Bravo CarePack Over the Counter by MikeJenny

VIEWS: 602 PAGES: 16

Bravo CarePack Over the Counter

More Info
									               Bravo CarePack
               2011
               A Catalogue for Over-the-Counter
               Medications and Products Offered
               Through the Bravo CarePack Benefit




11_MA_OTC_BH
                           Bravo CarePack


              Begin ordering                                        1        Check your Bravo Health
              Bravo CarePack                                                 enrollment materials,
                                                                             such as a sales brochure or Evidence
              medications and                                                of Coverage, to determine your
              products today!                                                monthly Bravo CarePack allowance.


                                                                    2        Choose from the covered list
                                                                             of Bravo CarePack medications
                                                                             and products in this catalog.


                                                                    3        Call Bravo Health
                                                                             Member Services
                                                                             at 1-866-442-7498
                                                                             to place your order. Please call
                                                                             TTY 711 for the hearing impaired.
                                                                             You can call this number seven
                                                                             days a week, 8 am – 8 pm.


                                                                    4        Verify your mailing address
                                                                             so that we can make sure your
                                                                             over-the-counter items get to you!




Bravo Health plans are offered by subsidiaries of Bravo Health, Inc. A Medicare Advantage Organization with a Medicare
contract. If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three
months for it take effect and you will ultimately be held responsible for those premiums. You must continue to pay your
Medicare Part B premium, even if your plan premium is $ 0. Medicare beneficiaries may enroll in Bravo Health through the
Centers for Medicare & Medicaid Services Online Enrollment Center, located at www.medicare.gov or call 1-800-MEDICARE
(1-800-633-4227), 24 hours a day/7 days a week. TTY/TDD users should call 1-800-325-0778. For more information, contact
Bravo Health Member Services at 1-800-291-0396 (TTY 711), seven days a week from 8 am to 8 pm.
Y0015_11_0017 CMS Approved 09112010_FINAL_1
                                                                bravo health
                                                                       live life well.



Bravo CarePack
Covered over-the-counter (OTC) medications
and health-related products delivered to
your door…without a delivery charge!

Available only through Bravo Health’s Medicare
Advantage plans, Bravo CarePack provides members with            Get a
a monthly allowance to order common, over-the-counter
medications and products up to twelve times per year.            monthly
                                                                 allowance
This monthly benefit includes over-the-counter                   to order
medications and products such as aspirin, acetaminophen,
vitamins, and more. Your monthly Bravo CarePack value            over-the-
depends on which Bravo Health plan you choose. Unused            counter
balances are nontransferable from month to month.
                                                                 items up to
Check your Bravo Health plan Evidence of Coverage or             twelve times
sales brochure to determine what your specific monthly           per year.
allowance will be. The total cost of items you select must be
less than or equal to your monthly allowance in order for
the items to be shipped. Please allow two weeks for delivery.




    OTC items may only be ordered for the plan
    enrollee. Bravo Health prohibits the purchase of
    OTC items for family members and friends.




                                                                                    3
Brand Equivalent Index Please use the index below for ease in locating preferred OTC items.

    Brand         Catalogue                            Brand        Catalogue
    Equivalent    Item                          Page   Equivalent   Item                         Page
    Abreva        Abreva                         10    Citrucel     Methylcellulose 480 gm         9
    Ace           Ankle Support                  11    Claritin-D   Loratadine-D 24 Hr (10 Tabs)   7
    Ace           Elastic Bandage 2 in x 5 yd    11    Claritin-D   Loratadine-D 24 Hr (15 Tabs)   7
    Ace           Elastic Bandage 3 in x 5 yd    11    Clear Care   Cleaning & Soaking Solution   10
    Ace           Elastic Bandage 4 in x 5 yd    12    Colace       Docusate Sodium 100 mg         8
    Ace           Elastic Bandage 6 in x 5 yd    12    Commit       Nicotine Lozenges 4 mg        13
    Acne Clear    Acne Gel 10%                    7    Compound     Wart Remover                  14
                  Benzoyl Peroxide                     W
    Advil         Ibuprofen 200 mg                7    Coppertone   Sunscreen Lotion SPF 15         13
    Afrin         Nasal Decongestant Spray        7    Coppertone   Sunscreen Lotion SPF 30         14
    Aleve         Naproxen 220 mg                 8    Cortaid      Hydrocortisone 1% Cream         10
    Alka-Seltzer Cold Head Congestion            10    Cortaid      Hydrocortisone Acetate          10
    AmLactin      Ammonium Lactate               13    CosaminDS    Glucosamine/Chondrointin        8
                                                                    250-200 mg
    Anbesol       Oral Pain Relief 1/2 oz        11
                                                       Curad        Alcohol Pads                    11
    Bacitracin    Bacitracin Ointment            14
                                                       Dramamine    Dimenhydrinate 50 mg            12
    Band-Aid      Generic Sheer Assorted         12
                                                       Dramamine    Dramamine Orange                12
    Bayer         Aspirin 325 mg                  7
                                                       Ecotrin      Aspir-Low 81 mg 120 Tablets      8
    BD            Digital Oral Thermometer       11
                                                       Ecotrin      Aspirin 325 mg Enteric Coated    7
    Benadryl      Banophen                       12
                  (Diphenhydramine)                    Efferdent    Denture Cleaning Tabs           11
                  25 mg 24 Caps                        Excedrin     Migraine Relief                 12
    Benadryl      Diphenhist 25 mg               7     Feosol       Ferrous Sulfate 325 mg          6
    Benadryl      Diphenhydramine HCL/           9     Fergon       Ferrous Gluconate 240 mg        6
                  Zinc 2% Topical
                                                       Fibercon     Polycarbophil 50 mg             9
    Bonine        Meclizine 12.5 mg              12
                                                       Fixodent     Fixodent                        11
    Braun         Digital Ear Thermometer        12
                                                       Fleet        Glycerin Suppository            9
    Breathe Right Nasal Strips Med/Lg            13
                                                       Fruit of     Aloe Vera Cream                 13
    Breathe Right Nasal Strips Sm/Med            13    the Earth
    Caltrate      Calcium Carbonate 600 mg       6     Gyne-        Clotrimazole Vaginal            8
    Caltrate      Calcium-Vitamin D              6     Lotrimin     Cream w/ Applicator
                  600 mg/400 u                         Hemocyte     Ferrous Fumarate 90 mg           6
    Capzasin-HP Capsaicin 2 oz                   13    Herpecin-L   Herpecin-L Lip Balm             10
    Centrum       Daily Multiple Vitamin         6     Hold DM      Sore Throat Lozenges            10
    Chlor-        Chlorpheniramine 4 mg          7     Hydrogen     Hydrogen Peroxide               12
    Trimeton                                           Peroxide

