Question 1

Who qualifies for Ontario Public Coverage?

Accepted Answer

ADP coverage for Dexcom G6 is available for adults and children (2 years and older) living with type 1 diabetes, who are residents of Ontario and have a valid Ontario health card. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6.     To be eligible for coverage, individuals must meet the following Medical Eligibility Criteria:  1. Lives with type 1 diabetes. 2. Meets one of the following:     a) Owing to their development stage or a previously diagnosed cognitive or physical impairment, applicant is:         i) unable to recognize or communicate symptoms of hypoglycemia, or         ii) unable to independently perform fingerstick glucose testing; or     b) Applicant had severe hypoglycemia in the past two (2) years without an obvious precipitant, despite optimized use of insulin therapy and glucose monitoring (at least 4 times/day) which result in one of the following:         i) suspension of the applicant’s driving license; or         ii) hospitalization or emergency room or EMS visit; or         iii) glucagon administration, unconsciousness, or seizure. 3. Applicant demonstrates experience with and commitment to managing blood sugar control and an ability to use CGM safely and effectively by ALL of the following:     a) Applicant demonstrates a commitment to long-term diabetes follow-up through regular assessments by diabetes educators, and prescribers at intervals deemed appropriate by the Diabetes Education Program.     b) Applicant agrees to wear the CGM system full-time.     c) Applicant agrees to share the data components of the Ambulatory Glucose Profile (AGP) with the diabetes health care providers/team such as:         i) percent time in target range, percent time above or below target range, percent time in hypoglycemia; and         ii) visual representation of average 24-hour glucose profile for a 2-week period.

Question 2

How do I get public coverage in  Ontario?

Accepted Answer

To receive coverage through ADP, you will need to be assessed and followed by a healthcare professional associated with a Diabetes Education Program (DEP) registered with ADP.     Your physician can refer you to a registered DEP clinic or you may choose the clinic yourself based on your needs.

Question 3

What if I have private insurance in Ontario?

Accepted Answer

If you or your child meet the medical eligibility criteria or would have met the medical eligibility criteria before using the Dexcom G6, you should visit an ADP registered clinic for an assessment regardless of your current insurance status.  Individual private insurance plans may differ and are subject to change. At this time, it is anticipated that private insurers already covering Dexcom G6 will expect plan members living with type 1 diabetes will be assessed for ADP funding. To help ensure uninterrupted coverage from your private health plan pending ADP determination, visit your healthcare professional to receive a prescription for Dexcom G6 with the notation "ADP Pending" written on it, to go along with your referral to ADP.

Question 4

How do I order my CGM supplies through Ontario Public Coverage?

Accepted Answer

Following your assessment, you or your healthcare professional should submit your completed application form to us as soon as possible by either email or by fax at 1-844-348-0784. We will provide updates via email on the status of your application throughout the application process.     Once you have been approved, we will contact you to confirm your application status and shipping details. We will then arrange for your Dexcom G6 supplies to be delivered right to your door. A Dexcom G6 Receiver is also available at no cost if you do not have a compatible smart device.

Question 5

How long will I be covered under Ontario Public Coverage?

Accepted Answer

The initial approval duration is two years. To continue receiving ADP coverage, you or your child must meet the Renewal Eligibility Criteria and complete the Renewal Form to confirm your continued eligibility every two years.

Question 6

Who qualifies for Alberta Public Coverage?

Accepted Answer

Dexcom G6 is funded for Albertans living with diabetes under the age of 18 who:  1. Require ongoing use of insulin or an insulin pump when prescribed by a Specialist in Endocrinology or Pediatrics. 2. Are enrolled in one of the following programs: Non-Group Coverage or Low-income programs including:  • Child and Family Services   • Alberta Child Health Benefit   • Children and Youth Services   • Income Support   • Learners Program   • Alberta Human Services (AISH)   • Alberta Adult Health Benefit

Question 7

How do I get public coverage in Alberta?

