General Policy Description
PharmaCare covers insulin, including biosimilar insulins, for patients with insulin-dependent diabetes.
Insulin claims are reimbursed in the following ways:
- Regular insulin is reimbursed at the regular retail price with no dispensing fee
- Short-acting insulin analogues, such as insulin aspart (Trurapi®), insulin lispro (Admelog®), and insulin glulisine (Apidra®), are reimbursed at the regular retail price, with no dispensing fee. These products are also referred to as rapid-acting insulin analogues. Coverage for NovoRapid® and Humalog® is continued for existing patients until May 29, 2022 as part of the Biosimilars Initiative switching process
- 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 Special Authority's list of Limited Coverage Drugs for more information.
Insulin can be dispensed and the claim entered in 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.