4
            To place your Bravo CarePack order, call 1-866-442-7498 (TTY 711).
            You can call this number seven days a week, 8 am – 8 pm.



Brand           Catalogue                              Brand          Catalogue
Equivalent      Item                            Page   Equivalent     Item                         Page
Icy Hot         Cold/Hot Packs for Injuries      11    Preparation    Hemorrhoid Cream              12
                                                       H
Imodium         Lopermide HCL 2 mg                9
A-D                                                    Prilosec OTC   Omeprazole 20 mg               8
Lactrase        Lactase                          12    Puralube       PuraLube Ointment             11
Lamisil AT      Terbinefine HCL                  9     Purell         Hand Sanitizer                12
Liquitears      LiquiTears (Artificial Tears)    11    Releev         Releev Cold Sore Treatment    10
Lotrimin AF     Clotrim Antifungal 1%            9     Rid            Pyrethrin Shampoo             13
Maalox          Mintox                           8     Robitussin     Guaifenesin Cough             10
                                                                      Suppressant 200 mg
Mag-Ox 400      Magnesium Oxide 250 mg           6
                                                       Robitussin     Guaifenesin Syrup             10
Metamucil       Natural Vegetable Laxative       9
                                                       Robitussin     Robitussin Cough Gels         10
Monistat 1      Tioconazole 1                    8
                                                       Senokot        Senna Plus                     9
Monistat 3      Miconazole 3                     8
                                                       Slo-Niacin     Niacin 100 mg                  6
Murine          Ear Drops                        11
                                                       Sudafed        Sudogest 30 mg                 9
Murine          Ear Wax Removal System           11    Sudafed PE     Sudogest PE 10 mg              7
Mylanta         Mylanta Ultimate Strength        8     Tinactin       Tolnaftate                     9
NasalCrom   Cromolyn Sodium                       7    Tucks          Tucks                         12
Neosporin   Triple Antibiotic Ointment           14    Tums           Chewable Antacids              8
Nicoderm CQ Nicotine Patch Step                  13    Tylenol        Acetaminophen 220 mg           7
            1 21 mg/24 hr
                                                       Tylenol        Acetaminophen 650 mg           8
Nicoderm CQ Nicotine Patch Step                  13
            2 14 mg/24 hr                              Unisom         Restfully Sleep               13
Nicoderm CQ Nicotine Patch Step                  13    Vicks®         All-Nite Cold/Flu             10
            3 7 mg/24 hr                               NyQuil
Nicorette   Nicorelief Gum 4 mg                  13    Vitamin B      Vitamin B Complex             6
                                                       Complex
Nix         Permethrin Cream Rinse               13
                                                       Vitamin        Vitamin B-1 100 mg            6
Ocean       Nasal Saline Spray                   10    B-1 100
Opti-clear  Eye Drops                            11    Vitamin B-12   Vitamin B-12 1000 mcg         6
Orajel      Orajel Cold Sore Ointment            10    Vitamin        Vitamin B-6 50 mg             6
Palmitate-A     Vitamin A 10 mu                  6     B-6 50 mg
5000                                                   Vitamin C      Vitamin C 500 mg              6
Pepcid          Famotidine 20 mg                 8     Vitamin D      Vitamin D 400 iu 100          6
Pepto Bismol    Bismatrol                        8     Vitamin E      Vitamin E 400 iu              6
Pepto-Bismol Pink Bismuth                        9     Zyrtec         All Day Allergy Tabs 10 mg    7
Phillips’       Milk of Magnesia                 9     Zyrtec-D       Allergy-D PSE/Cetizine        9

                                                                                                          5
Bravo CarePack Medications and Products

Dual Purpose Items
Before ordering dual purpose items, you must first discuss the use of these products with your doctor. Your
doctor must then orally recommend the dual purpose item(s) for a specific diagnosable condition.


