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 |
