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In memory of "Pumper Paul"
who's dedication and drive brought us the first insulin pump bill in
Canada The fight for insulin pump coverage in all
provinces across Canada has been going on for too many years! We are
finally seeing the results of dedication and drive by people throughout
this country. Ontario has insulin pump coverage for children and adults.
Saskatchewan announced in its March 2007 budget that it will also be
covering insulin pumps for children. Newfoundland has also joined those
provinces will offer assistance to people with diabetes up to age 25. British Columbia also now offer coverage for children
under 18 years! Let's continue to
fight to ensure that all provinces cover insulin pumps. Children are our
first step but not the last. We will all continue to push to see that
EVERYONE who wishes to use an insulin pump in Canada will be able to do
so.
Provinces offering pump
coverage British Columbia:
British Columbia currently provides insulin pump and
supply coverage for children under the age of 18 years.
From the government website...Effective
November 17, 2008, PharmaCare covers insulin pumps for children
and adolescents age 18 or younger with Type 1 diabetes or other forms of
diabetes requiring insulin. Supplies for insulin pumps are covered for
both children and adults.
Who is eligible for coverage?
Insulin pump coverage is available to children who:
- are 18 years of age or younger, and
- have Type 1 diabetes or another form of diabetes requiring
insulin, and
- are covered under Fair PharmaCare or PharmaCare Plan C (B.C.
Income Assistance Recipients), and
- whose diabetes physician confirms that they meet the
medical criteria.
How much will PharmaCare cover?
PharmaCare covers 100% of the cost of one of the approved insulin pumps
every five years subject to the rules of your PharmaCare plan. For
instance:
- if you are on Plan C (B.C. Income Assistance), PharmaCare covers
100%
- if you are covered under the Fair PharmaCare plan, PharmaCare
covers 70% of costs above your deductible and 100% of costs above
your family maximum.
Important: Be sure to register for Fair PharmaCare before
purchasing an insulin pump to ensure you get maximum coverage.
How do we obtain coverage?
The first step is to speak to your diabetes physician specialist. If
your child meets the medical criteria for coverage of a pump, the
specialist will submit a Special Authority request to PharmaCare.
When your physician specialist requests coverage, your child (or their
parent or guardian) will need to sign a form confirming that they are
committed to blood glucose monitoring, to the safe and appropriate use
of the insulin pump and to ongoing age-appropriate diabetes education.
If the request is approved, we will send an approval letter to your
specialist's office. Your specialist will give you a copy of this letter
to take to the insulin pump vendor of your choice.
Important: Be sure to wait for the approval letter before
purchasing the insulin pump. PharmaCare cannot provide retroactive
coverage for purchases made before approval is confirmed.
Where should I buy my insulin pump?
You may buy your insulin pump from any
approved vendor in B.C.
What if I encounter problems using a pump instead of regular
injections?
Speak to your diabetes specialist. If, in consultation with your
specialist, it is determined that you cannot continue using a pump, you
may be able to return it. Some vendors may allow you to return the pump
for a refund in the first 90 days after purchase. In this case, the
vendor will reverse the PharmaCare claim and refund any portion of the
cost you paid.
How often will PharmaCare cover a new pump?
PharmaCare covers only one insulin pump every five years and does not
cover repairs.
You may want to check that your home insurance covers any damage to the
pump that is not covered under the manufacturer warranty.
What if my pump stops working after the five year period is up?
If your pump is beyond economical repair, contact the vendor of your
pump and ask for a letter confirming your warranty expiry date. Take the
letter to your diabetes physician. Your specialist will include the
letter from the vendor with the Special Authority request to PharmaCare.
What if we already own an insulin pump that was not covered by
PharmaCare?
PharmaCare coverage is available if you meet the medical criteria for a
subsequent pump, your current pump is four or more years old and the
manufacturer's warranty has expired.
Your specialist can submit a Special Authority request to PharmaCare for
coverage.
Contact your pump vendor for a letter confirming your warranty expiry
date. Your specialist will include this proof that your warranty is
about to expire with the Special Authority request.
Insulin Pump Supplies
Who is eligible for coverage?
Individuals of any age who are covered by the Fair PharmaCare Plan, Plan
C (Income Assistance Recipients) or Plan F (At Home Program) are
eligible for coverage of certain insulin pump supplies. This coverage is
available whether or not your pump was covered by PharmaCare. PharmaCare
pre approval is not needed for insulin pump supplies.
Which supplies are covered?
PharmaCare covers infusion sets/kits and insulin pump
reservoirs/cartridges as shown on our
Insulin
Pump Supplies page. PharmaCare does not cover batteries, battery
caps, adhesive pads, etc.
Where should I buy my insulin pump supplies?
You can buy insulin pump supplies from any pharmacy and some approved
vendors
in British Columbia. All pharmacies and approved vendors can submit
claims to PharmaCare.
Other Diabetes Supplies
Blood Glucose Test Strips
PharmaCare covers blood glucose test strips
for individuals covered under Fair PharmaCare, Plan C (Income
Assistance) and Plan F (At Home Program).
PharmaCare covers your blood glucose test strips if:
- blood glucose testing has been deemed medically necessary for
you; and
- you have a Certificate of Training issued by a Diabetes
Education Centre.
Your Diabetes Education Centre will provide you with a printed
certificate (in a wallet card form) and fax your information to
PharmaCare.
