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 July 2015 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) 5 ADHESIVE REMOVERS (SPRAYS, LIQUIDS, WIPES) 6 BAG CLOSURES 8 BAG COVERS 9 BELTS 13 COLOSTOMY BAGS 38 COLOSTOMY SETS 81 DEODORANTS 81 DISCHARGE SOLIDIFYING AGENTS 83 FILTERS/BRIDGES 84 FLANGES 85 ILEOSTOMY BAGS 87 IRRIGATION/WASH-OUT APPLIANCES 143 PRESSURE PLATES/SHIELDS 145 SKIN FILLERS AND PROTECTIVES 147 SKIN PROTECTORS 151 STOMA CAPS/DRESSINGS 155 TUBING AND ACCESSORIES STOMA 157 TWO PIECE OSTOMY SYSTEMS 158 UROSTOMY BAGS 211 WOUND MANAGEMENT PRODUCTS 228 CROSS REFERENCE INDEX (STOMA APPLIANCES) 231 SUPPLIERS ADDRESSES & TELEPHONE NUMBERS 233 STOMA APPLIANCES ADHESIVE DISCS/RINGS/PADS/PLASTERS Manufacturer Appliance Order Qty Price No (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 Essentials Hydroframe Flange Extenders Accessories 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 Coloplast Ltd Coloplast Brava Elastic Tape 12070 20 1255 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 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 Ostomart Ltd. Astoa Adhesive Flange Extender Small AFES30 30 1172 Large AFEL30 30 1875 Wide AFEW30 30 1650 Ostofix Flange Security Tape 2.5cm x 10cm DGW1 100 415 5cm x 10cm DGW2 100 719 Ostofix Forty - security frames DFW3 40 1937 Ostofix Eighty - security frames DFW80 80 1904 Peak Medical Ltd Varimate Retention Strips VMT0311 60 3750 Varimate Extra Thin Hydrocolloid VMT CURVE 60 2400 Curved Retention Strips Prosys International Ltd AcuBond Strips SB2 30 1776 Salts Healthcare Transacryl Double Sided Plaster 25mm 833018 10 671 32mm 833019 10 671 38mm 833020 10 671 SecuPlast Circular Plasters 32mm SP32 10 1138 38mm SP38 10 1138 45mm SP45 10 1138 57mm SP57 10 1138 70mm SP70 10 1119 SecuPlast Hydro Aloe SPHA2 30 1293 SecuPlast Hydro Security Strips SPH1 30 1194 Trio Healthcare Ltd Silex Silicone Flange Extender TR1060 20 1289 STOMA APPLIANCES ADHESIVE (PASTES, SPRAYS, SOLUTIONS) Manufacturer Appliance Order Qty Price No (p) Hollister Ltd. Medical Adhesive Aerosol 7730 90g 1670 Salts Healthcare Latex Adhesive Solution 833005 28ml 234 STOMA APPLIANCES ADHESIVE REMOVERS (SPRAYS, LIQUIDS, WIPES) Manufacturer Appliance Order Qty Price No (p) Bullen CS ConvaTec Niltac Sting Free TR101 50ml aerosol 825 Medical Adhesive Remover TR102 30 wipes 1368 CD Medical Ltd Peel-Easy non sting spray 300714 50ml 710 Peel-Easy Wipes 300715 30 wipes 1166 Clinimed Ltd Essentials Appeel No Sting Medical 3505 30 wipes 1526 Accessories Adhesive Remover 3500 50ml aerosol 920 Coloplast Ltd Brava Adhesive Remover Spray 12010 50ml 842 Brava Adhesive Remover Wipes 12011 30 wipes 1396 ConvaTec Ltd ConvaCare Adhesive S208 100 wipes 1718 Remover Wipes Dansac Ltd Dansac No Sting Protector 081-30 30 wipes 2336 Wipes (individual sachets) Dansac No Sting Adhesive 082-01 50ml spray 924 Remover Dansac No Sting Adhesive 082-30 30 wipes 1497 Remover (individual sachets) Ecolab Adhesive Remover 3037050 50ml 408 Hollister Ltd. Adapt no-sting Medical 7731 76g 1372 Adhesive Remover Universal Remover Wipes 7760 50 1356 Medicareplus Medi Lifteez Non Sting 60314 75ml 1010 International Ltd Medical Aerosol Medi Lifteez Medical 60321 30 1105 Adhesive Remover Wipes 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 Qty Price No (p) Opus Healthcare Ltd Lift Medical Adhesive Remover 5500 30 sachets 885 5501 100ml bottle 624 Lift Plus Citrus Medical Adhesive Remover 5504 30 sachets 1445 5505 50ml spray 880 Lift Plus 360 Citrus Medical Adhesive Remover 5507 50ml spray 640 Lift Plus Medical Adhesive Remover 5502 30sachets 1445 5503 50ml bottle 880 Lift Plus 360 Medical Adhesive Remover 5506 50ml Spray 640 Ultra Cleanse Skin Cleanser 4400 30sachets 868 4401 200ml bottle 1685 Ostomart OstoClear MRW1 30 sachets 897 MRW2 100ml bottle 982 OstoPEEL No Sting Medical Adhesive Remover Spray Apple OPA50 50ml aerosol 649 Blackberry OPB50 50ml aerosol 649 Mint OPM50 50ml aerosol 649 No Fragrance OPN50 50ml aerosol 649 OstoPEEL Blackberry No Sting Medical Adhesive Remover Wipes OPBW30 30 1060 Pelican Healthcare Pelican Release Silicone Based Adhesive Remover Ltd. with added Vitamin E 130360 30 wipes 1549 130460 50ml spray 934 Prosys International Independence RS1 50ml aerosol 709 Ltd Adhesive Remover Independence No ARW1 30 sachets 1508 Sting Adhesive Remover Wipes Salts Healthcare WipeAway Adhesive WA1 30 sachets 899 Wipeaway Plus No Sting adhesive Remover Spray WAP 50ml spray 650 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 Essential Accessories 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 50 595 Opaque Longer Soft Wire ties 095-02 50 681 Hollister Ltd Drainable Pouch Clamp Beige 8770 1 125 10 1057 Peak Medical Curved Beige Clip for Drainable CLS10 10 580 Ltd. Pouches Pelican Healthcare Ltd. Drainable Pouch Clips 130406 20 728 Salts Closure Clips 833044 5 224 Healthcare Drainable Pouch Clips CL1 10 782 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 2565 * Uro 2002 4260 White 9014 5 2565 Uro 2002 4241 9016 5 2565 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 Cuiwear Ltd * Cuiwear Ostomy Support Underwear with built in pouch cover Ladies CF01-CF57 1 950 Mens CW01-CW15 1 950 CN01-CN15 1 950 with built in pouch cover with night drainage Ladies Black BS31-BS57 1 950 White BS01-BS27 1 950 * Cuiwear Ostomy Support Trunks Mens Denim LT16-LT30 1 950 Navy LT01-LT15 1 950 Jade-Euro- * Bag Cover Day Size WN124-01-C 1 1243 Med Ltd.