What is Diabetes Canada’s position on access to diabetes medications, devices and supplies?
People with diabetes should have timely access to medication, supplies and medical devices that can improve their immediate quality of life and that may decrease the likelihood of future interventions which are often more costly and less effective.
Federal, provincial and territorial governments should commit to the development of an effective formulary system (or systems), which is (are) mindful of products providing the best outcomes based on sound medical evidence and which do not create additional barriers to access.
New products with proven efficacy should be listed in a timely fashion.
Read Diabetes Canada's full position statement on access to diabetes medications, devices and supplies, including background and rationale.
What is Diabetes Canada’s position on the cost of diabetes medications, devices and supplies?
Federal, provincial and territorial governments should commit to a strategy such that the cost to the individual of diabetes medication, supplies and medical devices, as well as the costs associated with diabetes-related complications, are not a barrier or a burden to managing the disease.
Read Diabetes Canada's full position statement on the cost of diabetes medications, devices and supplies, including background and rationale.
Will my diabetes drugs and supplies be covered?
Whether you are covered by a private, employer or public health plan, you cannot assume all your drugs and supplies will be paid for. Each provincial, territorial, private, and employer health plan has its own “formulary” of medications and supplies, which is a listing of drugs and supplies covered by the plan and on what conditions.
Do I qualify for public drug coverage?
Provincial or territorial drug plans provide Canadians with diabetes who are over the age of 65 or receiving social assistance with access to diabetes mediations, devices and supplies listed on provincial formularies. Many provinces and territories provide drug and supplies coverage through income-related deductibles and co-payment programs.
To find out which medications are covered by your provincial public drug program, please read the Provincial/Territorial Formulary Chart.
What if the diabetes medication my doctor prescribed is not covered by my health plan (i.e. it is not listed on my plan’s formulary of medications)?
If you were denied coverage for a drug, an inquiry should be made with the health plan to learn if there are conditions that must be met in order for the drug to be covered. If there is no coverage, discuss alternatives with your physician.
What if the medication I need is not available in Canada?
Your doctor can apply on your behalf to Health Canada’s Special Access program (SAP). The cost of the medication and importation costs is an out-of-pocket expense for the patient.
Is animal insulin still available?
Yes. Although animal insulin is no longer manufactured in Canada or the United States, pork insulin (Hypurin Regular, Hypurin NPH) is available in Canada. Accessing beef insulin would have to be conducted through Health Canada’s Special Access program (SAP).
Will my pump and its supplies be covered?
Most provinces and territories have an insulin pump and supplies program, but eligibility criteria and coverage vary as indicated in the following chart of insulin pumps and supplies programs in Canada.
August 2014
|
Provinces/territories |
Program information |
Pump coverage |
Pump supplies coverage |
Implement date |
|
British Columbia |
Ministry of Health |
Age 25 or under
100% paid to an approved vendor subject to the rules of the Pharmacare plan. Renewable every 5 years.
|
All ages
Pump supplies available according to Pharmacare plan
|
Peds program November 2008
Expanded Feb. 2014
|
|
Alberta |
Alberta Insulin Pump Therapy Program |
All ages
Renewable every five years. A pump must be obtained from one of the four approved insulin pump manufacturers on a direct bill basis.
|
All ages
List of supplies covered can be viewed from the Alberta Health Insulin Pump Therapy Program.
Supplies include test strips
|
June 2013 |
|
Saskatchewan |
Saskatchewan Insulin Pump Program |
Age 25 or under
100% (up to $6,300). Renewable every 5 years.
|
Age 25 or under
Pump supplies are a regular benefit under the Saskatchewan Drug Plan. Supplies cost covered for some who are eligible.
|
Peds program July 2007
Expanded January 2012
|
|
Manitoba |
Contact Diabetes Education Resource for Children and Adolescents (DER-CA) at 204-787-3011 |
Age 17 or under
For medically eligible users, will cover the cost of the insulin pumps at an average cost of $6,000 to $7,000.
|
Age 17 or under |
April 2012 |
|
Ontario |
Assistive Devices Program |
All ages
Must be able to meet specific eligibility criteria to qualify for funding
Covers 100% of the cost of pump; paid directly to an ADP registered vendor of your choice, once funding has been approved
Eligible for a new pump once every 5 years
|
All ages
A yearly grant of $2,400 is paid directly in four equal instalments
|
Peds program: December 2006 retroactive to April 2006
Adult program: September 2008 |
|
Quebec |
|
Age 17 or under
Covers up to $6,300.
|
Age 17 or under
Covers up to $4,000 of supplies
|
April 2011 |
|
New Brunswick |
New Brunswick Pediatric Insulin Pump Program (PIPP) |
Age 18 or under
Covers up to 100% of the cost of pump. It is a sliding scale, based on the size and income of the family. (Means-tested)
|
Age 18 or under
Covers up to 100% of supplies based on the size and income of the family
(Means-tested)
|
January 2012 |
|
Prince Edward Island |
Prince Edward Island Insulin Pump Program |
Age 18 or under
May cover up to 90% of the cost of a pump for children and youth who qualify. Coverage is determined by a number of factors, including family income.
(Means tested)
|
Age 18 or under
May cover up to 90% of the cost of pump supplies based on family income.
(Means-tested)
|
1 July 2014 |
|
Nova Scotia |
Insulin Pump Program |
Age 25 or under
Coverage based on household income (Means-tested)
|
Age 25 or under
Coverage based on household income (Means-tested)
|
September 2013 |
|
Newfoundland & Labrador |
|
Age 24 or under
Coverage based on household income (Means-tested)
|
Age 24 or under
Coverage based on household income (Means-tested)
|
Peds program: November 2008
Expanded program (< 25): April 2010
|
|
NIHB & Yukon/Nunavut/Northwest Territories |
|
All ages
100%. Exception status, reviewed on a case by case basis.
|
All ages
100%
|
N/A |