Accepted Answer

You or your child will need to be evaluated by a Specialist in Endocrinology or Pediatrics to ensure you meet the medical criteria of the program.  The specialist does not need to complete any special forms, they will simply write a prescription for Dexcom G6 if you or your child meet the eligibility criteria.

Question 8

What if I have private insurance in Alberta?

Accepted Answer

Alberta Health’s announcement will not impact private health plan coverage.

Question 9

How do I order my CGM supplies through Alberta Public Coverage?

Accepted Answer

Once you receive a prescription from your specialist, you may take it to your local pharmacy for it to be filled. Your pharmacist will submit your claim and, when needed, coordinate coverage between Alberta Health and your private insurance.

Question 10

How long will I be covered under Alberta Public Coverage?

Accepted Answer

Once you receive a prescription from your specialist, coverage will continue until you or your child no longer meet the eligibility criteria.

Question 11

Who qualifies for public coverage in British Columbia?

Accepted Answer

To be eligible for coverage for Dexcom G6 under BC PharmaCare, you must:  • Be registered with Fair Pharmacare, Plan C 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.

Question 12

How do I get public coverage in British Columbia?

Accepted Answer

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.

Question 13

What if I have private insurance in British Columbia?

Accepted Answer

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.

Question 14

How do I order my CGM supplies through British Columbia Public Coverage?

Accepted Answer

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.

Question 15

How long will I be covered under British Columbia Public Coverage?

Accepted Answer

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.

Question 16

Who qualifies for RAMQ coverage?

Accepted Answer

To receive coverage for Dexcom G6 under RAMQ, you must meet the eligibility requirements for the Public Insurance Plan. In addition, you must be:  • living with type 1 diabetes and aged 2 years or older. AND, you must have one or more of the following:   • Failure to achieve an appropriate glycated hemoglobin (HbA1c) value despite taking prescribed medications and testing blood sugar regularly; or • Have experienced frequent episodes of hypoglycemia in the past year despite following a treatment plan; or • Are not able to recognize or report symptoms of hypoglycemia.

Question 17

What if I have private insurance in Quebec?

Accepted Answer

Private insurance plans must minimally offer coverage for medications covered by RAMQ. Now that Dexcom G6 is part of this list of medications, you should now qualify if you meet the eligibility requirements.   Your private plan may still offer coverage even if you do not meet the eligibility criteria. We suggest you contact your insurer for more details or speak to your pharmacist about verifying your coverage.

Question 18

How do I order my CGM supplies through RAMQ?

Accepted Answer

If you are trying to receive coverage under RAMQ or your private insurance plan, Dexcom CGM supplies must now be purchased at your local pharmacy. You will need a prescription from your physician or pharmacist to enable direct billing to RAMQ or your private insurer.

Question 19

How do I get coverage through RAMQ?

Accepted Answer

The first step is to tell your physician or pharmacist that you’d like to receive a prescription for the Dexcom G6 CGM System. They will then:  1. Complete an Exceptional Medication Form and submit it to RAMQ for approval. 2. Give you a prescription for Dexcom G6 that you will bring to your local pharmacy. 3. Once you have been approved, the pharmacy will process your order for Dexcom CGM supplies.

Question 20

How long will I be covered under RAMQ?

Accepted Answer

Once approved, your initial request is good for six months. After that, your doctor will reassess you and submit a request to continue treatment. Subsequent requests are authorized for 12 months at a time.

Question 21

Who qualifies for Saskatchewan Public Coverage?

Accepted Answer

To receive coverage for Dexcom G6 under the Saskatchewan Drug Plan, you must be:  • Under the age of 18, and  • On intensive insulin therapy, and  • Eligible under the provincial requirements, and  • Have an approved Exception Drug Status Application or a prescription from an approved Designated Prescriber noting that you meet the medical criteria for the Dexcom G6 CGM System.

Question 22

Who should apply for Saskatchewan Public Coverage?

Accepted Answer

We encourage residents of Saskatchewan whose child is under the age of 18, on intensive insulin therapy, and who is eligible under the provincial requirements to contact their pediatric diabetes specialist to initiate the coverage assessment process on your child's behalf.     If for some reason your child does not meet the criteria and your request is denied, you will still be able to seek reimbursement through your private insurance plan.

