{"id":70463,"date":"2022-03-29T17:24:57","date_gmt":"2022-03-29T17:24:57","guid":{"rendered":"https:\/\/www.lmc.ca\/?p=70463"},"modified":"2022-04-14T16:27:57","modified_gmt":"2022-04-14T16:27:57","slug":"update-ontario-adp-dexcom-medtronic-cgm-coverage","status":"publish","type":"post","link":"https:\/\/www.lmc.ca\/fr\/lmc-blog\/pharmacy\/update-ontario-adp-dexcom-medtronic-cgm-coverage\/","title":{"rendered":"Mise \u00e0 jour : Couverture de l'ADP de l'Ontario pour Dexcom et Medtronic CGM"},"content":{"rendered":"

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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\u2019ve been fielding with this new program:<\/h3>\n

How do I know if I qualify for Dexcom\/Medtronic CGM coverage under ADP?<\/strong><\/h3>\n

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.<\/h3>\n

Click the button to download the\u00a0application form if you\u2019d like to see the detailed criteria and other questions asked. Application form<\/a><\/h3>\n

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<\/a><\/h3>\n

What if I do not meet the ADP criteria?<\/strong><\/h3>\n

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.<\/h3>\n

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.<\/h3>\n

What are my glucose monitoring options and how does coverage work in Ontario?<\/strong><\/h3>\n\n\n\n\n\n\n\n\n
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Current terminology as of 2021<\/strong><\/h5>\n<\/td>\n
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CBG <\/strong><\/h5>\n
    \n
  • \n
    C<\/u><\/strong>apillary b<\/u><\/strong>lood g<\/u><\/strong>lucose<\/h5>\n<\/li>\n
  • \n
    Measuring capillary blood glucose using finger sticks<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n
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isCGM<\/strong><\/h5>\n
    \n
  • \n
    I<\/u><\/strong>ntermittently s<\/u><\/strong>canned c<\/u><\/strong>ontinuous g<\/u><\/strong>lucose m<\/u><\/strong>onitoring<\/h5>\n<\/li>\n
  • \n
    Measuring interstitial fluid glucose via intermittent scanning of sensing device<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n
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rtCGM<\/strong><\/h5>\n
    \n
  • \n
    R<\/u><\/strong>eal-t<\/u><\/strong>ime c<\/u><\/strong>ontinuous g<\/u><\/strong>lucose m<\/u><\/strong>onitoring<\/h5>\n<\/li>\n
  • \n
    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<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
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Previously referred to as<\/strong><\/h5>\n<\/td>\n
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Self-monitored blood glucose (SMBG) or blood glucose meters<\/h5>\n<\/td>\n
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Flash glucose monitoring (FGM)<\/h5>\n<\/td>\n
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Continuous glucose monitoring (CGM)<\/h5>\n
\u00a0<\/h5>\n<\/td>\n<\/tr>\n
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Devices<\/strong><\/h5>\n<\/td>\n
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    \n
  • \n
    Accu-Chek Guide<\/h5>\n<\/li>\n
  • \n
    Contour Next\/One Freestyle Lite<\/h5>\n<\/li>\n
  • \n
    OneTouch Verio<\/h5>\n<\/li>\n
  • \n
    Oracle<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n
\n
    \n
  • \n
    Libre<\/h5>\n<\/li>\n
  • \n
    Libre 2<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n
\n
    \n
  • \n
    Dexcom<\/h5>\n<\/li>\n
  • \n
    Medtronic Guardian Sensor 3<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
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Coverage \u2013 ADP <\/strong><\/h5>\n<\/td>\n
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Not covered via ADP<\/h5>\n<\/td>\n
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Not covered via ADP<\/h5>\n<\/td>\n
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If<\/u> a person qualifies for ADP coverage of rtCGM, it will be supplied at no charge to you via the vendor<\/h5>\n<\/td>\n<\/tr>\n
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Coverage \u2013 ODB drug plan<\/strong><\/h5>\n<\/td>\n
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Via Pharmacies \u2013similar process as prescription medications<\/h5>\n
    \n
  • \n
    LMC Pharmacy locations also have Certified Diabetes Educators for training<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n
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Via Pharmacies \u2013similar process as prescription medications<\/h5>\n
    \n
  • \n
    LMC Pharmacy locations also have Certified Diabetes Educators for training<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n
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Not covered on ODB<\/h5>\n<\/td>\n<\/tr>\n
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Coverage \u2013 Private insurance\/drug plans<\/strong><\/h5>\n<\/td>\n
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Via Pharmacies \u2013Most private drug plans include this as a benefit; similar process as prescription medications; plan may have a co-pay or deductible.<\/h5>\n
    \n
  • \n
    LMC Pharmacy locations also have Certified Diabetes Educators for training<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n
\n
Via Pharmacies \u2013Most private drug plans include this as a benefit; similar process as prescription medications; plan may have a co-pay or deductible.<\/h5>\n
    \n
  • \n
    LMC Pharmacy locations also have Certified Diabetes Educators for training<\/h5>\n<\/li>\n<\/ul>\n<\/td>\n
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Dexcom<\/strong> – Via Pharmacies \u2013 Some private drug plans include this as a benefit; similar process as prescription medications; plan may have a co-pay or deductible.\u00a0\u00a0 Some plans require you to pay first then submit a manual claim to the insurance company \u2013 in which case you can purchase on prescription or over-the-counter; although you should check whether your plan requires a prescription for coverage.<\/h5>\n