The economic burden of living with a permanent ostomy in the United States is something most individuals never thought about before they had surgery. Having an ostomy results in a dramatic change of toileting/elimination patterns and the need for lifelong use of disposable prosthetic devices (ostomy pouches) that must be changed every 3 to 4 days on average. Ostomy supplies are not free in the United States, as they are in many other countries around the world. Ostomates need to pay for a variety of essential supplies, and this can get very expensive. A physician’s prescription is required for insurers to reimburse for these supplies, which are only sold at durable medical equipment (DME) supply stores or distributors.
If an ostomate is old enough to be on Medicare, they will pay 20% of the cost of supplies. If an ostomate has Medicare and a supplemental policy, they typically won’t pay anything for supplies. However, those with private insurance will incur out-of-pocket expenses according to their plan’s requirements. These expenses can be upward of $200/month for ostomy supplies after meeting the plan’s deductible, which is often excessive. The out-of-pocket financial costs can be close to $3,000 per year (Table 1), which can have a negative impact on a person’s quality of life.1 Furthermore, if the individual has any complications such as peristomal skin breakdown (as up to 80% do at some point), the supply costs can be doubled due to multiple daily pouch changes. Meeting the financial needs for individuals with an ostomy can be a challenging task that many were not aware of when they had surgery. People living with an ostomy find that they are having to reevaluate household budgets to include these essential expenses.
Imagine life without being able to toilet yourself and maintain personal hygiene. This is what life is like for an ostomate who does not have access to ostomy supplies. Having access means the difference between leading an active life and being homebound. Quality of life and productivity are negatively affected when access to ostomy appliances is hampered. This can lead to depression, unemployment, and risk of severe skin infections and hospitalizations.
When faced with the challenges of supporting your patients who are uninsured/underinsured or facing unusual financial circumstances, it is good to know that there are resources to assist these patients, in particular ostomy supplies heroes such as the following.