Question 23

How do I get public coverage in Saskatchewan?

Accepted Answer

Contact your pediatric diabetes specialist to initiate the coverage assessment process. If your approval is successful, your Dexcom supplies will be covered in full under the Saskatchewan Drug Plan.

Question 24

How do I order my CGM supplies through Saskatchewan Public Coverage?

Accepted Answer

You will now have the option of purchasing your Dexcom supplies from your local pharmacy or directly from us.      To receive reimbursement through the Saskatchewan Drug Plan you will not be able to make purchases through the online Dexcom Store or our Subscription Program. However, we will be able to set up recurring shipments if you’d like to call in to order. If you have been approved under the provincial plan and would like to continue ordering from us directly, please contact our Customer Service team via email or 1-844-832-1810 (Mon-Fri 8am-7pm CST) to ensure we have everything we need to directly bill the province.     You are able to submit a claim for nine (9) G6 sensors and one (1) G6 transmitter every 90 days. If the quantity of your claim exceeds this approved limit by the Saskatchewan Health program you will be required to cover the additional costs.

Question 25

Who qualifies for Manitoba Public Coverage?

Accepted Answer

People living with Type 1 diabetes who are 25 years of age or under and meet all the following criteria:  1. Are either:  i. Currently approved for the Manitoba Pediatric Insulin Pump Program (MPIP) administered by the Winnipeg Regional Health Authority (WRHA) through the Child Health Program’s Diabetes Education Resource for Children and Adolescents (DER-CA); OR ii. On both basal AND bolus insulin. 2. Under the care and management of a Manitoba endocrinologist, diabetes specialist, or metabolic physician, and has routine follow-up with their diabetes care team;  3. Individual and/or their caregiver demonstrates the capacity to use the CGM system appropriately;  4. Individual and/or their caregiver demonstrates a reasonable understanding of what the CGM system can do and how it can benefit their care;  5. Individual and/or their caregiver agrees to use the CGM system properly and to use the data from this technology to make safe and effective diabetes management decisions.

Question 26

How do I get public coverage in Manitoba?

Accepted Answer

If you believe you or your child meet the program criteria, contact your endocrinologist or diabetes specialist. They will be able to assist in determining eligibility and provide you with a written referral.

Question 27

What if I have private insurance in Manitoba?

Accepted Answer

All individuals who qualify for Pharmacare coverage should enroll to in the program, even those with private insurance.   When enrolled in Pharmacare and eligible for CGM coverage:   • Your pharmacist will direct bill Pharmacare first, which will determine if you have reached your annual deductible amount.  • If the deductible is not met, Pharmacare will not pay and the claim will charged to your private insurance plan.  • If the deductible is met Pharamcare will cover 100% of costs.

Question 28

How do I order my CGM supplies under Manitoba Public Coverage?

Accepted Answer

Once you have a prescription from your endocrinologist or diabetes specialist and your request for coverage has been pre-approved by Pharmacare, you will be able to order your Dexcom CGM supplies from your local pharmacy.      Unless you have private insurance, you will be required to pay out-of-pocket until your Pharmacare deductible has been met for the year. Manitobans receiving Employment and Income Assistance will not be required to pay any out-of-pocket costs

Question 29

How long will I be covered through Manitoba Public Coverage?

Accepted Answer

The initial approval duration is one year. Coverage may be continued annually if the program criteria continue to be met.

Question 30

Who qualifies for public coverage in Prince Edward Island?

Accepted Answer

Individuals are eligible if they:  • Are a permanent resident as defined by the Drug Cost Assistance Act; • Have a valid PEI Health Card; • Filed their most recent income tax return; • Are diagnosed by a medical practitioner or nurse practitioner as having diabetes; • Are reliant on an insulin pump or multiple daily injections of insulin (i.e. 3 or more) to manage their diabetes; and • Have a signed Special Authorization form from their medical practitioner, nurse practitioner or certified diabetes educator.

Question 31

How do I get public coverage in Prince Edward Island?

