Drug Benefit List 2010

94:00 DEVICES

94:00.00 DEVICES

HYDROXYPROPYLCELLULOSE

5mg Ophthalmic Insert

889970 LACRISERT LAMELLE * FRS

SPACER DEVICE

Device

99400496 ACE ADAPTORS AUC

99400497 ACE KIT AUC

99400495 ACE MDI SPACER AUC

99400500 ACE SPACER WITH LARGE MASK AUC

99400499 ACE SPACER WITH MEDIUM MASK AUC

99400498 ACE SPACER WITH SMALL MASK AUC

964905 AEROCHAMBER AC BOYZ TRU

964891 AEROCHAMBER AC GIRLZ TRU

96899994 AEROCHAMBER MAX VHC WITH ADULT MASK TRU

96899995 AEROCHAMBER MAX VHC WITH CHILD MASK TRU

96899996 AEROCHAMBER MAX VHC WITH INFANT MASK TRU

96899997 AEROCHAMBER MAX VHC WITH MOUTHPIECE TRU

99400487 AEROCHAMBER PLUS VHC ADULT TRU

99400488 AEROCHAMBER PLUS VHC WITH ADULT MASK TRU

99400490 AEROCHAMBER PLUS VHC WITH INFANT MASK TRU

99400489 AEROCHAMBER PLUS VHC WITH PEDIATRIC MASK TRU

99400507 E-Z SPACER WEP

99400511 E-Z SPACER (MASK ONLY) WEP

99400508 E-Z SPACER WITH SMALL MASK WEP

99400501 OPTICHAMBER AUC

99400504 OPTICHAMBER LARGE MASK AUC

99400503 OPTICHAMBER MEDIUM MASK AUC

99400502 OPTICHAMBER SMALL MASK AUC

99400505 OPTIHALER AUC

99400506 OPTIVENT IN-LINE MDI SPACER AUC

99400787 POCKET CHAMBER MCA

99400791 POCKET CHAMBER WITH ADULT MASK MCA

99400788 POCKET CHAMBER WITH INFANT MASK MCA

99400790 POCKET CHAMBER WITH MEDIUM MASK MCA

99400789 POCKET CHAMBER WITH SMALL MASK MCA

99400512 RONDO INHALATION CHAMBER KIN

99400516 RONDO INHALATION CHAMBER-CHILD MASK KIN

99400515 RONDO INHALATION CHAMBER-INFANT MASK KIN

99400514 RONDO INHALATION CHAMBER-NEONATAL MASK KIN

99400513 RONDO INHALATION CHAMBER-UNIVERSAL MASK KIN

99400517 SPACE CHAMBER AUC

99400521 SPACE CHAMBER ADULT LARGE MASK AUC

99400520 SPACE CHAMBER ADULT REGULAR MASK AUC

99400518 SPACE CHAMBER INFANT MASK AUC

99400519 SPACE CHAMBER PEDIATRIC MASK AUC

99400491 VENT 170 SPACER NDE

99400493 VENT 170 SPACER AND MASK NDE

99400492 VENT 170 SPACER DELUXE NDE

99400494 VENTAHALER GSK

SPACER DEVICE

Kit

99400777 ACE LARGE MASK ACCESSARY KIT AUC

99400776 ACE MEDIUM MASK ACCESSARY KIT AUC

99400775 ACE SMALL MASK ACCESSARY KIT AUC

SYRINGE & NEEDLE (NON-INSULIN)

Syringe & Needle

99400534 NON-INSULIN 1CC

99400536 NON-INSULIN 3CC

99400537 NON-INSULIN 5CC

99400538 NON-INSULIN 10CC

SYRINGE (NON-INSULIN)

Syringe

99400530 LUER LOCK (DISP) 3CC

99400535 LUER LOCK (DISP) 5CC

99400539 LUER LOCK (DISP) 10CC

99400548 LUER LOCK (DISP) 20CC

99400823 LUER LOCK (DISP) 30CC BTD

99400549 LUER LOCK (DISP) 60CC

99400531 NON-INSULIN (DISP) 3CC

99400532 NON-INSULIN (DISP) 5CC

99400533 NON-INSULIN (DISP) 10CC

1 Syringe

99400529 NON-INSULIN (DISP) 1CC

VENTODISK DISKHALER

Device

905739 VENTODISK DISKHALER GSK

94:01.00 DEVICES (DIABETIC)

