Good news I guess for Ontarians! My $300 per month outlay for Dexcom will be ending soon after the announcement from the Ontario government. I got a call last week from my diabetes nurse, everyone with T1DM will have free Dexcom!
I need to do some paperwork but they will then send a supply to my home every 90 days.
The pump was already free, paid for by the province. And supplies get reimbursed although you need to pay up front. Insulin isn’t supplied but isn’t too expensive in Canada thank goodness.
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I live in Ontario as well and am using Medtronic Guardian 3 sensors with my pump. I just heard back from my endocrinologist today and not surprising there are a lot of if and’s and buts to receive the ADP coverage. I have lived with Type 1 for 52 years and am desperately hoping they will approve me.
Have you already been approved?
According to the diabetes nurse I’ve been working with, it’s approved with only paperwork formality yet to complete since I am already on the Dexcom and pump. So far I’ve been buying the Dexcom sensors on a monthly plan and have insurance that covers most of the cost. But all completely free, shipped to my home would be great!
I’m also on the Tandem pump (provided by Ontario) but which I have to buy the supplies for and get a check for $600 every three months back (which doesn’t really fully cover my outlay of $500 every two months — but that’s a separate issue).
Yeah I have the ADP pump coverage as well. I also had benefits through work which covered my Guardian sensors until I lost my job during Covid. I loaded up on sensors before my coverage ran out. I have about 3 or 4 boxes left and am hoping to have these covered by ADP as soon as possible. What part of Ontario do you live? We are in North Innisfil just outside of Barrie.
A lot farther North. Thunder Bay.
Have done the CRA disability tax paperwork? That helped a lot in my costs. And they automatically back calculate for ten years. I got a big check.
Probably the most restrictive eligibility criterion is this one:
- Applicant had severe hypoglycemia in the past 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 licence;
II. hospitalization or emergency room or EMS visit; or
III. glucagon administration, unconsciousness, or seizure.
You can download the full description of criteria from this link.
I bet this one is popular!!
Sorry to have such restrictions. US has its own odd procedures and restrictions.
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If I’m disallowed, I can continue with my current private insurance that covers about 90% of my costs.
But this is what I’m counting on:
Q4.6 Can I apply for ADP coverage if I am currently using a real-time continuous glucose monitoring system?
A4.6 If you are currently using a rtCGM, you may be eligible to receive ADP coverage for the sensors and transmitters used with your rtCGM if you meet all of the following:
• use a real-time continuous glucose monitoring system covered by the ADP;
• are followed by an ADP-registered DEP; and
• a physician or nurse practitioner, registered with the ADP-registered DEP as a prescriber, confirms that prior to starting real-time continuous glucose monitoring, you met the device-specific medical eligibility criteria.
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No kidding. I filled the form out yesterday. My endocrinologist is having a group zoom meeting about coverage at the end of the month. Are you living in Ontario?
Yeah, the guidelines for people already on GCM aren’t totally clear. All you need to say is “yes, I needed glucagon, once, three years ago (as long as it was TWO years or less before you started the Dexcom).
=meet criteria!
I think.
There are all kinds of restrictions based on who can get it. I don’t qualify for it. My pump educator sent me the information today. I figured it was too good to be true.
Are you already on the CGM? It seems to me from reading the whole link that if you are initiating coverage you have all these restrictions but if you’re already on it and have T1DM, the restrictions aren’t as severe?
I’m not sure about that. I’ve only seen one version of the application form, so I assume it’s for both groups. Regardless whether you are a current or new user, your ADP-approved endo or nurse practitioner must still certify that you meet “the medical eligibility criteria for rtCGM supplies as outlined in Section 2,” which is what @PattiM posted above.
Holy smokes, you Canadians have got it goin’ on! That is fantastic. I can only hope that one day the U.S. will do that, but I’m not holding my breath.
Well, we do pay a LOT of taxes!! 
My endo is very disappointed about the Ontario plan. Unless you are one of the extremely fragile and in a very real minority, you won’t qualify for Dexcom. Everyone cannot get it, in fact I suspect most T1d’s won’t qualify. I use the Libre 2 because it is paid by prescription under the Ontario Trillium plan. It’s mostly political because they didn’t announce the “if, ands, and buts”
Yes I believe you are correct. I have a zoom meeting with my endocrinologist next week. He is having a group meeting with patients to go over it. I am not optimistic. 
And we pay ALOT for healthcare…lol
Yes, I’m already on it, but it doesn’t matter. I don’t fit into any of the categories for approval. As my educator explained it to me, most of us would probably be in category 2.a), but since it qualifies the “unable to recognize or communicate symptoms of hypoclycemia” etc., with “owing to their developmental stage or a previously diagnosed cognitive or physical impairment,” that disqualifies many, maybe even most adult diabetics. I also don’t fit into any of the categories for 2.b), so it’s definitely a no for me. We can hope that since B.C. and Quebec are covering CGM without caveats, evenually Ontario will as well. Fingers crossed.
My team is disappointed as well.