    Category   Product                    Item # Brand Equivalent/Description                                   Cost
    Minerals   Calcium Carbonate          1291   Compare to Caltrate® 600, 600 mg tablets,                      $
                                                                                                                 7.00
               600 mg                            60 per bottle; A registered trademark
                                                 of Wyeth Consumer Healthcare
               Calcium-Vitamin D          1373      Compare to Caltrate®, 600 + D Calcium Supplement,           $
                                                                                                                 7.00
               600 mg/400 u                         600 mg tablets, 60 per bottle; A registered
                                                    trademark of Wyeth Consumer Healthcare
               Ferrous Fumarate           1374      Compare to Hemocyte®, 90 mg tablets,                        $
                                                                                                                 7.00
               90 mg                                100 per bottle; A registered trademark of
                                                    U.S. Pharmaceutical Corporation
               Ferrous Gluconate      1375          Compare to Fergon®, 240 mg tablets, 100 per bottle;         $
                                                                                                                 7.00
               240 mg                               A registered trademark of Bayer Consumer Care Products
               Ferrous Sulfate 325 mg 1376          Compare to Feosol®, 325 mg tablets, 100 per bottle;         $
                                                                                                                 6.00
                                                    A registered trademark of SmithKline Beecham Corporation
               Magnesium                  1377      Compare to Mag-Ox 400®, 250 mg tablets, 100 per             $
                                                                                                                 7.00
               Oxide 250 mg                         bottle; A registered trademark of Blaine Pharmaceuticals
               Niacin 100 mg              1378      Compare to Slo-Niacin®, 100 mg tablets, 100 per bottle;     $
                                                                                                                    7.00
                                                    A registered trademark of Upsher-Smith Laboratories, Inc.

    Vitamins   Daily Multiple             1385      Compare to Centrum®, 100 tablets per bottle;                $
                                                                                                                    7.00
               Vitamin                              A registered trademark of Wyeth Consumer Healthcare
               Vitamin A 10 mu            1379      Compare to Palmitate-A 5000®, 100 capsules                  $
                                                                                                                    7.00
                                                    per bottle; A registered trademark of Akorn, Inc.
               Vitamin B Complex          1382      Vitamin B Complex, 100 tablets per bottle                   $
                                                                                                                    7.00

               Vitamin B-1 100 mg         1016      Vitamin B-1 100 mg tablets, 100 per bottle                  $
                                                                                                                    7.00

               Vitamin B-12               1381      Vitamin B-12, 100 tablets per bottle                        $
                                                                                                                    7.00
               1000 mcg
               Vitamin B-6 50 mg          1380      Vitamin B-6 50 mg tablets, 100 per bottle                   $
                                                                                                                    7.00

               Vitamin C 500 mg           1017      Vitamin C, 100 tablets per bottle                           $
                                                                                                                    7.00

               Vitamin D 400 iu 100       1383      Vitamin D, 100 tablets per bottle                           $
                                                                                                                    7.00

               Vitamin E 400 iu           1384      Vitamin E, 100 tablets per bottle                           $
                                                                                                                    7.00


6
            To place your Bravo CarePack order, call 1-866-442-7498 (TTY 711).
            You can call this number seven days a week, 8 am – 8 pm.


Eligible Items
Consultation with your doctor is not needed to order the following items.




