Coverage for Dexcom CGM
https://www.dexcom.com/en-CA/public-coverage
Yes, Dexcom G6 and Dexcom G7 are covered for eligible Nova Scotians aged 2 years and older who have type 1 or type 2 diabetes and manage it with intensive insulin therapy.
Intensive insulin therapy is insulin pump therapy or multiple daily injections. Multiple daily injections of insulin are defined as one (or more) injection(s) of basal insulin and three (or more) injections of bolus insulin, with a minimum of at least four total insulin injections per day.
Coverage for Dexcom CGM products is provided through two publicly funded programs in Nova Scotia:
- Existing Nova Scotia Pharmacare programs: Coverage for eligible residents who are registered clients of Seniors Pharmacare, Community Services Pharmacare, or Family Pharmacare program These Pharmacare Programs may have deductibles, premiums, and/or copayments.
- New Sensor-based Glucose Monitoring (SBGM) program: Universal supplemental coverage for eligible residents, with upfront deductibles based on your adjusted annual family income. You will pay the full cost of the CGM supplies at the pharmacy until you reach your deductible, after which the program will pay the cost until the end of the program year. Note: The Program is the payer of last resort, meaning your private insurance would be the first to pay any claim.
Anyone who meets eligibility criteria for coverage of Dexcom CGM supplies can choose which program works best for their individual or financial circumstances.
Yes, you will need a valid prescription for Dexcom G6 or G7 as part of the coverage approval process. You can obtain this from your doctor, your nurse practitioner, or your pharmacist.
If you are switching from Dexcom G6 to Dexcom G7, you should obtain a new prescription for Dexcom G7 from your prescribing healthcare professional.
As well as writing you a prescription, your doctor, nurse practitioner or prescribing pharmacist will need to complete an exception status request form. They will need some of your personal information to complete the form such as your Nova Scotia Health Card number, diabetes diagnosis, device requested, and the eligibility criteria met Once submitted, exception status coverage requests are usually processed within 7-10 days
Download the Exception Status form here
Your prescribing doctor, nurse or pharmacist should mail or fax your completed exception status coverage request form to:
Nova Scotia Pharmacare Programs
P.O. Box 500
Halifax, NS B3J 2S1
Fax: (902) 496-4440
When your request for coverage is approved, you and your healthcare provider will be notified by letter.
If seeking coverage through the Sensor-Based Glucose Monitoring (SBGM) Program, you will also need to complete an enrolment form to establish your eligibility & annual deductible amount. It should take 1 to 2 weeks to get registered in the program. Nova Scotians with a yearly household income less than $60,000 will not have to pay a deductible. Households with incomes between $60,000 and $150,000 will pay a deductible between $500 and $1,000 annually.
Your program coverage is for 1-year, with automatic renewal every February unless you opt-out.
Once you are approved for coverage, you can pick-up your Dexcom G6 or G7 CGM supplies from your pharmacy of choice.
Once your coverage is approved, any pharmacy can bill the cost of your Dexcom G6 supplies (sensors, transmitters) or Dexcom G7 supplies (sensors, receiver) directly to the Programs. For Pharmacare Program beneficiaries, the usual copayment may apply if your annual maximum is not already met. For those registered and approved through the SBGM program, depending on your income, you may need to pay a deductible amount before the Program coverage begins. In both cases, if there is no private insurance in place to cover these costs, you can get up to 20% off your out-of-pocket cost for Dexcom G7 (based on reasonable upcharge, mark-up, and customary pharmacy dispensing fee) through the G7 Patient Benefit Program. Patient Benefit Program information and billing details can be found here : https://www.dexcom.com/en-ca/coverage
Our team is here to help! One of our Insurance Specialists can assist you in determining your coverage for Dexcom CGM. Get started by filling out our online form or call us at 1-844-832-1810.