5.18 Insulin Pump Supplies
General Policy Description
PharmaCare covers insulin pump infusion sets/kits and reservoirs/cartridges. PharmaCare does not cover other insulin pump supplies such as batteries, battery caps, adhesive pads, and pump covers.
PharmaCare covers insulin pump infusion sets/kits and reservoirs/cartridges for patients if they are covered under:
- Fair PharmaCare
- Plan B (Long-term Care)
- Plan C (Income Assistance)
- Plan F (Children in the At Home Program)
- Plan W (First Nations Health Benefits)
This coverage is available whether or not the cost of the insulin pump was covered by PharmaCare.
PharmaCare Special Authority pre-approval is not required for insulin pump supplies.
PharmaCare covers only the pods, infusion sets/kits and insulin pump reservoirs/cartridges listed on the Insulin Pump Supplies page.
PharmaCare does not cover other insulin pump supplies, such as batteries, battery caps, adhesive pads, pump covers, etc.
For people covered under Plan B (Long-term Care), insulin pump supplies are not covered by PharmaCare, because they are covered by the long-term care facility.
PharmaCare reimburses claims for eligible insulin pump supplies purchased from pharmacies and approved insulin pump vendors who submit medical supply claims on PharmaNet. PharmaCare does not accept paper/manual claims for insulin pump supplies.
- Exceptions may apply for patients living in border communities who are served by an out-of-province pharmacy that participates in PharmaCare.
Insulin pump supplies are reimbursed at the retail price up to the PharmaCare maximum allowable cost for the product with no dispensing fee.
Pharmacies and insulin pump supply vendors must use the correct Product Identification Number (PIN) and unit of measure for the dispensed quantity when entering claims in PharmaNet.
>> For correct quantity information and insulin pump supply PINs, refer to Insulin Pump Supplies.
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