Usually, a Certificate of Training gives you permanent PharmaCare
coverage of testing strips. However, if the Diabetes Education Center
enters an end date on your certificate (for instance, if you have
gestational diabetes), coverage of testing strips is only for the period
shown on your certificate.
Needles and syringes
PharmaCare covers 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.
Insulin
PharmaCare covers insulin if you are covered under Fair PharmaCare, Plan
B (Permanent Residents of Residential Care), 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.
PharmaCare covers most insulin up to the regular retail price but does
not cover a dispensing fee.
from
http://www.health.gov.bc.ca/pharme/medsup.html
Newfoundland:
The Newfoundland and Labrador Pump program is open to children living in
the province who have not yet turned 18 years of age. Those who are
prescribed an insulin pump by their physician, have no private pump
coverage and comply with guidelines provided by their diabetes care team
are eligible to receive their insulin pump, infusion sets, and
cartridges under this provincial program. Diabetes care centers
will help you to complete the application process.
March 29, 2010 budget announced the expansion of the existing Insulin
Pump Program to now include young adults up to age 25. Please watch for
further details or contact your diabetes care center.
Ontario:
Adult coverage is now available as of September 2008
Adults with type 1 and children with type 1 are now
as of September 1, 2008 eligible for insulin pump funding and the $2,400
grant for supplies. The Ontario Disability Support Programme is
funding ALL diabetic supplies for its clients and other people in the
benefit unit (read spouse and dependents). All diabetic supplies
includes all insulin pump supplies. The pump is available for
people with type 1 Diabetes if they apply to ADP
Details as of January 2007
We are pleased to inform you of an
initiative of the Ontario provincial government to fully fund insulin
pumps and provide a grant to help pay for insulin pump supplies for
children and youth with type 1 diabetes that live in the Province of
Ontario.
This exciting initiative, announced by the Ministry of Health and Long
–Term Care, will ensure that cost is not a barrier to the initiation of
insulin pump therapy in children and youth. This program is administered
by the Assistive Devices Program (ADP) and became effective December
1st, 2006. If you have purchased a pump and ongoing pump supplies
between April1 and November 30, 2006 and do not have 100% third party
coverage, then you may apply for the portion of the costs incurred
directly by you (eg. 20% not covered by insurance).
We have identified that you/your child is presently on an insulin pump
and you may be eligible for reimbursement of expenses under this
program. In order to do so you must submit an application and the
following items:
~Original receipts of the pump purchase and pump supplies indicating
the portion of costs incurred by you.
~If you started pump therapy prior to April 1st, 2006, you are also
eligible for reimbursement for the portion of costs related to supplies
incurred by you from April 1st to November 30th. You must submit
receipts of the supplies indicating portion paid.
To receive this grant for future insulin pump supplies, an application
must be made by our center on your behalf. In order for us to complete
this application, we must do an assessment to ensure you/your child
meets the established criteria outlined by this program. To be eligible
for the program, you/your child must have:
~ Completed an insulin pump education program
~Demonstrated a commitment to blood glucose monitoring before each
meal and before bedtime
~Commitment to ongoing recording of blood glucose results
~Demonstrated appropriate site rotation
~Demonstrated appropriate sick day knowledge and management
~No more than one DKA in last 6 months
~Maintained regular clinic visits (at least 3 visits in previous year)
~HbA1c less that 10
For applications and further information visit the ADP website at:
http://www.health.gov.on.ca/english/providers/program/adp/adp_mn.html
or contact your diabetes center for further information.
FAQ:
Although the MOH has indicated this
program is retroactive to April 1, 2006 is there an actual start date
to begin the process?
This new insulin pump and supplies program is scheduled to begin early
December. Please contact your Pediatric Diabetes Centre after December
1st, for details.
We understand the program is retroactive to April 1, 2006 for both
pumps and pump supplies, who do we contact in order to start the process
for reimbursement as we had to already purchase an insulin pump and or
supplies for our children?
This reimbursement process will begin at the same time as the program
for new pumps, please watch for further details on the Ministry of
Health and Long-Term Care (MOHLTC), Assistive Devices Program (ADP)
website at the following link:
http://www.health.gov.on.ca/english/public/program/adp/adp_mn.html
You must still work with your
Diabetes Pediatric Centre who will have complete details after December
1st, 2006.
We understand that insulin pumps under this program will be covered
100%, we do not have to pay a co-payment, however how do I start the
process to see if we can get coverage for an insulin pump and or
supplies for our children?
As with the first question, please contact your Pediatric Diabetes
Centre after December 1st, for complete details and process information.
You may also visit the following MOHLTC – Assistive Devices Program link
for information regarding the program. Use the link below.
http://www.health.gov.on.ca/english/public/program/adp/adp_mn.html
If I have any special
questions, whom would I contact?
Assistive Devices Program staff would be most pleased to answer
questions, phone contact information is provided below:
Contact numbers for ADP by telephone:
(416) 327-8804
Toll Free 1-800-268-6021
TDD 1-800-387-5559 or local 416-327-3282
Saskatchewan:
Government of Saskatchewan
Budget 2007-08 Making Life Better in Saskatchewan
March 22, 2007
Diabetes advocates welcomed the recent Saskatchewan
provincial budget announcement of a Children’s Insulin Pump Program. The
new program will provide children under the age of 17 who meet
eligibility requirements with one pump every five years, and coverage
for insulin pump supplies as regular benefits under the Drug Plan. This
commitment will benefit families
who pay approximately $6,000 per pump and an additional $300 per month
in supply costs.
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