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STOMA APPLIANCES STOMA APPLIANCES – REIMBURSEMENT PRICES Important Notices 1 This list includes those items which may be ordered by authorised prescribers on the appropriate lists of Health Board, and indicate the specifications and reimbursement prices which shall apply to the stoma services contractors (community pharmacy contractors and dispensing appliance contractors) who are authorised to dispense these lines. 2 Only those stoma appliances in this document shall be supplied and reimbursed 3 This version is dated 1st November 2017 4 Any application for addition, amendment or deletion of lines to this list must be made in writing to: Commodity Manager National Procurement Gyle Square EDINBURGH EH12 9EB 1. Original Belts (Apparatus) are supplied under the Hospital and Specialist Service. 2. Repairs and replacements may be supplied through the general medical services. 3. A contractor who will carry out the actual measurement, fitting and supply of the belt may only accept prescriptions ordering replacement of a complete Belt (Apparatus). 4. Orders for replacement of "a belt" are to be taken as being for the belt alone and the prescription referred back to the prescriber to specify order for a Complete Belt (Apparatus) where such appears to be required. 5. On discharge from hospital, the patient is issued with 2 copies of an Ostomy Appliance Record Form (a third copy is sent to the patient's general medical practitioner). The Form details the items that have been supplied (including code no, size of appliance and unit pack size). The patient is asked to retain one copy and to give the second copy to his pharmacist or appliance supplier for future reference. STOMA APPLIANCES STOMA APPLIANCES – REIMBURSEMENT PRICES 1 ADHESIVE DISCS/RINGS/PADS/PLASTERS 3 ADHESIVE (PASTES, SPRAYS, SOLUTIONS) 6 ADHESIVE REMOVERS (SPRAYS, LIQUIDS, WIPES) 6 BAG CLOSURES 8 BAG COVERS 9 BELTS 14 COLOSTOMY BAGS 45 COLOSTOMY SETS 94 DEODORANTS 94 DISCHARGE SOLIDIFYING AGENTS 96 FILTERS/BRIDGES 97 FLANGES 98 ILEOSTOMY BAGS 100 IRRIGATION/WASH-OUT APPLIANCES 162 PRESSURE PLATES/SHIELDS 164 SKIN FILLERS AND PROTECTIVES 166 SKIN PROTECTORS 170 STOMA CAPS/DRESSINGS 174 TUBING AND ACCESSORIES STOMA 176 TWO PIECE OSTOMY SYSTEMS 177 UROSTOMY BAGS 234 WOUND MANAGEMENT PRODUCTS 257 STOMA APPLIANCES ADHESIVE DISCS/RINGS/PADS/PLASTERS Order Price Manufacturer Appliance No Qty (p) Bullen CS Ltd. Double Sided Adhesive Plaster Zinc Oxide 89mm x 89mm UF 33 10 396 102mm x 102mm UF 34 10 489 127mm x 127mm UF 35 10 827 Double Sided Adhesive Plaster Acrylic base 89mm x 89mm UF 62 10 355 102mm x 102mm UF 63 10 457 127mm x 127mm UF 64 10 769 Flange Retention Strips 102mm x 25mm UF 440 100 354 102mm x 51mm UF 441 100 481 Shelter Safe Seal Stoma Flange Extender UF7000 40 2150 Clinimed Ltd Hydroframe Flange Extenders WAF H33 20 (strips) 1315 Hydroframe Mini Flange Extenders WAF M33 30 (strips) 1004 Hydroframe Flange Extenders with manuka honey MHWAF H33 20 (strips) 1315 Hydroframe Mini Flange Extenders with manuka honey MHWAF M33 30 (strips) 1004 CliniSupplies Ltd ZenSetiv Half Moon Strips Hydrocolloid A2015 20 2200 Microporous A2016 20 2200 Coloplast Ltd Brava Elastic Tape 12070 20 1310 Brava Elastic Tape Belt 12072 20 1327 Brava Elastic Tape Straight 12074 20 1301 Dansac Ltd Dansac X-tra Strips Barrier Extenders 075-30 30 1890 STOMA APPLIANCES ADHESIVE DISCS/RINGS/PADS/PLASTERS Order Price Manufacturer Appliance No Qty (p) Jade-Euro-Med Ltd. Kidney Seals – Adhesive Flange Retaining Strips Small WJ250-51-T 10 562 Large WJ250-75-J 10 562 Double Sided Adhesive Discs 76mm diam 19mm opening WJ002-19-R 10 530 25mm opening WJ002-25-L 10 530 90mm diam 32mm opening WJ005-32-V 10 530 38mm opening WJ005-38-J 10 530 Chiron