 Category               Product                     Item # Brand Equivalent/Description                        Cost
 Acne Treatment         Acne Gel 10%                1076   Compare to Acne Clear®, 45 gm tube                  $
                                                                                                                7.00
                        Benzoyl Peroxide                   A registered trademark of Johnson &
                                                           Johnson Consumer Companies, Inc.
 Allergy Prevention     All Day Allergy             1090      Compare to Zyrtec®, 10 mg tablets, 14 per box;   $
                                                                                                                   7.00
 and Treatment          Tabs 10 mg                            A registered trademark of McNeil-PPC, Inc.
                        Chlorpheniramine            1008      Compare to Chlor-Trimeton® Allergy, 4 mg         $
                                                                                                                   4.00
                        4 mg                                  tablets, 100 per box; A registered trademark
                                                              of Schering-Plough HealthCare Products, Inc.
                        Diphenhist 25 mg            1308      Compare to Benadryl®, 25 mg tablets, 100         $
                                                                                                                   10.00
                                                              per box; A registered trademark of Pfizer
                        Loratadine-D 24             1351      Compare to Claritin-D® 24 Hour, 15               $
                                                                                                                   12.00
                        Hr (15 Tabs)                          tablets per box; A registered trademark of
                                                              Schering-Plough HealthCare Products, Inc.
                        Loratadine-D 24             1083      Compare to Claritin-D® 24 Hour, 10               $
                                                                                                                   10.00
                        Hr (10 Tabs)                          tablets per box; A registered trademark of
                                                              Schering-Plough HealthCare Products, Inc.
                        Nasal Decongestant          1091      Compare to Afrin®, 30 ml spray;                  $
                                                                                                                   5.00
                        Spray                                 A registered trademark of Schering-Plough
                                                              HealthCare Products, Inc.
                        Sudogest PE 10 mg           1352      Compare to Sudafed PE®, 36 tablets per box;      $
                                                                                                                   5.00
                                                              A registered trademark of Johnson & Johnson
                        Cromolyn Sodium             1356      Compare to NasalCrom®, 26 ml per bottle;         $
                                                                                                                   10.00
                                                              A registered trademark of McNeil-PPC, Inc.
 Analgesics/            Acetaminophen               1001      Compare to Tylenol®, 220 mg tablets,             $
                                                                                                                   7.00
 Antipyretics           220 mg                                100 per bottle; A registered
                                                              trademark of McNeil-PPC, Inc.
                        Aspirin 325 mg              1095      Compare to Bayer® Genuine Aspirin,               $
                                                                                                                   5.00
                                                              325 mg tablets, 100 per bottle; A registered
                                                              trademark of Bayer HealthCare LLC
                        Aspirin 325 mg              1096      Compare to Ecotrin® Regular Strength,            $
                                                                                                                   5.00
                        Enteric Coated                        325 mg tablets, 100 per bottle; A registered
                                                              trademark of Bayer HealthCare LLC
                        Ibuprofen 200 mg            1004      Compare to Advil®, 200 mg tablets,               $
                                                                                                                   7.00
                                                              100 per bottle; A registered trademark
                                                              of Wyeth Consumer Healthcare


                                                                                                                           7
Bravo CarePack Medications and Products


    Category              Product                Item # Brand Equivalent/Description                          Cost
    Analgesics/           Naproxen 220 mg        1097   Compare to Aleve®, 220 mg tablets,                    $
                                                                                                               9.00
    Antipyretics                                        100 per bottle; A registered trademark
                                                        of Bayer HealthCare LLC
                          Aspir-Low 81 mg        1002     Compare to Ecotrin®, 81 mg tablets,                 $
                                                                                                                  5.00
                          120 Tablets                     120 per bottle; A registered trademark
                                                          of Bayer HealthCare LLC
    Antacids and          Chewable Antacids      1346     Compare to Tums®, 150 tablets per bottle;           $
                                                                                                                  6.00
    Acid Reducers                                         A registered trademark of SmithKline Beecham

                          Famotidine 20 mg       1108     Compare to Pepcid®, 20 mg tablets,                  $
                                                                                                                  7.00
                                                          30 per box; A registered trademark
                                                          of Merck & Co., Inc.
                          Mintox                 1006     Compare to Maalox® Regular Strength,                $
                                                                                                                  7.00
                                                          12 oz per bottle; A registered trademark
                                                          of William H. Rorer, Inc.
                          Mylanta Ultimate       1353     Compare to Mylanta® Ultimate                        $
                                                                                                                  13.00
                          Strength                        Strength, 355 ml per bottle; A registered
                                                          trademark of The Stuart Company
                          Omeprazole 20 mg       1110     Compare to Prilosec OTC®, 20 mg tablets,            $
                                                                                                                  15.00
                                                          30 per box; A registered trademark of AstraZeneca

    Anti-Arthritic        Acetaminophen          1311     Compare to Tylenol®, 650 mg tablets,                $
                                                                                                                  10.00
                          650 mg                          100 per bottle; A registered
                                                          trademark of McNeil-PPC, Inc.
                          Glucosamine/           1003     Compare to CosaminDS® (500-400),                    $
                                                                                                                  10.00
                          Chondrointin                    250-200 mg capsules, 60 per bottle;
                          250-200 mg                      A registered trademark of Nutramax Laboratories®
    Anticandial (Yeast)   Clotrimazole Vaginal   1115     Compare to Gyne-Lotrimin®, 45 gm per tube;          $
                                                                                                                  7.00
                          Cream w/ Applicator             A registered trademark of Schering-Plough
                                                          HealthCare Products, Inc.
                          Miconazole 3           1117     Compare to Monistat 3®, 1 kit;                      $
                                                                                                                  10.00
                                                          A registered trademark of McNeil-PPC, Inc.

                          Tioconazole 1          1119     Compare to Monistat 1®, 1 tube;                     $
                                                                                                                  15.00
                                                          A registered trademark of McNeil-PPC, Inc.