GLUCOMETER BATTERIES

Device

99401030 BATTERIES - 1.5 VOLT

99401031 BATTERIES - 3 VOLT

99401029 BATTERIES - AAA

99401056 BATTERIES - LITHIUM

99401032 BATTERIES - SIZE J 6V

INSULIN PUMP SUPPLIES

Device

99401049 ADAPTOR AUC

99401052 ADHESIVE PAD WITH COTTON AUC

99401053 ADHESIVE PAD WITHOUT COTTON AUC

99401050 INFUSION SETS AUC

99401038 INSULIN PUMP BATTERY AUC

99401047 INSULIN PUMP CARTRIDGES AUC

99401048 PISTON ROD AUC

9991061 RESERVOIR 5XX 1.8ML SYRINGE MDT

9991062 RESERVOIR 7XX 3.0ML SYRINGE MDT

99401051 TUBING AUC

ISOPROPYL ALCOHOL

70% Swab

480452 ALCOHOL PREP SWAB PFD

2247809 ALCOHOL SWAB TIP

809357 ALCOHOL SWABS BD BTD

2240759 B-D ALCOHOL SWAB BTD

99438102 MONOJECT ALCOHOL WIPES SHM

795232 WEBCOL ALCOHOL PREP JAJ

LANCET

Lancet

97799817 ACCU-CHEK MULTICLIX ROD

99401068 BD LATITUDE BTD

97799541 EZ HEALTH ORACLE LANCETS TRE

900834 FINGERSTIX BAY

995965 FINGERSTIX BAY

977839 FREESTYLE * ABB

99401063 FREESTYLE ABB

97799766 ITEST LANCETS 28G (100) AUC

97799767 ITEST LANCETS 33G (100) AUC

977853 LIFESCAN FINE POINT JAJ

901555 LIFESCAN REGULAR JAJ

906190 MEDISENSE AUC

906239 MICROLET BAY

977493 MICROLET BAY

977543 MONOLET ORIGINAL SHM

99401055 MONOLET THIN SHM

97799810 MPD THIN (100) MPD

97799811 MPD THIN (200) MPD

97799807 MPD ULTRA THIN (100) MPD

97799808 MPD ULTRA THIN (200) MPD

901359 ONE TOUCH ULTRA SOFT JAJ

905917 SOFT TOUCH ROD

977952 SOFT TOUCH ROD

99493957 SOFT TOUCH ROD

165 SOFTCLIX BOE

902144 SOFTCLIX SELECT BOE

977373 SOFTCLIX SELECT BOE

900141 ULTRA-FINE II BTD

977659 ULTRA-FINE II BTD

977051 UNILET COMFORT TOUCH BAY

977896 UNILET COMFORT TOUCH BAY

984167 UNILET COMFORT TOUCH BAY

LANCING DEVICE

Device

99401025 B-D LANCET BTD

99401020 GLUCOLET BAY

99401021 GLUCOLET 2 BAY

99401014 MEDISENSE TLC AUC

99401017 MICROLET BAY

99401015 MONOJECTOR SHM

99401016 PENLET PLUS JAJ

99401022 REGULAR ENDCAPS FOR GLUCOLET BAY

99401018 REGULAR ENDCAPS FOR MICROLET BAY

99401024 SOFTTOUCH ROD

99401023 SUPER ENDCAPS FOR GLUCOLET BAY

99401019 SUPER ENDCAPS FOR MICROLET BAY

MAGNIFIER

Magnifier

99400550 SYRINGE SCALE MAGNIFIER

NEEDLE

Needle

908452 B-D PEN BTD

977756 NOVOFINE NOO

22g Needle

977616 B-D DISPOSABLE 1 INCH 5155 BTD

977624 B-D DISPOSABLE 1½ INCH 5156 BTD

25g Needle

977071 B-D DISPOSABLE 5/8 INCH 5122 BTD

977063 B-D DISPOSABLE 1½ INCH 5127 BTD

27g Needle

977012 B-D DISPOSABLE ½ INCH 5109 BTD

28g Needle

99221028 NOVOFINE INSULIN PEN 28G NOO

29g Needle

977101 B-D ULTRA-FINE PEN BTD

97799897 BD ULTRA-FINE PEN NEEDLE 29G BTD

900513 OWEN MUMFORD UNIFINE PENTIPS 1/2 INCH AUC

97799561 SUPER-FINE STANDARD 29G 12.7MM PMS

908185 ULTRAFINE PEN ULTRA-FINE 29G BTD

29GX12MM Needle

97799543 ULTI 29GX1/2 WITH SHARP CONTAINER UMI

30g Needle

921114 NOVOFINE NOO

908169 NOVOFINE 30G NOO

99117796 NOVOFINE INSULIN PEN 30G NOO

31g Needle

977011 B-D ULTRA-FINE PEN III BTD

900511 OWEN MUMFORD UNIFINE PENTIPS 1/4 INCH AUC

900512 OWEN MUMFORD UNIFINE PENTIPS 5/16 INCH AUC

97799563 SUPER-FINE MICRO 31G 5MM PMS

97799562 SUPER-FINE XTRA 31G 8MM PMS

31GX6MM Needle

97799545 ULTI 31GX1/4 WITH SHARP CONTAINER UMI

31GX8MM Needle

97799544 ULTI 31GX5/16 WITH SHARP CONTAINER UMI

NEEDLE

32g Needle

97799821 NOVOFINE 32G 6MM NOO

NEEDLE (NON-INSULIN)

