Drug Benefit List

32:00 CONTRACEPTIVES (Non-Oral)

32:00.00 CONTRACEPTIVES (NON-ORAL)

CONDOM, FEMALE

Device

99400484     REALITY FEMALE CONDOM     PMS

CONDOM, MALE

Device

99400527     CONDOM, LATEX, LUBRICATED     

99400485     CONDOM, LATEX, LUBRICATED, NONOXYNOL     

99400486     CONDOM, LATEX, NON-LUBRICATED     

99400786     CONDOM, NON-LATEX, LUBRICATED     

DIAPHRAGM

Device

99400477     ORTHO DIAPHRAGM COIL KIT 65     JAJ

99400478     ORTHO DIAPHRAGM COIL KIT 70     JAJ

99400479     ORTHO DIAPHRAGM COIL KIT 75     JAJ

99400480     ORTHO DIAPHRAGM COIL KIT 80     JAJ

99400481     ORTHO DIAPHRAGM COIL KIT 85     JAJ

INTRAUTERINE DEVICE

Device

99400482     NOVA-T IUD COPP 3 CU 200     BEX

SPONGE

Device

99400483     PROTECTAID SPONGE     AXC