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Have you heard? Dexcom and Medtronic CGMs are now covered on the Assistive Devices Program (ADP) in Ontario! Here are some questions we’ve been fielding with this new program:
How do I know if I qualify for Dexcom/Medtronic CGM coverage under ADP?
Eligible individuals include those with type 1 diabetes whom are at risk of severe hypoglycemia or who are unable to recognize, or communicate about, symptoms of hypoglycemia.
Click the button to download the application form if you’d like to see the detailed criteria and other questions asked. Application form
The form does need to be completed by an Endocrinologist or another Specialist Physician or Nurse Practitioner who is associated with one of the diabetes programs in Ontario, such as at LMC Diabetes & Endocrinology Healthcare Centres. Click the button to visit our website: LMC Diabetes & Endocrinology
What if I do not meet the ADP criteria?
If you do not meet the ADP criteria for coverage of CGMs, you can still get Dexcom or Medtronic CGMs; however you would need to pay for these and/or claim them on your private insurance plan. Lately, more and more insurance groups are allowing for coverage of CGMs under their prescription drug plans.
To find out whether your drug plan covers Dexcom or Medtronic CGMs, please contact a representative at LMC Pharmacy, where they can check for you.
What are my glucose monitoring options and how does coverage work in Ontario?
Current terminology as of 2021
CBG
Capillary blood glucose
Measuring capillary blood glucose using finger sticks
Measuring interstitial fluid glucose via intermittent scanning of sensing device
rtCGM
Real-time continuous glucose monitoring
Measuring interstitial fluid glucose via a sensing device that continuously transmits the data to a device with real-time display for viewing at any time
Previously referred to as
Self-monitored blood glucose (SMBG) or blood glucose meters
Flash glucose monitoring (FGM)
Continuous glucose monitoring (CGM)
Devices
Accu-Chek Guide
Contour Next/One Freestyle Lite
OneTouch Verio
Oracle
Libre
Libre 2
Dexcom
Medtronic Guardian Sensor 3
Coverage – ADP
Not covered via ADP
Not covered via ADP
If a person qualifies for ADP coverage of rtCGM, it will be supplied at no charge to you via the vendor
Coverage – ODB drug plan
Via Pharmacies –similar process as prescription medications
LMC Pharmacy locations also have Certified Diabetes Educators for training
Via Pharmacies –similar process as prescription medications
LMC Pharmacy locations also have Certified Diabetes Educators for training
Not covered on ODB
Coverage – Private insurance/drug plans
Via Pharmacies –Most private drug plans include this as a benefit; similar process as prescription medications; plan may have a co-pay or deductible.
LMC Pharmacy locations also have Certified Diabetes Educators for training
Via Pharmacies –Most private drug plans include this as a benefit; similar process as prescription medications; plan may have a co-pay or deductible.
LMC Pharmacy locations also have Certified Diabetes Educators for training
Dexcom – Via Pharmacies – Some private drug plans include this as a benefit; similar process as prescription medications; plan may have a co-pay or deductible. Some plans require you to pay first then submit a manual claim to the insurance company – in which case you can purchase on prescription or over-the-counter; although you should check whether your plan requires a prescription for coverage.
LMC Pharmacy locations also have Certified Diabetes Educators for training
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Medtronic Guardian 3 Sensors – not generally available via Pharmacies.
Available viaLMC Pharmacy’s Diabetes Depot online shop as a specialized diabetes pharmacy.
