Are you living with Type 1 diabetes in Ontario? If yes, chances are you’ve probably witnessed the shock when a stranger finds out that Insulin is not free. Perhaps you’ve heard: “But we have OHIP here! That means it’s free!” “But it’s listed on the formulary. Anything on there the government pays for.” “My grandma has diabetes and she never has to spend money on insulin!”
As the costs of living with Type 1 diabetes continue to increase, we thought it was important to help you take a look at what the costs for you, as an individual are, associated with taking care of your Type 1 diabetes in Ontario; to break down what it means for a drug or device to be ‘covered’ in Ontario, how you may be able to access these provincially subsidized plans, and to provide you with some information so you can better navigate the ‘but insulin is free’ conversation over holiday dinner in our 5 part series.
- Part 1 – Ontario Diabetes Cost Calculator
- Part 2 – Trillium Drug Coverage Explained
- Part 3 – Assistive Devices Program
- Part 4 – Coverage for Seniors & OHIP+
- Part 5 – Disability Tax Credit & RDSP
If you’re living in another province, we hope to provide similar information to help you navigate the system at home. Keep your eyes peeled on our blog!
Please note that we’ve done our very best here to collect and sift through information, to create a tool that we hope will be useful, and to help folks navigate the world of diabetes costs in Ontario. We’ll work on keeping this tool and blog updated, but use it as an estimate and know that individual circumstances will, of course, vary.
The basics on how Canadian healthcare works.
In Canada, the roles and responsibilities of providing healthcare are divided between the federal, provincial and territorial governments. Before launching into this, we’ll admit, we are really simplifying things here. If you are interested in learning all of the ins and outs of the system and how it was developed, we suggest reading more, here.
On the most basic level, the Federal government sets out the rules that each of the provinces and territories must follow in order to qualify for federal healthcare funding. This is done, largely, by the Canada Health Act (1985). One example is that a provincial or territorial health insurance plan must be operated on a non-profit basis. Provinces and territories deliver and oversee most healthcare services locally. Most relevant to the topic of diabetes devices and drugs, provinces determine and manage their own diabetes device funding programs and decide what drugs will be added to the provincial formulary (see below.)
The CIM Team has worked on creating an Online Diabetes Costs Calculator for a few reasons:
- To provide a tool for people to use to plan for and understand the costs of various methods of managing diabetes in Ontario
- Help people better understand how the government programs in Ontario help people with Type 1
- Give people something to compare their current situation to, to make sure they are making the smartest choices for themselves
We encourage you to plug in your variables, and see where you sit in terms of out of pocket costs, potential benefits you could get from using the Assistive Devices Program (ADP) or one of the various Ontario Drug Benefit (ODB) programs, including Trillium.
The Fine Print
- We have done our best to use the most up-to-date non-sale or subscription prices listed on the internet for various products. These are accurate as of February 2020. We aim to keep these updated but have also linked to the source. If you notice that prices have changed, please flip us a note!
- This calculator assumes you are between the ages of 25 and 65 and living with diagnosed Type 1 diabetes in Canada. If you are under 25 or over 65, check out Part 4 of the blog series.
- Whenever possible, prices are quoted directly from the manufacturer.
- CIM has been unable to locate any online, published pricing for insulin pumps in Canada. We are waiting to hear directly from the companies who make these products themselves. In lacking this information, we are using what we have been found to be the most reliable quote for the average cost of a tubed insulin pump in Canada of $6500 and Tubeless PDM of $3200. The total cost of the pump or PDM has been divided evenly over the 4 year warranty period.
- Once you’ve checked out the Cost Calculator, head on over to Parts 2, 3, and 4 of the blog to read more about the programs referenced below (ADP and Trillium)
