OTC Order Forms
OTC drugs are non-prescription drugs that are not normally covered by a Medicare Prescription Drug Plan. HealthSun pays for certain OTC drugs. The plan will provide these OTC drugs at no cost to you. The cost to the plan of these OTC drugs will not count toward your total Part D drug costs (that is, the amount you pay does not count towards the coverage gap.)
- 2023 OTC Order Form - Plan 001 HealthAdvantage (HMO)
- 2023 OTC Order Form - Plan 006 MediMax (HMO)
- 2023 OTC Order Form - Plan 012 HealthAdvantage (HMO)
- 2023 OTC Order Form - Plan 013 HealthAdvantage (HMO)
- 2023 OTC Order Form - Plan 016 MediSun Plus (HMO D-SNP)
- 2023 OTC Order Form - Plan 017 HealthAdvantage Plus (HMO)
- 2023 OTC Order Form - Plan 018 HealthAdvantage Plus (HMO)
- 2023 OTC Order Form - Plan 019 MediSun Extra (HMO D-SNP)
- 2023 OTC Order Form - Plan 020 HealthAdvantage Plus (HMO)