    Antidiarrheal         Bismatrol              1045     Compare to Pepto-Bismol®,                           $
                                                                                                                  5.00
    and Laxatives                                         30 tablets per box; A registered
                                                          trademark of Proctor & Gamble
                          Docusate Sodium        1126     Compare to Colace®, 100 mg capsules,                $
                                                                                                                  7.00
                          100 mg                          100 per bottle; A registered
                                                          trademark of Purdue Products

8
             To place your Bravo CarePack order, call 1-866-442-7498 (TTY 711).
             You can call this number seven days a week, 8 am – 8 pm.




Category               Product                 Item # Brand Equivalent/Description                    Cost
Antidiarrheal          Glycerin Suppository    1125   Compare to Fleet® Glycerin Suppositories,       $
                                                                                                       7.00
and Laxatives                                         25 suppositories per bottle; A registered
                                                      trademark of C.B. Fleet Co., Inc.
                       Lopermide HCL 2 mg      1133     Compare to Imodium A-D®, 2 mg tablets,        $
                                                                                                          7.00
                                                        6 per box; A registered trademark
                                                        of McNeil-PPC, Inc.
                       Methylcellulose 480 gm 1354      Compare to Citrucel®, 16.9 oz per bottle      $
                                                                                                          15.00
                                                        A registered trademark of GlaxoSmithKline

                       Milk of Magnesia        1011     Compare to Phillips’® Milk of Magnesia,       $
                                                                                                          7.00
                                                        12 oz bottle; A registered trademark
                                                        of Bayer HealthCare LLC
                       Natural Vegetable       1340     Compare to Metamucil®, 13 oz per bottle       $
                                                                                                          7.00
                       Laxative                         A registered trademark of Procter & Gamble

                       Pink Bismuth            1318     Compare to Pepto-Bismol®, 12 oz per bottle;   $
                                                                                                          7.00
                                                        A registered trademark of Procter & Gamble

                       Polycarbophil 50 mg     1012     Compare to Fibercon®, 50 mg tablets,          $
                                                                                                          10.00
                                                        90 per bottle; A registered trademark
                                                        of Whitehall-Robins Healthcare
                       Senna Plus              1130     Compare to Senokot®, 60 tablets per bottle;   $
                                                                                                          7.00
                                                        A registered trademark of Purdue Products

Antifungal             Clotrim Antifungal 1% 1047       Compare to Lotrimin AF®, 28.35 gm per tube;   $
                                                                                                          7.00
                                                        A registered trademark of Schering-Plough
                                                        HealthCare Products, Inc.
                       Terbinefine HCL         1046     Compare to Lamisil AT®, 15 gm per tube;       $
                                                                                                          10.00
                                                        A registered trademark of Novartis
                                                        Consumer Health, Inc.
                       Tolnaftate              1064     Compare to Tinactin®, 15 gm per tube;         $
                                                                                                          7.00
                                                        A registered trademark of Schering-Plough
                                                        HealthCare Products, Inc.
Antihistamines         Allergy-D PSE/          1355     Compare to Zyrtec-D® 12 hr,                   $
                                                                                                          12.00
                       Cetirizine                       12 tablets per box; A registered
                                                        trademark of McNeil-PPC, Inc.
                       Sudogest 30 mg          1087     Compare to Sudafed® Non-Drowsy,               $
                                                                                                          5.00
                                                        30 mg tablets, 24 per box; A registered
                                                        trademark of Johnson & Johnson
Anti-Itch Lotions      Diphenhydramine         1140     Compare to Benadryl® Extra Strength Itch      $
                                                                                                          5.00
and Creams             HCL/Zinc 2% Topical              Stopping, 30 gm per tube;
                                                        A registered trademark of Pfizer

