Insulin pumps & insulin pump supplies

On this page: Insulin pumps | Insulin pump supplies

PharmaCare covers:

• Insulin pumps for patients with type 1 diabetes or other forms of diabetes requiring insulin
• Supplies for insulin pumps, regardless of whether or not the pump was covered by PharmaCare

​​Insulin pumps

Who is eligible for coverage?

Insulin pump coverage is available to patients who

• Are covered under Plan I (Fair PharmaCare), Plan C (B.C. Income Assistance Recipients), Plan F (Children in the At Home Program), or Plan W (First Nations Health Benefits), and
• Have type 1 diabetes or another form of diabetes requiring insulin, and
• Have confirmation from their endocrinologist or diabetes specialist that they meet the medical criteria, and
• Have Special Authority approval for coverage

How do I obtain coverage?

Speak to your endocrinologist or diabetes specialist. If you meet the criteria for coverage of a pump, your specialist will submit a Special Authority request to PharmaCare.

If the request is approved, PharmaCare will send an approval letter to your specialist's office. Your specialist will give you a copy of this letter to take to the insulin pump manufacturer when purchasing your pump.

Be sure to wait for the approval letter before purchasing your insulin pump. PharmaCare cannot provide retroactive coverage for purchases made before your approval is confirmed.

What kinds of pump are covered?

PharmaCare provides coverage for:

• Omnipod Insulin Management System manufactured by Insulet
• YpsoPump manufactured by Ypsomed
• MiniMed Insulin Pump System manufactured by Medtronic

How much will PharmaCare cover?

Omnipod

The Omnipod system's personal diabetes manager is available to you at no cost, regardless of the PharmaCare plan you are covered under or any deductible you may have. PharmaCare considers the Omnipod system's pods as insulin pump supplies, which are covered according to the rules of your plan. Read Infusion sets and supplies.

YpsoPump

The YpsoPump is only available with the purchase of a Ypsomed starter kit. The starter kit includes the YpsoPump—YpsoPump Orbit^® micro or soft infusion sets (any length)—reservoirs, inserter, BeltClip, reservoir storage box, and screen protector. It is supplied at the cost of $800 and is covered as follows, subject to the rules of your PharmaCare plan:

• If you are covered under Plan I (Fair PharmaCare), you must pay for the costs of the Ypsomed starter kit until you meet your deductible. Once you have met your deductible, PharmaCare covers 70% of eligible costs. If you have met both your deductible and family maximum, PharmaCare covers 100% of eligible costs
• If you are covered under Plan B  (Long-term Care), Plan C (Income Assistance), Plan F (Children in the At Home Program), or Plan W (First Nations Health Benefits), PharmaCare covers 100% of the cost

MiniMed

The MiniMed Insulin Pump System is supplied at the cost of $6,600 and is covered as follows, subject to the rules of your PharmaCare plan:

• If you are covered under Plan I (Fair PharmaCare), you must pay for the costs of the insulin pump until you meet your deductible. Once you have met your deductible, PharmaCare covers 70% of eligible costs. If you have met both your deductible and family maximum, PharmaCare covers 100% of eligible costs
• If you are covered under Plan B (Long-term Care), Plan C (Income Assistance), Plan F (Children in the At Home Program), or Plan W (First Nations Health Benefits), PharmaCare covers 100% of the cost

Infusion sets and supplies

Infusion sets and supplies for all insulin pump systems are covered as follows:

• If you are covered under Plan I (Fair PharmaCare), you must pay for the costs of the insulin pump supplies until you meet your deductible. Once you have met your deductible, PharmaCare covers 70% of eligible costs. If you have met both your deductible and family maximum, PharmaCare covers 100% of eligible costs
• If you are covered under Plan C (Income Assistance), Plan F (Children in the At Home Program), or Plan W (First Nations Health Benefits), PharmaCare covers 100% of the cost

Insulin pump supplies

Who is eligible for coverage of pump supplies?

PharmaCare covers certain insulin pump supplies if you are covered under:

• Plan I (Fair PharmaCare)
• Plan C (B.C. Income Assistance)
• Plan F (Children in the At Home Program)
• Plan W (First Nations Health Benefits)

This coverage is available whether or not your pump was covered by PharmaCare.

Special Authority pre-approval is not required for insulin pump supplies.

Which supplies are covered?

PharmaCare covers pods, infusion sets/kits, and insulin pump reservoirs/cartridges.

PharmaCare does not cover batteries, battery caps, adhesive pads, skin wipes, etc.

Where should I buy supplies?

PharmaCare covers eligible insulin pump supplies purchased from pharmacies and approved insulin pump vendors who submit claims on PharmaNet. PharmaCare cannot accept manual/paper claims for insulin pump supplies.

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