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 |
