Starting July 3, the government will lift the age restriction (which was 25 years) for pump coverage.
Man,That is Great news!! Was a little disappointed when I didn’t hear anything about it after the election but Hey!!- I could use this in two years when my pump comes up for renewal. Ins only covers one in a lifetime!
Congrats to my neighbors to the north! That is smart public policy. Any idea what eligibility criteria someone needs to qualify for coverage? Would it be the same in adults as it is in children and young adults?
Let me guess, Pacific Blue Cross?? My insurance is the same. And, although I haven’t used up this once-in-a-lifetime pump, it weighs heavily on my mind because I have no plans to leave my current job anytime soon. So, I’ll have to see what the rules are and whether I can get the government to cover my pump in the fall. Hoping that the t:slim will be on the market by then, too!
These are the current guidelines. I’d expect the new ones would be the same minus the age limit. Seems very straightforward to me.
Yes B/C --If you haven’t already, resister for pharmacare ( online I think ) and you will be covered based on your income,ie: the more you make, the bigger your deduction will be. you can find that info on there as well. You need your last years income tax info. My deduction is the max but B/C pays the first $$ and then bills BC pharmacare after–Go figure–LOL
Looks like it will be provided to anyone who wants one. Not all people with diabetes like pumps but I think they provide great therapy for those who know how to use one.
It’s a good news day down here, too. The Medicare program announced its intention to change its existing prohibition on the use of smartphones in conjunction with CGMs to provide notification to care-givers and family. Mentioned prominently today is the unintended effect the old policy had especially with sight impaired people with diabetes. It was never a well-thought policy but it did provide initial access to CGMs to Medicare beneficiaries.
I’m already registered for Fair PharmaCare, so that’s done. I hope the t:slim will be on their list of covered pumps when it gets here rather than having to wait a year or more as with many insulins (still waiting on Fiasp).
I like the idea of the tslim but had to go with a 630 g, I like it , no cgm though- ins wont cover that for me as my numbers are too good --once again – go figure LOL
Yes, the phone-connected CGMs are the only accessible way to use CGMs. That is good to hear. Insurance companies are starting to pick up CGM coverage a bit here, but many are using highly-restrictive criteria (i.e., requiring a high A1c every year to “re-qualify”) and only including it in their top-tier plans. To my knowledge, no provincial government will cover them. It would be nice if that would change soon.
Looks like it’s not quite as good as it seems at first glance.
"To enable this expansion of insulin pump coverage, the province engaged in a competitive value process to find the best value for insulin pumps in B.C. The result of this process is a tiered approach, where new and existing insulin pump users who qualify for coverage will be provided the tier 1 device (the Omnipod system) at no cost, regardless of which PharmaCare plan they are covered under or what their deductible or family maximum is.
People with an exceptional clinical need, or for whom the tier 1 device is not suitable, can have their endocrinologist or diabetes specialist submit a request for exceptional coverage of the tier 2 device (the MiniMed pump) instead. This device may come with an out-of-pocket cost to the person, depending which PharmaCare plan they are covered under and what their deductible and family maximum are."
I am in BC with Pacific Blue Cross and the once in a lifetime has the R&C beside it which is “Reasonable and Customary Limits”. If you read the comments it is “The number of medical services rendered or supplies bought that is considered reasonable in a certain time period, based on medical rationale.” I have had 3 pumps covered. One approximately every 5 years. The latest was in June of 2017 the Medtronic 630. The full amount was covered.
Given that we can only get Omnipod and Medtronic pumps in BC, there was not a lot to choose from
This is interesting @jen - As you know in the US the Omnipod PDM costs around $199 USD while in Canada we pay $6300 for the PDM.
Pharmacare already covers “Insulin Pump Supplies” and the omnipods are actually covered as “pump supplies” under pharmacare. I love the description of the pods here in the pharmacare documentation.
So… Basically, the large cost (the pods) are already covered, so I assume that Insulet is offering the province a PDM for somewhere between $199 and $6300, which is less than the Medtronic pump cost. So the Province can now claim they are covering pumps for not a lot of extra money. Interesting…
@AE13 The BC Pharmacare listing for the Omnipods is red because it’s new – just been added after the announcement, not “already covered.”
The $6000 cost for the OmniPod systems seems outrageously high, as the next tier, the Medtronic 630G, is quoted as costing $6600.
The Omnipod system covered by BC Pharmacare is not Insulet’s new “Dash” system, but uses the older PDA with the built-in Abbott Libre blood glucose “finger-prick” meter.
Offical docs call it “Omnipod Personal Diabetes Manager CAT45E manufactured by Insulet Canada”, and according to https://diatribe.org/fda-clears-insulets-omnipod-dash-touchscreen-handheld-bluetooth, the Dash system is not yet approved for use in Canada.