Disclaimer: Please check out CIM’s Partners Page to learn more about the companies we work with. It’s important for CIM to recognize and to disclose that our writing may be biased, based on the fact that Dexcom Canada provides sponsorship and support to CIM. We work hard to get information into the hands of the diabetes community whenever we feel it may help people live life without limits.
Continuous glucose monitors (CGMs) such as Dexcom G6 have really transformed the diabetes management landscape. Being able to see glucose levels continuously is a total game-changer for the fingertips, safety, and peace of mind of people living with diabetes. Studies have shown that continuous glucose monitoring has positive effects on glycemic control, and there is evidence that starting a CGM soon after diagnosis can lead to better outcomes. CGM data can be especially helpful to support virtual diabetes care, which has had an important role in the COVID-19 pandemic. Recently, Dexcom G6 has also been integrated with insulin delivery in hybrid closed loop systems.
Despite all of these benefits, CGM coverage is unfortunately still limited to only small subsets of individuals. Here, we will take a closer look at current Dexcom access and coverage options in Canada and discuss where it might be headed in the future.
Status of Dexcom Access in Canada
Dexcom Canada has put together a comprehensive summary of Dexcom insurance coverage by province. We will give a brief overview of the information they have provided, but check out their website to learn more.
In terms of public insurance…
Provinces with broad coverage in people living with T1D and T2D:
- British Columbia was the first province to announce Dexcom G6 coverage for individuals with type 1 and individuals with type 2 diabetes on multiple daily injections of insulin under BC Pharmacare public plans. A special authorization form needs to be completed by a prescriber confirming the medical eligibility criteria have been met and request must be approved by BC Pharmacare
- Prince Edward Island very recently announced the Glucose Sensor Program and Dexcom G6 is covered for individuals with type 1 and individuals with type 2 diabetes on multiple daily injections of insulin. An application form must be completed and a Special Authorization document that must be completed by a medical practitioner, nurse practitioner or diabetes educator
Provinces/territory with coverage in T1D for all age groups:
- Quebec offers Dexcom G6 coverage under RAMQ for people with type 1 diabetes. To receive coverage, a RAMQ exception drug form must be completed by a prescriber for prior approval by RAMQ.
- Ontario covers Dexcom G6 under Assistive Devices Program (ADP) for all Ontarians with type 1 diabetes who meet the medical eligibility criteria. Conditions for coverage require that individuals be referred to an ADP registered diabetes education program (DEP) in the province and followed-up periodically by that DEP for continued coverage. The ADP application form is then submitted to ADP by Dexcom
- Yukon Health covers Dexcom G6 under the chronic disease program for all residents with type 1 diabetes who do not have private insurance or covered by the Non-Insured Health Benefits (NIHB). A prescriber needs to contact Yukon Health for prior approval.
Provinces with age restrictions:
- Alberta covers Dexcom G6 for Albertans living with diabetes under the age of 18 who require ongoing use of insulin and are enrolled in non-group coverage or a low-income program. No special authorization form is required but individuals need to be evaluated by a Specialist in Endocrinology or Pediatrics.[LS1]
- Saskatchewan covers Dexcom G6 for people under the age of 18 who are on intensive insulin therapy. Individuals must meet the medical eligibility criteria and followed by a designated prescriber or non-designated prescribers need to complete an application form for prior approval by Saskatchewan Health.
- Manitoba covers Dexcom G6 for people with type 1 diabetes age 25 and under. An Exception Drug Status (EDS) form must be completed by a diabetes specialist to confirm you meet the medical eligibility criteria and approval by Manitoba Pharmacare.
- Non-Insured Health Benefits (NIHB) covers Dexcom G6 for program members ages 2-19 who are on intensive insulin therapy once a limited use request form has been completed and approved by NIHB. NIHB also provides coverage for adults on intensive insulin on a case-by-base basis.
Provinces and territories without public CGM coverage currently:
- New Brunswick
- Nova Scotia
- Newfoundland and Labrador
- Northwest Territories
- Nunavut
In terms of private coverage…
Most private insurers now cover Dexcom G6 for people with type 1 and type 2 diabetes on fast-acting insulin. Increasingly, private plan coverage is transitioning from manual “medical” claims to automated pay-direct claims in pharmacy, which can be more convenient and cost-effective. We encourage you to contact your insurance provider or HR plan administrator if you would like to learn more about your specific situation. Dexcom Account Specialists are also available by phone to talk you through your public coverage and private insurance coverage options.
Increasing Dexcom Access for All Canadians
While huge strides have been made to increase provincial insurance coverage for CGMs, there is still significant work to be done to make CGMs as accessible as possible to all Canadians. Some provinces do not provide any coverage for CGMs while in other provinces there are either age restrictions as we see in Alberta, Saskatchewan, and Manitoba or significant barriers to access as many individuals are experiencing with ADP in Ontario. At Connected in Motion, we understand the importance of supporting people living with diabetes throughout their entire life and into adulthood.
One avenue that is being explored to increase Dexcom access is pharmacy distribution. If you are someone that currently purchases your Dexcom supplies through the Dexcom eStore, be aware that you may now obtain your supplies at a pharmacy instead. You may be eligible for coverage through a government-funded program or have pay-direct pharmacy coverage through your private insurer. Check with your pharmacist to determine your eligibility.
Advocacy from the diabetes community can also play a big role in expanding access to diabetes supplies. If you would like to get involved in advocacy for CGM coverage, or diabetes advocacy more broadly, here are a few tips for getting started:
Think global, act local. When feeling overwhelmed with big problems, it can be helpful to realize that local issues are representative of larger systems so small wins can have rippling consequences. Consider focusing your advocacy efforts locally, where you know the environment best.
Familiarize yourself with the landscape. If you are new to an advocacy space, read up on the relevant policies, talk to folks already involved, and learn what initiatives are underway. You probably don’t have to start from scratch! Ask how you can best support plans already in place.
Find your network. Connect with involved groups. Research new groups to potentially partner with. Identify friends that may be interested and enlist their help. Make friends at an event. There’s strength in numbers!
Establish clear messaging. Not everyone is going to be as familiar with the issue as you are. Think about what you want your main takeaways to be for your audience. Why is this issue important and what can they do to help? It’s easier for people to get involved if they are given quick & clear calls to action.
Share your story. Speaking about your personal experiences can be very powerful. Take some time to figure out what you feel comfortable sharing publicly and use it! Whether you’re writing a letter to a local representative, speaking at a rally, holding a teach-in, posting on social media, or handing out flyers, infusing a few sentences about why the issue is important to YOU always helps.
With the value that continuous glucose monitoring can add to life with diabetes, CGMs should be readily available to everyone who can benefit. Until this is the case, advocacy and awareness efforts can help expand access to CGMs for all Canadians.
Editorial Note: To further advance this advocacy work, an independent research group, supported by a grant from Dexcom Canada, has launched a survey to better understand gaps in CGM coverage across the country. Data gathered from the survey will provide evidence-based findings for advocacy efforts with provincial governments across the country for all glucose monitoring systems and users. You can access this survey here.
