Financial Assistance for people with diabetes

Diabetes is a costly disease both financially and emotionally. Trying to afford diabetes supplies and managing high and low blood glucose levels can be taxing. Thankfully some provinces and states in North America offer financial assistance to help cover the costs of some or even all diabetes supplies.

That is still not enough though. There should not be a gap in care.  It should not matter where you live or what your work benefits package is. Until this happens, we will continue to advocate for change.

Through the continued dedication of individuals and groups, we are seeing small steps towards change. One day there will be complete equity in access to diabetes care and devices. Until that happens, here is an overview of assistance available for people with diabetes across Canada.

If you live in the United States, please check out our tax savings page for options also available to you.

RDSP

Registered Disability Savings Plan from the government of Canada offers eligible claimants annual grant money that can later be used to offset some of the costs of diabetes supplies. This plan is similar in principle to an RRSP but for the assistance of medical expenses.  It is only available to those who qualify for the Disability Tax Credit.

Read more about RDSPs below.

Provincial Assistance Programs

Download the provincial programs overview here

Alberta

Alberta provides insulin pump coverage to all residents with type 1 diabetes.  Individuals must:

• Be a resident of Alberta, eligible for coverage under the Alberta Health Care Insurance Plan.
• Be diagnosed with Type 1 diabetes and be under the care of a physician or nurse practitioner for the condition.
• Meet the clinical criteria established by Alberta Health Services for the IPT Program.
• Follow steps outlined in the IPT Program for new or existing IPT users.

For more information contact your health care provider or go to the 
Alberta government website.

British Columbia

B.C. offers a PharmaCare program. Financial assistance under this program depending on income level. They cover all insulin listed on the BC formulary as well as an insulin pump every 5 years and supplies for all ages under a two-tiered system.

Under Tier 1, PharmaCare covers 100% of the cost of an Omnipod or Ypsopump and supplies every five years subject to the rules of your PharmaCare plan.

Under Tier 2, PharmaCare will cover a portion of a tubed (Medtronic) insulin pump IF this pump is prescribed by your doctor and approved by special authorization.

Important: Be sure to register for Fair PharmaCare before purchasing an insulin pump to ensure you get maximum coverage.

PharmaCare covers infusion sets/kits and insulin pump reservoirs/cartridges. It does not cover batteries, battery caps, adhesive pads, etc.

The PharmaCare program will cover needles and syringes if you have insulin-dependent diabetes and you are covered under Fair PharmaCare, Plan C (Income Assistance) and Plan F (At Home Program). You do not need a Certificate of Training from a Diabetes Education Centre to qualify for this coverage. For needles and syringes for insulin therapy, PharmaCare covers the regular retail price but does not cover a dispensing fee.

Continuous Glucose Monitors are currently not covered under the PharmaCare program.

Manitoba

Manitoba offers coverage for insulin pumps and supplies for those under 25 years of age.

In the April 2021 budget​, the government of Manitoba announced that they were providing continuous glucose monitor coverage for eligible children and youth under 25 years of age. 

For more information on how to access this program, contact Diabetes Education Resource for Children and Adolescents (DER-CA) at 204-787-3011

New Brunswick

Financial assistance for insulin in New Brunswick is only available to individuals who are receiving income support or low-income seniors. They only offer coverage to those insulins listed on their provincial formularies unless special authorization is given. Insulin pumps are now covered for those with type 1 diabetes up to 25 years of age.

Newfoundland and Labrador

Newfoundland and Labrador has an Assurance Drug Plan that offers protection against the financial burden of eligible high drug costs, whether from the cost of one extremely high-cost drug or the combined cost of different drugs.

Depending on their income level, individuals and families will be assured that their annual out-of-pocket costs for eligible drugs will be capped at a percentage of their net family income.

Annual Income (net)	Maximum % of Income to Spend on Eligible Drug Costs
$0 -$39,999	5%
$40,000- $74,999	7.5%
$75,000to $149,999	10%

Applications are available in physician’s offices and pharmacies as well as on-line at www.gov.nl.ca/health.

Insulin pumps and supplies are covered for all ages but are subject to income levels. Individuals with a combined family income over $150,000 will not qualify for the expanded insulin pump program.

Nova Scotia

In Nova Scotia the Diabetes Assistance Plan covers test strips, lancets, syringes and insulin listed on its formulary.

This financial assistance plan is designed to assist low-income families and people who are under the age of 65 and have no other drug coverage. Registration forms and information booklets are available by calling the Nova Scotia Diabetes Assistance Program. Information is also available on the Department of Health website. You can also find forms and booklets in doctors’ offices, pharmacies, and diabetes centres.

Insulin pumps and supplies are covered for those under 25yr.

Ontario

Ontario has a number of drug plans including the Ontario Drug Benefit Plan, OHIP+ and Seniors Co-Payment Program.

Those using the Ontario Drug Benefits Program may also qualify to have coverage of the FreeStyle Libre system.

OHIP+

OHIP+ provides drug coverage for anyone age 24 years or younger who is not covered by a private plan. Residents of Ontario do not need to enroll in this plan. According to the website, those eligible for OHIP+ only need to give pharmacists their health card number and a valid prescription for an eligible medication. The pharmacist may ask the patient or their parent/guardian if they are covered by a private plan. In some cases, it may be possible to have Libre covered under this plan.