                                                                                                                  9
 Bravo CarePack Medications and Products


 Category            Product                Item # Brand Equivalent/Description                          Cost
 Anti-Itch Lotions   Hydrocortisone         1074   Compare to Cortaid® Maximum Strength                  $
                                                                                                          7.00
 and Creams          1% Cream                      Cream, 30 gm per tube; A registered
                                                   trademark of Johnson & Johnson Corporation
                     Hydrocortisone         1147     Compare to Cortaid® Maximum Strength                $
                                                                                                             7.00
                     Acetate                         Cream, 30 gm per tube; A registered
                                                     trademark of Johnson & Johnson Corporation
 Cold Sore and       Abreva                 1152     Compare to Abreva®, 2 gm per tube;                  $
                                                                                                             22.00
 Fever Blister                                       A registered trademark of GlaxoSmithKline
                     Herpecin-L Lip Balm    1153     Compare to Herpecin-L® Lip Balm,                    $
                                                                                                             8.00
                                                     2.5 gm per tube; A registered
                                                     trademark of Chattem, Inc.
                     Orajel Cold Sore       1154     Compare to Orajel® Cold Sore Ointment,              $
                                                                                                             10.00
                     Ointment                        1.6 gm per tube; A registered trademark
                                                     of Church & Dwight Co., Inc.
                     Releev Cold Sore       1359     Compare to Releev® Cold Sore Treatment,             $
                                                                                                             21.00
                     Treatment                       6 ml per tube; A registered trademark of
                                                     Merix Pharmaceutical Corporation
 Cold,Flu            Cold Head Congestion   1357     Compare to Alka-Seltzer® Plus Cold &                $
                                                                                                             7.00
 Decongestant                                        Cough, 24 tablets per box; A registered
 and Sinus                                           trademark of Bayer HealthCare LLC
                     Nasal Saline Spray     1052     Compare to Ocean® Premium Saline                    $
                                                                                                             5.00
                                                     Nasal Spray, 45 ml spray; A registered
                                                     trademark of Fleming Pharmaceuticals
 Contacts Lens       Cleaning & Soaking     1468     Compare to Clear Care®, 120 ml per bottle;          $
                                                                                                             6.00
 Supplies            Solution                        A registered trademark of Ciba
                                                     Vision Corporation
 Cough               All-Nite Cold/Flu      1361     Compare to Vicks® NyQuil® Cough,                    $
                                                                                                             8.00
 Suppressants or                                     120 ml per bottle; A registered
 Expectorants                                        trademark of Procter & Gamble
                     Guaifenesin Cough      1180     Compare to Robitussin®, 200mg tablets,              $
                                                                                                             7.00
                     Suppressant 200 mg              60 per bottle; A registered trademark of
                                                     American Home Products Corporation
                     Guaifenesin Syrup      1054     Compare to Robitussin®, 120 ml per bottle;          $
                                                                                                             7.00
                                                     A registered trademark of American
                                                     Home Products Corporation
                     Robitussin Cough Gels 1362      Compare to Robitussin® Cough Gels,                  $
                                                                                                             10.00
                                                     20 per box; A registered trademark of
                                                     American Home Products Corporation
                     Sore Throat Lozenges   1360     Compare to Hold DM®, 10 per box;                    $
                                                                                                             7.00
                                                     A registered trademark of B.F. Ascher & Co., Inc.


10
           To place your Bravo CarePack order, call 1-866-442-7498 (TTY 711).
           You can call this number seven days a week, 8 am – 8 pm.




Category             Product               Item # Brand Equivalent/Description                           Cost
Dental /             Denture Cleaning Tabs 1032   Compare to Efferdent® Anti-Bacterial                   $
                                                                                                          7.00
Denture Care                                      Denture Cleanser, 40 tablets per box;
                                                  A registered trademark of Warner-
                                                  Lambert Consumer Healthcare
                     Oral Pain Relief 1/2 oz   1286   Compare to Anbesol®, 1/3 oz;                       $
                                                                                                          7.00
                                                      A registered trademark of American
                                                      Home Products Corporation
                     Fixodent                  1187   Compare to Fixodent, 0.75 oz per tube;             $
                                                                                                          7.00
                                                      A registered trademark of Procter & Gamble
Ear Care             Ear Drop                  1190   Compare to Murine® Ear Drops,                      $
                                                                                                          7.00
                                                      15 ml per bottle; A registered trademark
                                                      of Prestige Brands International, Inc.
                     Ear Wax Removal           1363   Compare to Murine® Ear Wax Removal                 $
                                                                                                          7.00
                     System                           System, 1.5 ml per bottle; A registered
                                                      trademark of Prestige Brands International, Inc.
Eye Care             Eye drops                 1061   Compare to Opti-clear®, 15 ml per tube;            $
                                                                                                          7.00
                                                      A registered trademark of OTC Generics
                     LiquiTears                1192   Compare to Liquitears®, 1.5 ml per bottle;         $
                                                                                                          7.00
                     (Artificial Tears)               A registered trademark of PharmaDerm,
                                                      A Division of Nycomed US. Inc.
                     PuraLube Ointment         1194   Compare to Puralube® Tears, 3.5 gm per tube;       $
                                                                                                          5.00
                                                      A registered trademark of Altana Inc.
First Aid and        Alcohol Pads              1200   Compare to Curad® Alcohol Swabs,                   $
                                                                                                          5.00
Medical Supplies                                      100 per box; A registered
                                                      trademark of Beiersdorf, Inc.
                     Ankle Support             1225   Compare to Ace® Ankle Brace, 1 per pack;           $
                                                                                                          8.00
                                                      A registered trademark of BD
                                                      Consumer Healthcare
                     Cold/Hot Packs            1062   Compare to Icy Hot®, 2 per pack;                   $
                                                                                                          7.00
                     for Injuries                     A registered trademark of Chattem, Inc.
                     Digital Oral              1063   Compare to BD® Digital Thermometer,                $
                                                                                                          7.00
                     Thermometer                      1 per pack; A registered trademark of
                                                      Becton Dickinson and Company
                     Elastic Bandage           1207   Compare to Ace® Elastic Bandage,                   $
                                                                                                          4.00
                     2 in x 5 yd                      1 per pack; A registered trademark
                                                      of BD Consumer Healthcare
                     Elastic Bandage           1209   Compare to Ace® Elastic Bandage,                   $
                                                                                                          5.00
                     3 in x 5 yd                      1 per pack; A registered trademark
                                                      of BD Consumer Healthcare


