5.21 Ostomy Supplies

General Policy Description

PharmaCare covers certain ostomy supplies for patients who have undergone surgery on the bowel and/or bladder that results in a colostomy, ileostomy or urostomy, requiring the application of an external pouch.

Policy Details

PharmaCare covers eligible ostomy supplies for patients who have undergone surgery on the bowel and/or bladder that results in a colostomy, ileostomy or urostomy, requiring the application of an external pouch.

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 support belts
• Pouch covers
• Night drainage bottle covers
• Stoma hole cutters
• In-pouch deodorants—such as Banish, M9, Uri-Kleen
• Cleansers—such as Hollister Restore Wound Cleanser, Uni-Wash, ConvaTec AloeVesta products
• Room deodorants—such as M9
• Tapes (other than paper-type)—such as Elastoplast, Dermicel, Waterproof, 3M Blenderm
• Creams—such as Sween Cream, Chiron Cream, BAZA
• Lubricants—such as KY Jelly, Hollister Stoma Lubricant
• Products for management of incontinence—such as catheters, condoms, Attends, drainage containment equipment
• Hydrocolloid dressings—such as DuoDerm, Restore, Tegasorb
• Transparent dressings—such as Opsite, Tegaderm
• Sterile/unsterile gauze
• Alcohol swabs
• Products for the management of feeding tubes and draining wounds—such as Hollister Drain Tube Attachment Device, Hollister Drainage Collectors
• Instruments—such as scissors, dressings sets