Provincial coverage changes for diabetes technologies in Canada

Provincial coverage changes for diabetes technologies

For Canadians living with diabetes, there were two big provincial coverage changes for diabetes technologies last week.  The Ontario government agreed to cover the Libre system while the government of British Columbia declined to cover the t:SlimX2 insulin pump or supplies for its residents. This is one step forward and one step back when it comes to choice in the treatment of insulin-dependent diabetes in Canada.

Ontario Drug Program covers the Libre Flash Glucose Monitor

Effective September 16, 2019, the Ontario government has stated that they will cover the complete cost of the Freestyle Libre Flash Glucose Monitoring Systems for those who are eligible for the Ontario Drug Benefit program.  This is fabulous news for those living with insulin-dependent diabetes.  Those opting to use this system will be eligible to have 33 sensors covered per year.

While people in Ontario are celebrating the expansion of their provincial health program, others are waiting for their provinces to follow suit. 

Get the provincial overview of diabetes devices and supplies coverage here.

The BC Government declines coverage of the t:slimX2™ insulin pump

BC denies coverage of tslim insulin X2 pump

People living with diabetes in BC, however, were disheartened last week to see that once again their choice in insulin pump therapy had been restricted by their government.  The Minister of Health stated that the government would not be adding the t:slimX2™ to their provincial insulin pump coverage

If you are considering purchasing an insulin pump, our ebook can help you to know the right questions to ask your local pump reps.

Your Diabetes May Vary

As we have stated time and time again, diabetes is not a one size fits all disease. What works well for one person with diabetes may not work for another. What works at one stage in your life may not work for you at a different stage.  It is vital that people living with diabetes have a choice in how they manage their diabetes care. 

In Canada, currently, we have the choice of four insulin pumps, one flash monitoring system, and two continuous glucose monitors. In theory, this is fabulous but using these devices are costly.  If you do not have great private insurance (and not all private insurance is great for people living with diabetes), you most likely will not have access to your choice of technologies. 

If your job does not offer private insurance coverage or the company you work for has not negotiated for extensive coverage of diabetes supplies, you are most likely looking to the provincial government to provide aid.  Depending on where you live in Canada, you may or may not have extensive provincial coverage for diabetes technologies.

There should be an increase in public coverage for diabetes supplies and devices

Once again, we feel that a reduction in provincial coverage for diabetes technologies is wrong.  All Canadians living with insulin dependent diabetes should have access to the best possible diabetes care regardless of wallet size or geographic location. 

Providing Canadians with diabetes with the best possible care benefits everyone. It helps the person with diabetes to stay healthy.  This means that they are in the hospital less often.  If they are in the hospital or at the doctor less often, then they are not costing the health care system as much money.  These individuals are also taxpayers.  If they are not ill, they are able to work which provides the public coffers with more money as well.  It is a win-win situation that we continue to hope that more provinces will start to realize.

If you are currently looking to use an insulin pump or other technology but are concerned about how you will pay for it, the pump companies and CGM manufacturers have staff dedicated to helping you look at your options.  Be sure to contact them before you give up on being able to use the technology of your choice.

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Ontario covers Libre
diabetes supplies coverage depends on where you live in Canada

5 thoughts on “Provincial coverage changes for diabetes technologies in Canada”

  1. ODB [Ontario Drug Benefit plan] is only for those who are over 65 or who are on ODSP (Ontario Disabilities Support Programme) or OW (Ontario Works). I doubt it will cover children, but I’m not sure about that. They are covered if the family is uninsured (totally uninsured) by OHIP+. This is probably a ploy by the Ford government to take the wind out of the NDP’s sails since I imagine the NDP’s proposal for universal public pharmacare and assistive devices from coast to coast is not very popular in PC circles, but very popular among the population. Paying for fgms (flash glucose monitoring system) for those on the ODB plan and Trillium (I presume) is a step in the right direction and will probably save the government money since fewer bg sticks will be required to keep your bg in range. Thanks for this. I’ll have to check into this yarn and post on local diabetic fb pages.

    1. People on the Trillium Drug Plan are covered, but the person I talked with at the Ministry wants someone else to call me back to see if kids (people under 25) with no private EHB plan coverage are covered. Now, what about kids who are under 25, but who have EHB plan coverage but no cgms coverage? How will they be covered by public healthcare insurance? Also, isn’t it the worker bees who should be covered as well since they are producing the honey and more and more people are working on contract and have no prescription drug benefits. I guess Jagmeet Singh with his head to toe prescription drug coverage and the devices to deliver these drugs and hormones safely and effectively from coast to coast is scaring those who say they are “For the People”, but are only for the rich people without health issues.

    2. For more information about this new Ontario coverage you can call the following numbers: Members of the public should call 1-866-532-3161 Media (is that us or not?) should call 888-414-4774 for more information about this new programme. I wonder what this will do to strip coverage by ODB. Can you still get the strips you need if you are covered for Libre sensors or not? Even some CDEs are under the mistaken impression you don’t have to test with a bg monitor any more if you use a fgms and that is not true! If you are unaware that you are going into a hypoglycemic episode, you are supposed to confirm a low fgms number. If you think you are high, but the fgms number doesn’t show this, you are to confirm with a bg test on your monitor. Blood glucose test strips are still necessary for monitoring your blood glucose and, of course, a lab test number is the most accurate.

      1. An interesting wrinkle in the story about coverage of fgms, Abbott’s Libre: Libre will only be prescribed to people on insulin if they are over 18. The government will not pay for off label prescriptions. That’s what the pharmacist at Costco Kingston told me yesterday. That means that a lot of kids are still not covered which is ridiculous. Remember when Ontario would pay for kids who needed insulin pumps and supplies but wouldn’t pay for adults who needed insulin pumps and supplies? I do. Now, we have the opposite situation: Ontario’s ODB won’t pay for people under 18 who are prescribed a Libre and are on insulin. I pointed out to the pharmacist that Dexcom can be used by kids over 2 years of age. Her response? “Oh!” Maybe, the government of Ontario didn’t know about this wrinkle either. I would think that a young child would have difficulty running a pump and would need a lot of expensive help, but many young kids could easily use the scanner to find out what their bg was. Strangely, even though I’ve always used a Medtronic cgms, I don’t know how old you have to be to be eligible to use a Medtronic cgms. I guess I should find that out. Also, people on CPP-D but who meet ODSP’s income and assets eligibility criteria can also be on the ODB plan so they are eligible as well for government paid fgms as are members of their family, I believe. People in homecare and in nursing homes are also able to use the ODB plan, but only for themselves, not for dependents or wives. I think a fgms would be a real boon to residents of long term care facilities. A staff member or family member if the patient looks low or is agitated could scan the fgms and find out where the bg of that resident is and determine what action to take if the bg is high or low very speedily. . Reading all this discussion about who is eligible makes me strongly agree with the NDP’s position that there should be 1 nationwide publicly administered public pharmacare plan. A lot of people are now eligible for the Libre, but a lot of people who must use cgms or could use fgms if it were approved for their age group are excluded.

  2. Hmm, So a new wrinkle, when I got tossed out of the US and I have to go live somewhere else (Donald Trump said when I am expelled he will find a new place for me, and he never lies) like in Canada it means I will no doubt need advice on which province to choose to live in. Oh life is so complicated.

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