                                                                                                                 11
 Bravo CarePack Medications and Products


 Category            Product               Item # Brand Equivalent/Description                          Cost
 First Aid and       Elastic Bandage       1211   Compare to Ace® Elastic Bandage,                      $
                                                                                                         5.00
 Medical Supplies    4 in x 5 yd                  1 per pack; A registered trademark
                                                  of BD Consumer Healthcare
                     Elastic Bandage       1213     Compare to Ace® Elastic Bandage,                    $
                                                                                                            7.00
                     6 in x 5 yd                    1 per pack; A registered trademark
                                                    of BD Consumer Healthcare
                     Generic Sheer Assorted 1344    Compare to Band-Aid® Sheer,                         $
                                                                                                            6.00
                                                    Box of 60 per box; A registered
                                                    trademark of McNeil-PPC, Inc.
                     Hydrogen Peroxide     1228     Hydrogen Peroxide, 240 ml                           $
                                                                                                            5.00


                     Digital Ear           1285     Compare to Braun® ThermoScan Compact                $
                                                                                                            30.00
                     Thermometer                    Ear Thermometer, 1 per pack; A registered
                                                    trademark of Procter & Gamble
 Hand Sanitizer      Hand Sanitizer        1065     Compare to Purell®, 8 oz per bottle;                $
                                                                                                            7.00
                                                    A registered trademark of Basell N.V. Corporation
 Hemorrhoidal        Hemorrhoid Cream      1066     Compare to Preparation H® Hemorrhoidal              $
                                                                                                            7.00
 Preparations                                       Cream, 30 gm per tube; A registered
                                                    trademark of Wyeth Consumer Healthcare
                     Tucks                 1364     Compare to Tucks®, 100 per box;                     $
                                                                                                            8.00
                                                    A registered trademark of Warner-Lambert
                                                    Consumer Healthcare
 Lactose Intolerance Lactase               1067     Compare to Lactrase®, 60 per bottle;                $
                                                                                                            8.00
                                                    A registered trademark of
                                                    Kremers-Urban Company
 Migraine Relief     Migraine Relief       1365     Compare to Excedrin® Migraine,                      $
                                                                                                            7.00
                                                    500 mg tablets, 100 per bottle; A registered
                                                    trademark of Bristol-Myers Company
 Motion Sickness     Banophen              1009     Compare to Benadryl®, 100 per pack;                 $
                                                                                                            5.00
                     (Diphenhydramine)              A registered trademark of Pfizer
                     25 mg 24 Caps
                     Dimenhydrinate 50mg   1263     Compare to Dramamine®, 50 mg tablets,               $
                                                                                                            5.00
                                                    12 per pack; A registered trademark
                                                    of G.D. Searle & Co. Corporation
                     Dramamine Orange      1264     Compare to Dramamine®, 8 chewable                   $
                                                                                                            7.00
                                                    tablets per pack; A registered trademark
                                                    of G.D. Searle & Co. Corporation
                     Meclizine 12.5 mg     1366     Compare to Bonine®, 12.5 mg; A                      $
                                                                                                            7.00
                                                    registered trademark of Pfizer


12
             To place your Bravo CarePack order, call 1-866-442-7498 (TTY 711).
             You can call this number seven days a week, 8 am – 8 pm.




Category               Product                 Item # Brand Equivalent/Description                          Cost
Nasal Strips           Nasal Strips Med/Lg     1267   Compare to Breathe Right®, 12 per box;                $
                                                                                                             7.00
                                                      A registered trademark of CNS, Inc.

                       Nasal Strips Sm/Med     1265     Compare to Breathe Right®, 12 per box;              $
                                                                                                                7.00
                                                        A registered trademark of CNS, Inc.

Pediculicide           Permethrin              1269     Compare to Nix®, 59 ml per bottle;                  $
                                                                                                                11.00
                       Cream Rinse                      A registered trademark of Insight
                                                        Pharmaceuticals Corporation
                       Pyrethrin Shampoo       1271     Compare to Rid®, 2 oz per bottle;                   $
                                                                                                                7.00
                                                        A registered trademark of Pfizer

Skin Care              Aloe Vera Cream         1070     Compare to Fruit of the Earth®,                     $
                                                                                                                9.00
                                                        240 ml per tube; A registered trademark
                                                        of Fruit of the Earth, Inc.
                       Ammonium Lactate        1368     Compare to AmLactin®, 240 ml; A registered          $
                                                                                                                9.00
                                                        trademark of Upsher-Smith Laboratories, Inc.

