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