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
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CBG
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Capillary blood glucose
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Measuring capillary blood glucose using finger sticks
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isCGM
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Intermittently scanned continuous glucose monitoring
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Measuring interstitial fluid glucose via intermittent scanning of sensing device
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rtCGM
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Real-time continuous glucose monitoring
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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
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Previously referred to as
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Self-monitored blood glucose (SMBG) or blood glucose meters
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Flash glucose monitoring (FGM)
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Continuous glucose monitoring (CGM)
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Devices
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Accu-Chek Guide
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Contour Next/One Freestyle Lite
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OneTouch Verio
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Oracle
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Dexcom
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Medtronic Guardian Sensor 3
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Coverage – ADP
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Not covered via ADP
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Not covered via ADP
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If a person qualifies for ADP coverage of rtCGM, it will be supplied at no charge to you via the vendor
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Coverage – ODB drug plan
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Via Pharmacies –similar process as prescription medications
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LMC Pharmacy locations also have Certified Diabetes Educators for training
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Via Pharmacies –similar process as prescription medications
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LMC Pharmacy locations also have Certified Diabetes Educators for training
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Not covered on ODB
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Coverage – Private insurance/drug plans
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Via Pharmacies –Most private drug plans include this as a benefit; similar process as prescription medications; plan may have a co-pay or deductible.
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LMC Pharmacy locations also have Certified Diabetes Educators for training
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Via Pharmacies –Most private drug plans include this as a benefit; similar process as prescription medications; plan may have a co-pay or deductible.
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LMC Pharmacy locations also have Certified Diabetes Educators for training
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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.
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LMC Pharmacy locations also have Certified Diabetes Educators for training
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Medtronic Guardian 3 Sensors – not generally available via Pharmacies.
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Available viaLMC Pharmacy’s Diabetes Depot online shop as a specialized diabetes pharmacy.
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©LMC Pharmacy – April 2022
