............................................................................................................................. 6
Artificial tears................................................................................................................... 7
Aspirin ............................................................................................................................. 8
Auro-Dri........................................................................................................................... 7
Axid AR ........................................................................................................................... 5
Azo Tabs ......................................................................................................................... 9
Bacitracin ........................................................................................................................ 8
B-Complex ...................................................................................................................... 9
Beano.............................................................................................................................. 6
Benadryl ...................................................................................................................... 7, 9
Benadryl-D Allergy & Sinus ............................................................................................. 5
Benefiber......................................................................................................................... 6
Benzocaine ..................................................................................................................... 8
Bioflavonoids................................................................................................................... 9
Biotin ............................................................................................................................... 9
Bisacodyl......................................................................................................................... 6
Caltrate............................................................................................................................ 9
Capsaicin ........................................................................................................................ 8
Centrum .......................................................................................................................... 9
Chlor-trimetron ................................................................................................................ 7
Citrucel ............................................................................................................................ 6
Claritin ............................................................................................................................. 7
Claritin-D ......................................................................................................................... 5
Clotrimazole .................................................................................................................... 8
Colace ............................................................................................................................. 6
Coricidin HBP Chest Congestion .................................................................................... 5
Corn & Callus remover.................................................................................................... 6
Cortizone-10.................................................................................................................... 9
Day-Time Cold/Flu Relief ................................................................................................ 5
Debrox............................................................................................................................. 7
Delsym ............................................................................................................................ 5
Dermoplast...................................................................................................................... 8
Note: All over the counter drugs included in this guide are also covered in their generic
10
version.

Desenex .......................................................................................................................... 8
Diabetic Tussin Cold/Flu ................................................................................................. 5
Diabetic Tussin Ex .......................................................................................................... 6
Ear Dry ............................................................................................................................ 7
Electrolytes...................................................................................................................... 9
Emetrol............................................................................................................................ 7
Excedrin Migraine ........................................................................................................... 7
Fiber Choice.................................................................................................................... 6
Folic Acid......................................................................................................................... 9
Gas-X .............................................................................................................................. 6
Gaviscon chew tab & liquid ............................................................................................. 5
Gaviscon Extra Strength ................................................................................................. 5
Genteal............................................................................................................................ 7
Guaifenesin-DM .............................................................................................................. 5
Hydrocortisone ................................................................................................................ 9
Ibuprofen ......................................................................................................................... 8
Imodium AD .................................................................................................................... 6
Iophen DM-NR ................................................................................................................ 5
Iophen-NR....................................................................................................................... 5
Iron.................................................................................................................................. 9
Kaopectate ...................................................................................................................... 6
Lacri-lube ........................................................................................................................ 7
Lactaid............................................................................................................................. 6
Lamisil............................................................................................................................. 8
Lanacane ........................................................................................................................ 8
Lanacort 10 ..................................................................................................................... 9
Lotrimin ........................................................................................................................... 8
Maalox............................................................................................................................. 5
Magnesium...................................................................................................................... 9
Metamucil........................................................................................................................ 7
Micatin............................................................................................................................. 8
Motrin .............................................................................................................................. 8
Motrin Migraine ............................................................................................................... 7
Mucinex........................................................................................................................... 6
Mucinex-DM .................................................................................................................... 5
Murine ............................................................................................................................. 7
Murine Ear Drops ............................................................................................................ 7
Myco-Nail ........................................................................................................................ 8
Mylanta............................................................................................................................ 5
Mylanta Gas .................................................................................................................... 6
Mylicon ............................................................................................................................ 6
Naphcon.......................................................................................................................... 7
Naproxen......................................................................................................................... 8
Nasalcrom ....................................................................................................................... 7
Neosporin........................................................................................................................ 8
Neo-Synephrine .............................................................................................................. 7
Note: All over the counter drugs included in this guide are also covered in their generic
11
version.

Niacin .............................................................................................................................. 9
Nizoral ............................................................................................................................. 8
One-A-Day ...................................................................................................................... 9
Opcon ............................................................................................................................. 7
Pediacare ........................................................................................................................ 5
Pepcid ............................................................................................................................. 5
Pepcid AC ....................................................................................................................... 5
Pepto-Bismol................................................................................................................... 6
Permethrine..................................................................................................................... 8
Phazyme ......................................................................................................................... 6
Phenazopyridine ............................................................................................................. 9
Polysporin ....................................................................................................................... 8
Potassium ....................................................................................................................... 9
Preparation H .................................................................................................................. 6
Pre-Protein ...................................................................................................................... 8
Prevacid 24hr OTC ......................................................................................................... 5
Prilosec OTC................................................................................................................... 5
Proteinex ......................................................................................................................... 8
Pseudoephedrine ............................................................................................................ 7
Robitussin ....................................................................................................................... 5
Robitussin Chest Congestion .......................................................................................... 6
Robitussin-DM, Robitussin Cough & Cold....................................................................... 5
Rolaid .............................................................................................................................. 5
Salicylic Acid Solution ..................................................................................................... 6
Senokot ........................................................................................................................... 7
Simethicone .................................................................................................................... 6
Sudafed........................................................................................................................... 7
Surfak.............................................................................................................................. 7
Tagamet .......................................................................................................................... 5
Tinactin............................................................................................................................ 8
Triaminic.......................................................................................................................... 5
Triple Antibiotic................................................................................................................ 8
Tucks .............................................................................................................................. 6
Tums ............................................................................................................................... 5
Tussin ............................................................................................................................. 5
Tussin-DM....................................................................................................................... 5
Tylenol (Acetaminophen) ................................................................................................ 8
Tylenol Cold Relief, Tylenol Cold Multi-Symptom ........................................................... 5
Vasoflex .......................................................................................................................... 9
Vicks ............................................................................................................................... 6
Vicks Formula 44 ............................................................................................................ 6
Vicks Nyquil Multi-Symptoms .......................................................................................... 6
Visine .............................................................................................................................. 7
Vitamin A......................................................................................................................... 9
Vitamin B......................................................................................................................... 9
Vitamin C......................................................................................................................... 9
Note: All over the counter drugs included in this guide are also covered in their generic
12
version.

Vitamin D......................................................................................................................... 9
Vitamin E......................................................................................................................... 9
Vitamin K......................................................................................................................... 9
Zantac ............................................................................................................................. 5
Zegerid OTC ................................................................................................................... 5
Zinc ................................................................................................................................. 9
Zyrtec .............................................................................................................................. 7
Zyrtec-D .......................................................................................................................... 6

Note: All over the counter drugs included in this guide are also covered in their generic
13
version.