Needle

99400528 NEEDLES (NON-INSULIN) DISPOSABLE

SHARPS CONTAINER

Device

99401026 B-D SHARPS CONTAINER 1.4L BTD

99401027 B-D SHARPS CONTAINER 3.1L BTD

99401028 B-D SHARPS CONTAINER 3.8L SHM

SYRINGE

0.3cc Syringe

977961 B-D MICRO-FINE BTD

977977 B-D ULTRA-FINE / ULTRA-FINE II BTD

920169 MICRO-FINE BTD

977951 MONOJECT SHM

99254011 MONOJECT DISP 3/10CC (100) SHM

99253047 MONOJECT DISP 3/10CC (30) SHM

920053 SYRN MONOJECT SHM

920193 ULTRA-FINE BTD

0.5cc Syringe

977985 B-D ULTRA-FINE II BTD

920177 MICRO-FINE BTD

920355 MONOJECT SHM

99432799 MONOJECT (100) SHM

99432633 MONOJECT (30) SHM

920207 ULTRA-FINE BTD

1cc Syringe

99328369 B-D ULTRA-FINE BTD

920045 MONOJECT * SHM

99433383 MONOJECT (100) SHM

99432914 MONOJECT (30) SHM

920215 ULTRA-FINE BTD

909238 ULTRA-FINE II 30G BTD

SYRINGE & NEEDLE

0.3cc Syringe and Needle

99328419 B-D INSULIN 1/3CC 29G UF 1 BTD

99639286 B-D MICRO-FINE 1/3CC BTD

909092 SYRN INS U-II 3/10CC 30G BTD

905690 SYRN INSULIN MICRO 3/10CC 28G BTD

906786 SYRN INSULIN ULTRA 3/10CC 29G BTD

97799509 ULTI SYG WITH ULTIGUARD 29G 1/2 UMI

97799551 ULTI SYG WITH ULTIGUARD 30G 1/2 UMI

97799506 ULTI SYG WITH ULTIGUARD 30G 5/16 UMI

97799548 ULTI SYG WITH ULTIGUARD 31G 5/16 UMI

900506 ULTICARE 29G UMI

964018 ULTICARE 29G UMI

900503 ULTICARE 30G UMI

964174 ULTICARE 30G UMI

97799513 ULTICARE 31G SYG 5/16 UMI

97799999 ULTICARE INSULIN SYR 29G.3CC UMI

97799996 ULTICARE INSULIN SYR 30G.3CC UMI

97799908 ULTIGUARD INSULIN SYR 29G.3CC UMI

97799905 ULTIGUARD INSULIN SYR 30G.3CC UMI

0.5cc Syringe and Needle

99328377 B-D INSULIN 50U 29G BTD

99221044 B-D MICRO-FINE INSULIN 50U BTD

983004 INSULIN LO DOSE MICRO 28G BTD

909084 SYRN INSULIN U-II 30G BTD

906727 SYRN INSULIN ULTRA 29G BTD

97799508 ULTI SYG WITH ULTIGUARD 29G 1/2 UMI

97799550 ULTI SYG WITH ULTIGUARD 30G 1/2 UMI

97799505 ULTI SYG WITH ULTIGUARD 30G 5/16 UMI

97799547 ULTI SYG WITH ULTIGUARD 31G 5/16 UMI

97799518 ULTICARE 28G SYG 1/2 UMI

900505 ULTICARE 29G UMI

963941 ULTICARE 29G UMI

900502 ULTICARE 30G UMI

964115 ULTICARE 30G UMI

97799512 ULTICARE 31G SYG 5/16 UMI

97799998 ULTICARE INSULIN SYR 29G.5CC UMI

97799995 ULTICARE INSULIN SYR30G.5CC UMI

97799510 ULTICARE LOW DEAD SPACE SYG UMI

97799907 ULTIGUARD INSULIN SYR 29G.5CC UMI

97799904 ULTIGUARD INSULIN SYR 30G.5CC UMI

SYRINGE & NEEDLE

1cc Syringe and Needle

99262295 B-D INJECT-EASE WITH MICRO-FINE BTD

99767467 B-D MICRO-FINE INSULIN 100U BTD

901911 B-D MICRO-FINE INSULIN 28G BTD

906816 SYRN INSULIN ULTRA 29G BTD

97799507 ULTI SYG WITH ULTIGUARD 29G 1/2 UMI

97799549 ULTI SYG WITH ULTIGUARD 30G 1/2 UMI

97799504 ULTI SYG WITH ULTIGUARD 30G 5/16 UMI

97799546 ULTI SYG WITH ULTIGUARD 31G 5/16 UMI

97799517 ULTICARE 28G SYG 1/2 UMI

900504 ULTICARE 29G UMI

963895 ULTICARE 29G UMI

900501 ULTICARE 30G UMI

964069 ULTICARE 30G UMI

97799511 ULTICARE 31G SYG 5/16 UMI

97799997 ULTICARE INSULIN SYR 29G.1CC UMI

97799994 ULTICARE INSULIN SYR 30G.1CC UMI

97799906 ULTIGUARD INSULIN SYR 29G.1CC UMI

97799903 ULTIGUARD INSULIN SYR 30G.1CC UMI

SYRINGE CASE

Syringe Case

99400552 MYHEALTH SYRINGE CASE-7 AUC

99400551 MYHEALTH SYRINGE CASE-SINGLE AUC