To initiate coverage for Dexcom rtCGM for an eligible PSHCP plan member, please provide them with:

• A prescription for Dexcom rtCGM, and
• A signed medical letter confirming their Type 1 diabetes diagnosis.

Eligible plan participants may submit the claim form* online at www.canadalife.com/pshcp for prior authorization before making their first purchase, or they may purchase their first order out-of-pocket and submit it for prior authorization and reimbursement simultaneously.

*The initial claim form should be signed by the plan member and accompanied by the prescription, medical letter confirming diagnosis, and a purchase receipt.

Subsequent Dexcom rtCGM purchases can be made in pharmacy and will be directly billed to the patient’s health plan.