| Document Date: 2015-03-05 07:55:30
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Company Drug Name Quantity Limits Miscellaneous Supplies / Ocean Spray / / Facility pharmacy PDL / / IndustryTerm nebulizer solutions / herbal products / growth products / assist device / / MedicalCondition rash ointment / Gestational diabetes / wart / Cystic Fibrosis / Tavist Allergy / pain / / Person Simethicone Drops (Mylicon) / S.Thermop / Strength (Tylenol) Aspirin Excedrin Migraine Ibuprofen (Motrin) / Glycerin Levonorgestrel Permethrin / Gaviscon Ranitidine / Cough / Allergy Artificial Tears Cetirizine / Diphenhydramine (Benadryl) Chlorpheniramine / Cold / Ibuprofen (Motrin) Naproxen / Ammonium Lactate / Chlorhexidine Gluconate / Miconazole Nitrate / / / Position Advocate / / Product Zantac / Miconazole Nitrate / Mucinex / Loratadine / Acetaminophen / Benadryl / Ranitidine / Zyrtec / Imodium A-D / Lotrimin AF / Sodium Chloride / Mucinex DM / Clotrimazole / Prevacid / Niacin / Clemastine Fumarate / Mucinex D / Monistat / Tylenol / Polyethylene Glycol / Mycelex / Sudafed 12 Hour / Sodium Bicarbonate / Claritin-D / Abreva / Vitamin D / Naphcon-A / Gyne-Lotrimin / Alaway / Aleve / Zegerid / Permethrin / Dimetapp / Cimetidine / Motrin / Omeprazole / Naproxen / Lamisil AT / Triple / Nix / Bacitracin / Levonorgestrel / Excedrin / Gaviscon / Tagamet HB / Periogard / Alavert / Ibuprofen / Prilosec OTC / folic acid / Famotidine / Chlorhexidine Gluconate / Miralax / Benylin / Tavist / Lansoprazole / Ketoconazole / Neosporin / Nizoral A-D / Pepcid AC / Ammonium Lactate / Vitamin A / Polysporin / Claritin / Hydrocortisone / Ketotifen / Zaditor / Nicotine / / URL http /
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Over-the-Counter Drug List This list includes some of the over-the-counter drugs covered by Passport Health Plan. To get these covered, you must have a prescription from your doctor. NOTE: