Drug Benefit List 2012

94:00 DEVICES

94:00.00 DEVICES

SPACER DEVICE

Device

96899962 AEROCHAMBER AC BOYZ TRU

96899963 AEROCHAMBER AC GIRLZ TRU

96899969 AEROCHAMBER PLUS FLOW-VU LG TRU

96899970 AEROCHAMBER PLUS FLOW-VU MED TRU

96899968 AEROCHAMBER PLUS FLOW-VU MOUTH TRU

96899971 AEROCHAMBER PLUS FLOW-VU SM 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

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

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

99400823 LUER LOCK (DISP) 30CC BTD

99400549 LUER LOCK (DISP) 60CC

99400529 NON-INSULIN (DISP) 1CC

99400531 NON-INSULIN (DISP) 3CC

99400532 NON-INSULIN (DISP) 5CC

99400533 NON-INSULIN (DISP) 10CC

94:01.00 DEVICES (DIABETIC)

INSULIN PUMP SUPPLIES

Device

99401049 ADAPTOR AUC

99401052 ADHESIVE PAD WITH 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

09991061 RESERVOIR 5XX 1.8ML SYRINGE MDT

09991062 RESERVOIR 7XX 3.0ML SYRINGE MDT

99401051 TUBING AUC

ISOPROPYL ALCOHOL

70% Swab

00480452 ALCOHOL PREP SWAB PFD

02247809 ALCOHOL SWAB TIP

00809357 ALCOHOL SWABS BD BTD

02240759 B-D ALCOHOL SWAB BTD

99438102 MONOJECT ALCOHOL WIPES SHM

00795232 WEBCOL ALCOHOL PREP JAJ

LANCET

Lancet

97799817 ACCU-CHEK MULTICLIX ROD

99401068 BD LATITUDE BTD

97799541 EZ HEALTH ORACLE TRE

00900834 FINGERSTIX BAY

00995965 FINGERSTIX BAY

00977839 FREESTYLE ABB *

99401063 FREESTYLE ABB

97799766 ITEST LANCETS 28G (100) AUC

97799767 ITEST LANCETS 33G (100) AUC

00901555 LIFESCAN REGULAR JAJ

00906190 MEDISENSE AUC

00906239 MICROLET BAY

00977493 MICROLET BAY

00977543 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

00965561 ONE TOUCH DELICA JAJ

00901359 ONE TOUCH ULTRA SOFT JAJ

00905917 SOFT TOUCH ROD

00000165 SOFTCLIX BOE

97799945 SOFTCLIX ROD

00902144 SOFTCLIX SELECT BOE

00977373 SOFTCLIX SELECT BOE

00900141 ULTRA-FINE II BTD

00977659 ULTRA-FINE II BTD

00977051 UNILET COMFORT TOUCH BAY

00977896 UNILET COMFORT TOUCH BAY

00984167 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

99401023 SUPER ENDCAPS FOR GLUCOLET BAY

99401019 SUPER ENDCAPS FOR MICROLET BAY

MAGNIFIER

Magnifier

99400550 SYRINGE SCALE MAGNIFIER

NEEDLE

Needle

97799526 BD AUTOSHIELD PEN BTD

00908452 B-D PEN BTD

97799527 BD ULTRA-FINE NANO PEN BTD

00977756 NOVOFINE NOO

22g Needle

00977616 B-D DISPOSABLE 1 INCH 5155 BTD

00977624 B-D DISPOSABLE 1� INCH 5156 BTD

25g Needle

00977071 B-D DISPOSABLE 5/8 INCH 5122 BTD

00977063 B-D DISPOSABLE 1� INCH 5127 BTD

27g Needle

00977012 B-D DISPOSABLE � INCH BTD

28g Needle

99221028 NOVOFINE INSULIN PEN 28G NOO

29g Needle

00977101 B-D ULTRA-FINE PEN BTD

97799897 BD ULTRA-FINE PEN NEEDLE 29G BTD

00900513 OWEN MUMFORD UNIFINE PENTIPS 1/2 INCH AUC

00908185 ULTRAFINE PEN ULTRA-FINE 29G BTD

29GX12MM Needle

97799566 INSUPEN 29GX12MM DPI

97799561 SUPER-FINE STANDARD 29G 12.7MM PMS

97799543 ULTI 29GX1/2 WITH SHARP CONTAINER UMI

30g Needle

00921114 NOVOFINE NOO

00908169 NOVOFINE 30G NOO

99117796 NOVOFINE INSULIN PEN 30G NOO

30GX8MM Needle

97799567 INSUPEN 30GX8MM DPI

31g Needle

00977011 B-D ULTRA-FINE PEN III BTD

00900511 OWEN MUMFORD UNIFINE PENTIPS 1/4 INCH AUC

00900512 OWEN MUMFORD UNIFINE PENTIPS 5/16 INCH AUC

31GX5MM Needle

97799563 SUPER-FINE MICRO 31G 5MM PMS

31GX6MM Needle

97799569 INSUPEN 31GX6MM DPI

97799545 ULTI 31GX1/4 WITH SHARP CONTAINER UMI

31GX8MM Needle

97799568 INSUPEN 31GX8MM DPI

97799562 SUPER-FINE XTRA 31G 8MM PMS

97799544 ULTI 31GX5/16 WITH SHARP CONTAINER UMI

32GX6MM Needle

97799571 INSUPEN 32GX6MM DPI

97799821 NOVOFINE 32G 6MM NOO

32GX8MM Needle

97799570 INSUPEN 32GX8MM DPI

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

SYRINGE

0.3cc Syringe

00977961 B-D MICRO-FINE BTD

00977977 B-D ULTRA-FINE / ULTRA-FINE II BTD

00977951 MONOJECT SHM

99254011 MONOJECT DISP 3/10CC (100) SHM

99253047 MONOJECT DISP 3/10CC (30) SHM

00920053 SYRN MONOJECT SHM

00920193 ULTRA-FINE BTD

0.5cc Syringe

00977985 B-D ULTRA-FINE II BTD

00920177 MICRO-FINE BTD

00920355 MONOJECT SHM

99432799 MONOJECT (100) SHM

99432633 MONOJECT (30) SHM

00920207 ULTRA-FINE BTD

1cc Syringe

99328369 B-D ULTRA-FINE BTD

00920045 MONOJECT SHM *

99433383 MONOJECT (100) SHM

99432914 MONOJECT (30) SHM

00920215 ULTRA-FINE BTD

00909238 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

00909092 SYRN INS U-II 3/10CC 30G BTD

00905690 SYRN INSULIN MICRO 3/10CC 28G BTD

00906786 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

00900506 ULTICARE 29G UMI

00964018 ULTICARE 29G UMI

00900503 ULTICARE 30G UMI

00964174 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

00983004 INSULIN LO DOSE MICRO 28G BTD

00909084 SYRN INSULIN U-II 30G BTD

00906727 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

00900505 ULTICARE 29G UMI

00963941 ULTICARE 29G UMI

00900502 ULTICARE 30G UMI

00964115 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

1cc Syringe and Needle

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

99767467 B-D MICRO-FINE INSULIN 100U BTD

00901911 B-D MICRO-FINE INSULIN 28G BTD

00906816 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

00900504 ULTICARE 29G UMI

00963895 ULTICARE 29G UMI

00900501 ULTICARE 30G UMI

00964069 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