Answer:

AETNA BETTER HEALTH®

Over the counter (OTC) product list

ALL OTC PRODUCTS REQUIRE A PRESCRIPTION

NOTE: CERTAIN PRODUCTS ON THIS LIST MAY HAVE QUANTITY LIMITS (QLL), STEP THERAPY, OR PRIOR

AUTHORIZATION REQUIREMENTS. THESE REQUIREMENTS ARE PROVIDED NEXT TO THE COVERED PRODUCT.

1

COVERED OTC DRUG REFERENCE DRUG NAME REQUIREMENTS/LIMITS

TOPICAL ANTIBACTERIAL/ANTIFUNAL OTC DRUGS

OTC bacitracin topical ointment

OTC clotrimazole (vaginal use) Mycelex

OTC clotrimazole (topical use) Lotrimin

OTC miconazole 2% ointment

OTC miconazole vaginal suppositories, cream

OTC triple antibiotic cream Neosporin

PAIN RELIEVER OTC DRUGS

OTC acetaminophen tablets, capsules,

suppositories, liquids, drops

Tylenol QLL= up to 4 grams APAP/day

OTC EC aspirin 81 mg, 325 mg,

OTC aspirin 325 mg

Ecotrin

OTC ibuprofen Motrin

OTC naproxen Aleve

SMOKING CESSATION OTC DRUGS

OTC nicotine patch Nicoderm Duration for all formulary smoking

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Explanation: