Insulin pumps & insulin pump supplies

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

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.

PharmaCare provides coverage for:

• Omnipod Insulin Management System manufactured by Insulet
• YpsoPump manufactured by Ypsomed

If your endocrinologist/diabetes physician specialist determines that these systems are clinically unsuitable for you, exceptional coverage may be provided for a MiniMed Insulin Pump System manufactured by Medtronic.

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.

The Ypsomed starter kit is supplied at the cost of $800, which will be applied to your Fair PharmaCare deductible/family maximum. The Ypsomed starter kit includes the YpsoPump—YpsoPump Orbit^® micro or soft infusion sets (any length)—reservoirs, inserter, BeltClip, reservoir storage box, and screen protector.

The Omnipod pods and Ypsomed's infusion sets and supplies 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 (B.C. Income Assistance), Plan F (Children in the At Home Program), or Plan W (First Nations Health Benefits), PharmaCare covers 100% of the cost.

For those approved for exceptional coverage of the MiniMed pump, PharmaCare coverage is dependent on your PharmaCare plan and any associated deductible and family maximum:

• If you are covered under Plan I (Fair PharmaCare), you must pay for the costs of the insulin pump and 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 (B.C. Income Assistance), Plan F (Children in the At Home Program), or Plan W (First Nations Health Benefits), PharmaCare covers 100% of the cost.

For more information, speak to your endocrinologist or diabetes specialist or contact PharmaCare through Health Insurance BC.

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.

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

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

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.