Double-Sided Plasters: 90mm square 19mm opening WJ-010-19N 10 720 35mm opening WJ-010-35L 10 720 102mm square 19mm opening WJ-011-19S 10 827 35mm opening WJ-011-35Q 10 827 127mm square 19mm opening WJ-012-19W 10 912 35mm opening WJ-012-35U 10 912 STOMA APPLIANCES ADHESIVE DISCS/RINGS/PADS/PLASTERS (Continued Manufacturer Appliance Order No Qty Price (p) Jade-Euro-Med Ltd. Chiron Double-Sided Plasters: 150mm square 19mm opening WJ-013-19B 10 1019 102mm x 76mm 19mm opening WJ-014-19F 10 1019 102mm square 25mm opening WJ-016-25J 10 1019 125mm square 25mm opening WJ-018-01C 10 1117 Oakmed Ltd Curvies flange extenders CUR001 30 1857 Peak Medical Ltd Varimate Retention Strips VMT0311 60 3750 Varimate Extra Thin Hydrocolloid Curved VMT 60 2400 Retention Strips CURVE Pelican Healthcare Ltd Pelican Contour Flange Extender 130860 30 1995 Prosys International Ltd AcuBond Strips SB2 30 1776 Respond Healthcare Ltd OstoMart Astoa Adhesive Flange Extender Small AFES30 30 1183 Large AFEL30 30 1893 Wide AFEW30 30 1666 OstoMart OstoFIX40 HydroAV Security Frames DWK40 40 2574 OstoMart Ostofix Forty - security frames DFW3 40 1972 OstoMart Ostofix Eighty - security frames DFW80 80 1938 Salts Healthcare Transacryl Double Sided Plaster 25mm 833018 10 683 32mm 833019 10 683 38mm 833020 10 683 SecuPlast Circular Plasters 32mm SP32 10 1158 38mm SP38 10 1158 45mm SP45 10 1158 57mm SP57 10 1158 70mm SP70 10 1139 SecuPlast Flange Extender with Aloe SPHA2 30 1293 SecuPlast Hydro Security Strips SPH1 30 1194 Trio Healthcare Ltd Elite Sting Free Adhesive Remover TR201 50ml spray 698 TR202 30 wipes 1222 Silex Silicone Flange Extender TR1060 20 1289 STOMA APPLIANCES ADHESIVE (PASTES, SPRAYS, SOLUTIONS) Order Price Manufacturer No Qty (p) Hollister Ltd. Medical Adhesive Aerosol 7730 90g 1701 Salts Healthcare Latex Adhesive Solution 833005 28ml 238 ADHESIVE REMOVERS (SPRAYS, LIQUIDS, WIPES) Manufacturer Appliance Order Qty Pric e No (p) CD Medical Ltd Peel-Easy non sting spray 300714 50ml 710 Peel-Easy Wipes 300715 30 wipes 1166 Clinimed Ltd Appeel No Sting Medical Adhesive 3505 30 wipes 1526 Remover 3500 50ml aerosol 920 Appeel Advance No Sting Medical 3501 50ml aerosol 937 Adhesive Remover Appeel Hydrosolve Flushable Medical 3506 30 wipes 1539 Adhesive Remover Wipes Coloplast Ltd Brava Adhesive Remover Spray 12010 50ml 911 Brava Adhesive Remover Wipes 12011 30 wipes 1510 ConvaTec Ltd ConvaCare Adhesive S208 100 wipes 1718 ConvaTec Niltac Sting Free Medical TR101 50ml aerosol 825 Adhesive Remover TR102 30 wipes 1368 Dansac Ltd Dansac No Sting Protector Wipes 081-30 30 wipes 2378 (individual sachets) Dansac No Sting Adhesive Remover 082-01 50ml spray 940 Dansac No Sting Adhesive Remover 082-30 30 wipes 1524 (individual sachets) Dansac EasiSpray Adhesive Remover 083-01 50ml spray 657 Ecolab Adhesive Remover 3037050 50ml 408 Hollister Ltd. Adapt no-sting Medical Adhesive 7731 76g 1450 Remover 7737 50ml 702 Universal Remover Wipes 7760 50 1380 Medicareplus Medi Lifteez Medical Adhesive 60321 30 1105 International Ltd Remover Wipes Medi Lifteez Non Sting Medical 60833 50ml aerosol 675 Adhesive Remover Oakmed Ltd EasyLease No Sting Medical Adhesive Remover 1206 30 wipes 1492 1408 50ml spray 920 STOMA APPLIANCES ADHESIVE REMOVERS (SPRAYS, LIQUIDS, WIPES) (continued Manufacturer Appliance Order No Qty Price (p) Opus Healthcare Ltd Lift Medical Adhesive Remover 5500 30 sachets 911 5501 100ml bottle 642 Lift Plus Citrus Medical Adhesive Remover 5504 30 sachets 1445 5505 50ml spray 888 Lift Plus 360 Citrus Medical Adhesive Remover 5507 50ml spray 640 Lift Plus Medical Adhesive Remover 5502 30sachets 1445 5503 50ml bottle 888 Lift Plus 360 Medical Adhesive Remover 5506 50ml Spray 640 Ultra Cleanse Skin Cleanser 4400 30sachets 868 4401 200ml bottle 1685 Peak Medical Ltd Offmate