Ostomy Supplies PINs

The ostomy supplies listed below are covered for eligible patients who have undergone bowel and/or bladder surgery that results in a colostomy, ileostomy, or urostomy, requiring an external pouch. Actual reimbursement is subject to the rules of the patient’s PharmaCare plan, including any deductible requirements.

Note: PharmaCare covers certain ostomy supplies for First Nations Health Authority clients under Plan W (see list below). The Non-Insured Health Benefits (NIHB) program may still cover some supplies not eligible under Plan W which may require NIHB prior authorization. 

Ostomy PINs

PIN	PRODUCT	PRODUCT EXAMPLES/NOTES*
88123418	Ostomy pouch – drainable	Coloplast Sensura pouch #10471
88123420	Ostomy pouch – closed	Hollister Center Point Lock pouch #3347
88123431	Ostomy pouch – urostomy	Coloplast urostomy pouch #5570
88123443	Stoma caps, colostopads	Hollister #1796
88123455	Ostomy flanges and convex inserts	Coloplast Assura flange #14246
88123467	Colostomy irrigation sets	ConvaTec #1916
88123479	Colostomy irrigation cone, tip, faceplate, sleeves	ConvaTec VisiFlow cone , Hollister sleeves #7728
88123480**	Urostomy night drainage sets	ConvaTec #27060
88123492**	Urostomy tubing and adaptor	ConvaTec Accuseal adaptor
88123510**	Urostomy leg bag and straps	Hollister #9825
88123522	Tape for securing the edges of an ostomy pouch— paper type only	3M paper tape
88123534	Ostomy skin barriers	Eakin seals #83900, Hollihesive skin barriers
88123642	Ostomy barrier strips/extenders	Coloplast Brava elastic barrier strip, Brava elastic tape straight, Brava elastic tape belt, SALTS flange extender with aloe, Hollister Adapt barrier extender
88123546	Skin care wipes, sprays and adhesive removers	Hollister skin gel wipes, ConvaTec All Kare  wipes
88123558	Ostomy paste, cement and powder	Stomahesive powder #5507, Hollister Adapt paste #9301
88123560	Ostomy accessories—belt (excluding ostomy support belts), belt rings, closures, filters, and guide strips	Hollister filters #7766, ConvaTec belt #175507
88123571	Ostomy adhesive spray	Hollister 7730
88123583	Tincture of benzoin
88123595	Ostomy pouch – reusable style	Marlen Neoprene, Permatype, Torbot
88123625	Faceplates for reusable ostomy pouches (i.e., faceplates for PIN 88123595 above)	Permatype, Marlen
88123637	Internal deodorants (oral tablets)	200mg capsules of bismuth subgallate

*Products in the right-hand column are examples only. Their inclusion is not an endorsement of these products. Coverage is not limited to these products or manufacturers.

**These items are covered only for patients using Ostomy Pouch – Urostomy (PIN 88123431)

 

Non-benefit Items

The following items are not benefits.

Note: Exclusion of a product from this list does not imply it is a benefit product.

• Catheters—for any use, including
  • for management of any medical or post-surgical condition
  • all products for management of continent urostomies—catheters, absorbent pads
  • Note: PINs 88123480, 88123492 and 88123510 are benefits for patients using a urostomy pouch (PIN 88123431)
• All products for the management of nephrostomy tubes, feeding tubes, other drainage tubes, wound  drainage—such as Hollister drain tube attachment device, or urinary drainage collection equipment  (including PINs 88123480, 88123492 and 88123510, except as noted above)
• All products for management of urinary incontinence—catheters, condoms, drainage containment  equipment, diapering systems, incontinence pads, tubing and adapters (including PINs 88123480, 88123492 and 88123510, except as noted above)
• Cotton covers for pouches or night drainage bottles
• Pouch liners—such as Colo-Majic
• Stoma hole cutters
• Ostomy support belts—such as Nu-Hope
• Skin protectants—such as Marathon skin protectant
• Creams—such as Sween Cream, Chiron Cream, BAZA cream
• Cleansers—such as Uni-Wash, ConvaTec AloeVesta products
• Lubricants—such as KY Jelly, Hollister stoma lubricant
• Tapes (other than paper-type or elastic barrier tape)—such as waterproof tape, Elastoplast, straight  transparent dressings—such as OpSite, Tegaderm
• Room deodorants—such as M9
• In-pouch deodorants—such as Uri-Kleen, M9, Banish
• Hydrocolloid dressings—such as DuoDerm, Restore, Tegasorb
• Instruments—such as scissors, dressings sets
• Alcohol swabs, sterile and unsterile gauze
• Any items purchased through online suppliers – items must be purchased from authorized PharmaCare providers.

PharmaCare does not cover any items, even if they are listed in this document, not used for the purposes stated. Non-benefit uses include management of a catheter, diabetes, an insulin pump, wounds, ineligible types of ostomy (e.g., a cecostomy or nephrostomy), feeding tubes, or urinary incontinence.