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Humana Medicaid OTC Order Form This benefit gives your household up to 25 a month of over-the-counter products. This product list is subject to change. This program is available only to Humana Medicaid members who have a plan which includes this over-the-counter offering. OTC-Form 01/01/15 The benefit information provided is a brief summary not a complete description of benefits. Phone 1-800-526-1490 Fax 1-888-778-8384 MEMBER S INFORMATION Informaci n del Name Humana ID Address City Sex M F...

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