Stoma Adhesive Remover OM50 50ml spray 695 Offmate Stoma Adhesive Remover Wipes OM30 30 wipes 900 Pelican Healthcare Pelican Release Silicone Based Adhesive Remover with added Ltd. Vitamin E 130360 30 wipes 1577 130460 50ml spray 951 Prosys International Independence RS1 50ml aerosol 709 Ltd Adhesive Remover Independence No ARW1 30 sachets 1508 Sting Adhesive Remover Wipes Respond Healthcare OstoMart OstoClear MRW1 30 sachets 913 Ltd MRW2 100ml bottle 1000 OstoMart OstoPEEL No Sting Medical Adhesive Remover Spray Apple OPA50 50ml aerosol 655 Blackberry OPB50 50ml aerosol 655 Mint OPM50 50ml aerosol 655 No Fragrance OPN50 50ml aerosol 655 OstoMart OstoPEEL Blackberry No Sting Medical Adhesive Remover Wipes OPBW30 30 1070 Salts Healthcare Salts Adhesive Remover WA1 30 wipes 899 Salts Adhesive Remover Spray WAP 50ml spray 650 Salts Adhesive Remover Wipes WAP2 30 wipes 865 STOMA APPLIANCES BAG CLOSURES (Available separately from the bags) Manufacturer Appliance Order Qty Price No (p) C S Bullen Plastic Bag Clamp 400 10 605 Soft Wire Ties 410 50 512 Clinimed Ltd Closure Clamps (Drainable Bags) 3750 1 122 ConvaTec Ltd. (Beige) (1-piece pouch) S207 10 329 Soft Wire Ties S205 50 569 Curved Clip for Drainable Pouches S202 10 583 Dansac Ltd. Opaque Soft Wire Ties 095-01 50 606 Opaque Longer Soft Wire ties 095-02 50 693 Hollister Ltd Drainable Pouch Clamp Beige 8770 10 1076 Peak Medical Curved Beige Clip for Drainable CLS10 10 580 Ltd. Pouches Pelican Healthcare Ltd. Drainable Pouch Clips 130406 20 741 Salts Closure Clips 833044 5 228 Healthcare Drainable Pouch Clips CL1 10 796 STOMA APPLIANCES BAG COVERS These stoma bag covers can be washed and re-used many times. Cloth fabric * types are more durable than those made of non-woven fabric /. Refer to the manufacturer’s instructions. Manufacturer Appliance Order Qty Price No (p) AMI Medical * Suportx Ostomy support bag device with built in Ltd universal stoma bag holder/cover and night drainage outlet Mens Shorts Black Small, Medium, Large, X Large, AM11- 1 975 XX Large AM15 Bespoke Size AM16 1 975 Dark Grey Marl Small, Medium, Large, X Large, AM21- 1 975 XX Large AM25 Bespoke Size AM26 1 975 White Small, Medium, Large, X Large, AM01- 1 975 XX Large AM05 Bespoke Size AM06 1 975 Mens Fitted Trunks Black Small, Medium, Large, X Large, AM61- 1 975 XX Large AM65 Bespoke Size AM66 1 975 Dark Grey Marl Small, Medium, Large, X Large, AM71- 1 975 XX Large AM75 Bespoke Size AM76 1 975 White Small, Medium, Large, X Large, AM51- 1 975 XX Large AM55 Bespoke Size AM56 1 975 Bullen CS Ltd. * Night Bag Cover UF 57 1 420 * Day Bag Cover UF 58 1 420 Coloplast Ltd. * Mini decorated / Open MC2000 White 9013 5 2686 * Uro 2002 4260 White 9014 5 2686 Uro 2002 4241 9016 5 2686 STOMA APPLIANCES BAG COVERS (continued) Manufacturer Appliance Order Qty Price No (p) Cover Care * Cover Care Pouch Covers Mini 32/38mm pouches L198 3 772 45/57mm pouches L199 3 772 Standard Drainable pouches and L201 3 817 urostomy pouches Small 38/45mm closed pouches small drainable pouches and Combihesive L203 3 817 closed pouches Medium 57 and 70mm closed pouches L204 3 817 Large urostomy pouches L200 3 817 CUI * Cuiwear Ostomy Support Underwear International with built in pouch cover Ladies CF01-CF57 1 1022 Mens CW01-CW15 1 1022 CN01-CN15 1 1022 with built in pouch cover with night drainage Ladies Black BS31-BS57 1 1022 White BS01-BS27 1 1022 * Cuiwear Ostomy Support Trunks Mens Denim LT16-LT30 1 1022 Navy LT01-LT15 1 1022 Jade-Euro- * Bag Cover Day Size WN124-01-C 1 1243 Med Ltd. Night Size WN125-04-N 1 1243 Pelican * Eakin Cotton Bag Covers Healthcare Size of opening Ltd. Small 32mm 839030 1 515 45mm 839031 1 515 Large 32mm 839033 1 515 45mm 839034 1 515 64mm 839035 1 515
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