British Columbia Public Coverage
All B.C. residents can register for Fair PharmaCare, an income-based plan that covers eligible drugs and medical supplies. Residents may also be eligible for PharmaCare’s Income Assistance Plan (Plan C) and First Nations Health Benefits Plan (Plan W). Those who meet the clinical criteria set by BC PharmaCare for the Dexcom G6 CGM System will receive coverage according to the rules of their BC PharmaCare drug plan. For more details about BC PharmaCare’s drug plans, please visit their website.
Who qualifies?
To be eligible for coverage for Dexcom G6 under BC PharmaCare, you must:
- Be registered with Fair Pharmacare, Plan C, Plan F or Plan W; and
- Have your primary care provider or endocrinologist confirm you meet the provincial clinical requirements; and
- Have your primary care provider or endocrinologist submit a BC PharmaCare Special Authority request on your behalf.
How do I get coverage?
Contact your primary care provider or endocrinologist to initiate the BC PharmaCare Special Authority approval process. If your approval is successful, your future Dexcom purchases will need to be made at your local pharmacy.
What if I have private insurance?
Group and individual private insurance plans in BC are generally designed to supplement coverage provided by Fair PharmaCare. Your private insurance may cover some or all of the cost of your Fair PharmaCare deductible. After you meet your deductible, PharmaCare helps you with eligible costs for the rest of the year. Some or all of your out-of-pocket costs not covered by PharmaCare may be eligible for coverage under your private insurance as well.
How do I order my CGM supplies?
Once your primary care provider or endocrinologist has submitted a Special Authority application. Please confirm that the request has been approved before you bring your prescription to your local pharmacy. Call your prescriber or pharmacist to confirm, or call PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland).
When you present your prescription at the pharmacy, the pharmacist will submit your coverage claim to BC PharmaCare and, when needed, coordinate coverage between BC Pharmacare and private insurance. Please be aware that BC PharmaCare will not retroactively reimburse for benefits purchased before approval of a Special Authority request.
How long will I be covered?
Initially you will be covered for 1 year. After that time, your coverage may be renewed if you continue to require intensive insulin therapy and your healthcare professional recommends that you would benefit from continued CGM use. After than initial 1 year period, coverage may be renewed for 5 years.
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Have Insurance Questions?
We are here to help. A Dexcom Account Specialist can assist you in determining your benefits for CGM coverage. Get started by filling out our online form or call us toll-free at 1-844-832-1810.