5.21 Ostomy Supplies

General Policy Description

PharmaCare covers certain ostomy supplies for patients who require the application of an external pouch due to the presence of an enterocutaneous fistula or a colostomy, ileostomy or urostomy after having undergone surgery on the bowel and/or bladder.

Policy Details

PharmaCare covers eligible ostomy supplies for patients who require the application of an external pouch due to the presence of an enterocutaneous fistula or a colostomy, ileostomy or urostomy after having undergone surgery on the bowel and/or bladder.

Coverage is subject to the rules of the patient's primary PharmaCare plan, including any annual deductible requirements.

PharmaCare covers eligible ostomy supplies up to the regular retail price with no dispensing fee.

Claims must be entered into PharmaNet using the Product Identification Number (PIN) indicated in the list of eligible ostomy supplies.

Other ostomy supplies, including but not limited to the following, are not PharmaCare benefits:

• Catheters—for any use
• Ostomy hernia support belts
• Pouch covers
• Night drainage bottle covers
• Stoma hole cutters
• In-pouch deodorants—(e.g., Banish, M9, Uri-Kleen)
• Cleansers—(e.g., Uni-Wash, ConvaTec AloeVesta products)
• Room deodorants—(e.g., M9)
• Advanced skin protectants—(e.g., Cavilon Advanced, Marathon Liquid Skin Protectant)
• Creams—(e.g., Sween Cream, BAZA cream)
• Lubricants—(e.g., KY Jelly, Hollister stoma lubricant)
• Products for management of urinary incontinence—(e.g., catheters, condoms, drainage containment equipment, diapering systems, incontinence pads)
• Hydrocolloid dressings—(e.g., DuoDerm, Restore, Tegasorb)
• Transparent dressings—(e.g., Opsite, Tegaderm)
• Sterile/unsterile gauze
• Alcohol swabs
• Products for the management of feeding tubes and draining wounds—(e.g., Hollister drain tube attachment device, Hollister drainage collectors)
• Instruments—(e.g., scissors, dressings sets)