What is the Canadian Diabetes Association’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 the CDA's full position statement on access to diabetes medications, devices and supplies, including background and rationale.

What is the Canadian Diabetes Association’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 the CDA'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