Plan W Non-Drug OTC Benefits
When entering claims for non-drug, over-the-counter (OTC) products for Plan W beneficiaries, use the appropriate PIN below.
General supplies
PRODUCT |
PIN |
Alcohol wipes/pads |
11120001 |
Needle/syringe for non-diabetic use |
11200016 |
Adhesive wipes |
11200021 |
Diabetic supplies
PRODUCT |
PIN |
Blood ketone strips |
11120002 |
Urine ketone strips |
11120003 |
Lancets for diabetic use |
11120004 |
Inhaler spacers
PRODUCT |
PIN |
Spacer device AeroChamber® type |
11200005 |
Spacer device AeroChamber® type/mask |
11200006 |
Spacer device AeroChamber® child |
11200007 |
Spacer device compact space type |
11200008 |
Spacer device compact space type/mask |
11200009 |
Spacer device E-Z spacer type |
11200010 |
Spacer device E-Z spacer type/mask |
11200011 |
Spacer device OptiChamber type |
11200012 |
Spacer device OptiChamber type/mask |
11200013 |
Spacer device RespiChamber™ type |
11200014 |
Spacer device exceptional |
11200015 |
Intrauterine devices (IUDs)
PRODUCT |
PIN |
FLEXI-T 300 IUD |
66127954 |
FLEXI-T +300 IUD |
66128087 |
FLEXI-T +380 IUD |
66128088 |
LIBERTE UT380 short |
66128089 |
LIBERTE UT380 standard |
66128090 |
LIBERTE TT380 short |
66128091 |
LIBERTE TT380 standard |
66128092 |
MONA LISA 10 |
66128153 |
MONA LISA 5 |
66128154 |
MONA LISA N |
TBD |
IUD exceptional |
11200017 |