                       Capsaicin 2 oz          1367     Compare to Capzasin-HP®, 2 oz per tube;             $
                                                                                                                7.00
                                                        A registered trademark of Thompson
                                                        Medical Company, Inc.
Sleep Aids             Restfully Sleep         1276     Compare to Unisom® Nighttime Sleep-Aid,             $
                                                                                                                7.00
                                                        24 tabs per box; A registered trademark of Pfizer

Smoking Cessation      Nicorelief Gum 4 mg     1372     Compare to Nicorette®, 50 per box;                  $
                                                                                                                25.00
                                                        A registered trademark of GlaxoSmithKline

                       Nicotine Lozenges 4 mg 1281      Compare to Commit®, 72 per box;                     $
                                                                                                                40.00
                                                        A registered trademark of GlaxoSmithKline

                       Nicotine Patch Step     1369     Compare to Nicoderm® CQ®, 14 per box;               $
                                                                                                                40.00
                       1 21 mg/24 hr                    A registered trademark of Hoechst
                                                        Marion Roussel, Inc.
                       Nicotine Patch Step     1370     Compare to Nicoderm® CQ®, 14 per box;               $
                                                                                                                40.00
                       2 14 mg/24 hr                    A registered trademark of Hoechst
                                                        Marion Roussel, Inc.
                       Nicotine Patch Step     1371     Compare to Nicoderm® CQ®, 14 per box;               $
                                                                                                                40.00
                       3 7 mg/24 hr                     A registered trademark of Hoechst
                                                        Marion Roussel, Inc.
Sunscreen              Sunscreen               1283     Compare to Coppertone®, 4 oz per bottle;            $
                                                                                                                7.00
                       Lotion SPF 15                    A registered trademark of Schering-Plough
                                                        HealthCare Products, Inc.


                                                                                                                        13
 Bravo CarePack Medications and Products


  Category                 Product                       Item # Brand Equivalent/Description                            Cost
  Sunscreen                Sunscreen Lotion              1284   Compare to Coppertone®, 4 oz per bottle;                $
                                                                                                                         7.00
                           SPF 30                               A registered trademark of Schering-Plough
                                                                HealthCare Products, Inc.
  Topical Antibiotics      Bacitracin Ointment           1020      Bacitracin, 30 gm per tube                           $
                                                                                                                            5.00


                           Triple Antibiotic             1014      Compare to Neosporin®, 30 gm per tube;               $
                                                                                                                            7.00
                           Ointment                                A registered trademark of Pfizer
  Wart Removal             Wart Remover                  1075      Compare to Compound W® Wart Remover,                 $
                                                                                                                            7.00
                                                                   15 ml per bottle; A registered trademark
                                                                   of Medtech Products, Inc.




              To place your Bravo CarePack order, call 1-866-442-7498 (TTY 711).
              You can call this number seven days a week, 8 am – 8 pm.



 Please note:
 Each item in this alphabetized list is either a medicine, ointment or spray, or a condition which is addressed by a medicine,
 ointment or spray, which has active medical ingredients: acne, allergy, analgesics (which reduce pain, inflammation),
 anti-acid, anti-arthritics, antibiotics, antiradicals, anti-diarrheas, anti-fungals, anti-gas, anti-histamines, anti-
 inflammatory, anti-insect, anti-itch, anti-parasitic, antiseptics, antipyretics (fever reducing), arthritis, asthma, blood
 clotting, bruises, burns, calluses, corns, colds, cold sores, cough, diabetes, flu, decongestants, dermatitis, eczema, digestive
 aids, ear drops, expectorants (mucus), eye drops, gastro-intestinal, hay fever, headaches, hemorrhoidal, incontinence,
 influenza, laxatives, (medicated) lactose intolerance products, lice, (medicated) lip products, menopausal, menstrual,
 sinus, motion sickness, nasal, osteoporosis, pain, psoriasis, pediculicide, rash, respiratory, scars, sleep, smoking, snoring,
 sore throat, stomach problems, travel sickness, steroids, sunscreen, thrush, wart, worms, wounds.
 The following items are not eligible for purchase through the Bravo CarePack benefit and will not be covered by Bravo
 Health: baby Medicines, dehydration drinks, dry skin lotions (e.g. Eucerin, Aquaphor) contraceptives and dairy care
 products (Lactaid milk) are not considered adult medications and are therefore non-eligible. Certain smoking cessation
 aides and diabetic supplies may be covered under Medicare Part B and/or Part D. Please contact your Bravo Health
 member service representative for more information. Shampoos to fight dandruff and hair-loss products are non-
 eligible, as well as lip balm, deodorants, facial cleansers, feminine products, grooming devices, hair conditioners, hair
 removal, hair bleaches, moisturizers, perfumes, anti-perspirants, shampoos, shaving and men’s grooming, and soaps.
 Translation of this material into another language may be available. For assistance, please call our Member Services
 Department at 1-800-291-0396, seven days a week, 8 am to 8 pm. TTY/TDD 711.
 Es probable que haya traducciones de este material en otro idioma. Para obtener ayuda, llame a nuestro Departamento
 de Servicios a los Miembros al 1-800-291-0396, siete días de la semana, de 8 a.m. a 8 p.m. TTY/TDD 711.

14
My Orders Keep track of your OTC orders below.

  Date                 Items                     Date   Items




                                                                15
www.mybravohealth.com
Call Bravo Health today at 1-866-442-7498.
(TTY 711). You can call this number seven
days a week, 8 am – 8 pm.

								
To top