32:00 Contraceptives (Non-Oral)

32:00.00 CONTRACEPTIVES (NON-ORAL)

CONDOM

Table: CONDOM
Drug strength and dosage form DIN Brand name Manufacturer code
Device 99400527 CONDOM, LATEX, LUBRICATED UNK
Device 99400486 CONDOM, LATEX, NON-LUBRICATED UNK
Device 99400786 CONDOM, NON-LATEX, LUBRICATED UNK
Device 09991648 FC2 FEMALE CONDOMS UNK

CONTRACEPTIVE

Table: CONTRACEPTIVE
Drug strength and dosage form DIN Brand name Manufacturer code
Device 09991647 TODAY SPONGE VAGINAL CONTRACEPTIVE UNK
Device 09991646 VCF VAGINAL CONTRACEPTIVE FILM UNK
Foam 09991645 VCF FOAM VAGINAL CONTRACEPTIVE UNK

CONTRACEPTIVE DEVICE

Table: CONTRACEPTIVE DEVICE
Drug strength and dosage form DIN Brand name Manufacturer code
Device 00970905 CAYA CONTOURED DIAPHRAGM TSN

FEMCAP

Table: FEMCAP
Drug strength and dosage form DIN Brand name Manufacturer code
Device 09991642 CERVICAL UNK

INTRAUTERINE DEVICE

Limited use benefit with quantity and frequency limits (prior approval is not required).

Coverage is granted for 1 device every 12 months.

Table: INTRAUTERINE DEVICE
Drug strength and dosage form DIN Brand name Manufacturer code
Device 00970328 FLEXI-T +300 IUD TSN
Device 00970336 FLEXI-T +380 IUD TSN
Device 98099999 FLEXI-TD TSN
Device 99401085 LIBERTE UT380 SHORT IUD MSF
Device 99401086 LIBERTE UT380 STANDARD IUD MSF
Device 00970379 MONA LISA 10 SEA
Device 00970387 MONA LISA 5 SEA
Device 00970395 MONA LISA N SEA
Device 99400482 NOVA-T BEX
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