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 people who:

• Are covered under Fair PharmaCare, Plan B (Long-Term Care), Plan C (Income Assistance and Family Services), Plan F (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 to 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 Personal Diabetes Manager, Omnipod Dash Personal Diabetes Manager and Omnipod 5 Automated Insulin Delivery (AID) system manufactured by Insulet
• mylife YpsoPump manufactured by Ypsomed
• MiniMed 670G, 770G, and 780G Insulin Pump Systems manufactured by Medtronic

How much will PharmaCare cover?

Omnipod

Insulet's Omnipod 5 automated insulin delivery (AID) system includes a starter kit containing Omnipod 5 Locked-down Controller with App and User Guides. The Omnipod 5 system can be paired with the Dexcom G6 or G7 continuous glucose monitor (CGM) to create a hybrid closed-loop (HCL) system that offers automated insulin delivery. The Omnipod 5 starter kit is available at a cost of $6,300 and is covered as follows, subject to the rules of your PharmaCare plan:

• If you are covered under Fair PharmaCare, you must pay for the costs of the Omnipod 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 (At Home Program), or Plan W (First Nations Health Benefits), PharmaCare covers 100% of the cost

The Omnipod Personal Diabetes Manager and Omnipod Dash Personal Diabetes Manager remain available at no cost, regardless of the PharmaCare plan you are covered under or any deductible you may have. 

PharmaCare considers all Omnipod systems' pods as insulin pump supplies, which are covered according to the rules of your plan. Read Infusion sets and supplies.

YpsoPump

The mylife YpsoPump is available as part of a starter kit which includes the insulin pump, a mylife infusion set (any length), reservoir, inserter (if applicable), reservoir storage box and screen protector. The starter kit is supplied at a cost of $7,000 and is covered as follows, subject to the rules of your PhamaCare plan:

• If you are covered under 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 (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 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 (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 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 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

What if I encounter problems using a pump instead of regular injections?

Speak to your endocrinologist or diabetes specialist. If in consultation with your specialist, it is determined that you cannot continue using a pump, you may be able to return it. Vendors may allow you to return the pump for a refund within 90 days of purchase. In this case, the vendor will reverse the PharmaCare claim and refund any portion of the cost you paid.

Insulin pump supplies

Who is eligible for coverage of pump supplies

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

• Fair PharmaCare
• Plan B (Long-Term Care)
• 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, 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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