Trillium Drug Plan

The Trillium Drug plan (TDP) works in a similar way to the OHIP+. It is for people who spend approximately 3 to 4 per cent or more of their after-tax household income on prescription-drug costs. The incomes of TDP household members under age 25 would still be factored into the household deductible calculation.

Any medications funded through OHIP+ (for children and youth that do not have coverage through a private plan) do not contribute towards the household’s TDP deductible, as they are not considered out-of-pocket expenses.

Both Trillium and OHIP+ cover for most insulins (but not Fiasp), most medications, the Freestyle Libre, and, for their children under age 25, blood glucose test strips up to 3,000 per annum. If the family gets a letter from their endocrinologist that says they need test strips, the Senior Pharmacist of Ontario can approve the allowance of more strips.

Ontario has two provincial drug programs that work the same way. The Ontario Drug Benefits Program and the Trillium Drug Plan both offer insulin coverage for families meeting the provincial criteria. Insulin covered only includes those listed on the provincial drug formulary.

Ontario Disability Support Program

The Ontario Disability Support Program (ODSP) also provides coverage for diabetes supplies for those who qualify. Under this program, some individuals are being granted coverage for continuous glucose monitors despite the fact that these devices are not listed on the website.

Prince Edward Island

The province of PEI covers 90% of the cost of an insulin pump every 5 years for residents under 26 years of age.  It also covers 140 infusion sets and 140 insulin reservoirs per year.

The 2020 budget also announced expanded invested in coverage for diabetes supplies and test strips under the Diabetes Drug Program. Monthly glucose test strip coverage will now expand to 120 strips per month effective January 2021.

Quebec

On April 16, 2011 Quebec Health Minister Bolduc announced a reimbursement program that will cover insulin pumps for Type 1 diabetes patients aged 0 to 18 years old. To get the device, the patient and parents must pledge their compliance to the treatment protocol.

The government has also announced that they will cover the cost of the FreeStyle Libre system. You can view details here.

For a comprehensive look at the current program please view the work of Anna Kiff.

Saskatchewan

The province of Saskatchewan covers syringes and lancets for people with diabetes.

Saskatchewan’s 2021-2022 budget has added a $5.0 million investment to increase supports for people with diabetes.  Financial coverage will now include continuous and flash glucose monitoring systems for children and youth under 18 who are insulin dependent.  The Insulin Pump Program will also expand to support individuals of all ages with Type 1 Diabetes.

Financial Assistance in the Territories

The situation in the Yukon and other territories remains somewhat unique. Many people living in the north receive 100% coverage of all insulins, pumps and pump supplies under the Non-Insured Health Benefits plan (NIHB).

For those not covered under NIHB, there are different policies for the different territories. In the Yukon for example, all insulins except Levemir® are covered. They also cover insulin pumps and supplies. To have your pump paid for, you must have an application filled that gives details of your case history stating your failure on MDI, evidence of your commitment and competence to use the pumps, as well as support for initiation and follow up therapy. If your request is based on a lifestyle choice, it will not be considered. The request must be signed by an endocrinologist. There are no specialists in the North. Patients seeking the support of doctors such as endocrinologists must go to major centres such as Vancouver, Edmonton, and Winnipeg to have their pumps prescribed

Download our ebook detailing all provincial programs here.

Insulin assistance options for those living in the United States of America

Colorado

Colorado has capped insulin costs at $100 dollars per monthly supply.

Diatribe has noted that there are a few loopholes to this legislation.  Some health plans were exempt from the legislation, leaving the people on those health plans ineligible for the insulin price cap when purchasing their monthly insulin. Also, instead of offering a flat $100 maximum on monthly insulin prescriptions, Diatribe has found that “the current legislation allows insurers to charge $100 per prescription per month, which translates to $200 for those who take both basal and mealtime insulin or two other insulins, such as short-acting and long-acting.”

Connecticut

Connecticut’s proposed insulin bill for 2021 limits out-of-pocket insulin expenses to $50 per month.

Illinois

Illinois has capped insulin costs at $100 for a 30-day supply beginning January 1, 2021.

Maine

Maine has capped insulin costs at $35 for a 30-day supply, including before a plan’s deductible is met, and applies to state-regulated commercial insurance. This provision takes effect as plans are renewed or issued on or after January 1, 2021.

New Mexico

Effective January 1, 2021, New Mexico has capped insulin costs at $25 for a 30-day supply .

New York

New York has capped insulin costs at $100 for 30-day supply (for state-regulated commercial plans) effective January 1, 2021.

Utah

Utah has capped insulin costs at $30 cap for 30-day supply effective January 1, 2021.

Washington

Washington has capped insulin copayments, deductibles, and other forms of cost-sharing at $100 cap for 30-day supply effective January 1, 2021.

West Virginia

West Virginia has capped insulin costs at $100 cap for 30-day supply effective July 1, 2021.

Insulin Assistance programs

The American Diabetes Association offers information on obtaining local help with insulin costs as well as a way to contact the three insulin manufacturers to help obtain a long term solution. Go to the ADA site here.

Lilly Cares Patient Assistance Program

Lilly Cares offers assistance to help people obtain the Lilly medicines they need including diabetes products.