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

 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