General Policy Description
PharmaCare covers insulin for patients with insulin-dependent diabetes.
Insulin claims are reimbursed in the following manners:
- Regular insulin is reimbursed at the regular retail price with no dispensing fee.
- Short acting insulin analogues such as insulin aspart (Novorapid®), insulin lispro (Humalog®), and insulin glulisine (Apidra®) are reimbursed up to the applicable PharmaCare maximum allowable cost for the product with no dispensing fee. Patients are required to pay any cost in excess of the PharmaCare maximum allowable cost.
- Long acting insulin analogues such as insulin glargine (Basaglar™) and insulin detemir are reimbursed at the regular retail price with no dispensing fee. These insulins are Limited Coverage products and therefore require prior Special Authority approval for coverage.
>> See the list of Limited Coverage Drugs on the Special Authority page for more information.
Insulin can be dispensed and the claim entered on PharmaNet without a prescription.
When submitting a claim for non-prescription insulin, pharmacists should enter their Pharmacist ID in place of the Practitioner ID. Before using a Practitioner’s ID for a claim, the pharmacist must obtain authorization from the practitioner for the insulin to be dispensed.