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.

Policy Details

PharmaCare covers insulin pump infusion sets/kits and reservoirs/cartridges for patients if they are covered under

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.

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, see Insulin Pump Supplies.

 

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