Accepted Answer

First, an application must be submitted by mailing a completed PEI Glucose Sensor Program Initial Family Contribution Assessment and Release of Information form to:  Glucose Sensor Program Administrator,  Health PEI  16 Garfield Street  Charlottetown, PE  C1A 6A5  You may download and print the application form from the Health PEI website or pick up a copy at your local Health PEI Diabetes Education Centre.  Within this initial application form, there is a one-page Special Authorization document that must be completed by a medical practitioner, nurse practitioner or diabetes educator. Please ensure it is complete and signed prior to submitting the application.

Question 32

What if I have private insurance in Prince Edward Island?

Accepted Answer

If you have private health insurance that provides partial coverage for glucose sensors, your co-payment will be the lesser of:  - 20% of a standard copay, - the amount remaining after payment by your private insurance.

Question 33

How do I order my CGM supplies through Prince Edward Island Public Coverage?

Accepted Answer

Once enrolled for benefits under the Glucose Sensor Program, you must purchase your CGM supplies at your local pharmacy.

Question 34

How long will I be covered through Prince Edward Island Public Coverage?

Accepted Answer

You or your loved one will be eligible for benefits for up to one year. Benefits will end each year on June 30th, regardless of your approval date.     You will need to re-apply by July 1st each year to continue your benefits coverage and may do so any time between April 1st and June 30th. When reapplying, your income tax for the previous year must have been filed with the Canada Revenue Agency.     Coverage will be continued as long as you or your loved one continue to meet the eligibility criteria.

Question 35

Who qualifies for public coverage in Yukon?

Accepted Answer

All Yukoners living with type 1 diabetes will now have access to fully funded continuous glucose monitoring.

Question 36

How do I get public coverage in Yukon?

Accepted Answer

Yukoners living with type 1 diabetes who meet the benefit criteria must register with the Chronic Disease and Disability Benefit program at 1-867-667-5092. People aged 65 or older can contact the Pharmacare program at 1-867-667-5403.

Question 37

How do I order my Dexcom CGM supplies through Yukon Public Coverage?

Accepted Answer

Those approved will have the option of purchasing their Dexcom supplies from their local pharmacy or Dexcom directly.     To order from Dexcom directly, please contact our Customer Service team via email or 1-844-832-1810 (Mon-Fri 9am-6pm PST) to ensure we have everything we need to directly bill the territory.

Question 38

Where can I find more information on the Yukon program?

Accepted Answer

For more information, click here.

Question 39

Who qualifies through the Non-Insured Health Benefits (NIHB) program?

Accepted Answer

NIHB program members ages 2 to 19 years old who are on intensive insulin therapy are covered in full under the program. Intensive insulin is defined as taking short-acting insulin three or more times per day.

Question 40

How do I get coverage through the Non-Insured Health Benefits (NIHB) program?

Accepted Answer

Your doctor or pharmacist can apply for coverage on your behalf by contacting the NIHB Drug Exception Centre at 1-800-580-0950. After completing and submitting a Limited Use Request form, your healthcare provider will be able to update you on the status of your approval.

Question 41

How do I order my CGM supplies through the Non-Insured Health Benefits (NIHB) program?

Accepted Answer

Once your coverage is approved by the NIHB Drug Exception Centre, your pharmacist will be able to order your Dexcom CGM supplies to your local pharmacy. Your pharmacist can confirm your coverage is in place and bill the cost of your supplies directly to the NIHB program.

Question 42

How long will I be covered under the Non-Insured Health Benefits (NIHB) program?

Accepted Answer

Coverage approvals are long-term and do not require resubmission.

Coverage For Dexcom CGM

Have Insurance Questions?

Ontario Public Coverage

Alberta Public Coverage

British Columbia Public Coverage

Quebec Public Coverage

Saskatchewan Public Coverage

Manitoba Public Coverage

New Brunswick

Newfoundland and Labrador

Northwest Territories

Prince Edward Island

Yukon

NIHB

For people living with T1D or T2D on fast-acting insulin

Most Private Insurers Cover Dexcom CGM*

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