Glucose Sensor Program

As of June 1, 2022 a new program will be available for eligible Islanders to assist with the cost of purchasing glucose sensors at their local community pharmacy.

What is a glucose sensor?

Glucose sensor technology, often referred to as Continuous Glucose Monitoring (CGM) is a method to track glucose levels throughout the day and night. Unlike a blood glucose meter which provides just a single glucose reading, glucose sensor systems can provide glucose information up to every five minutes.

People living with diabetes can gain valuable insight about their glucose levels, including rate and direction of change, allowing them to better manage their diabetes. Studies have shown that glucose sensor systems may help reduce A1C levels and reduce hypoglycemia.

Users insert a tiny sensor wire just underneath the skin with an applicator. An adhesive patch holds the sensor in place so the sensor can measure glucose levels in the interstitial fluid. A transmitter sends readings wirelessly to a device (i.e receiver, compatible smart phone / smart watch, or insulin pump), so users can view the information. Depending on the product, the user will change the sensor every 7 to 14 days.

Am I eligible for benefits under the Glucose Sensor Program?

You are eligible if you:

  • Are a permanent resident as defined by the Drug Cost Assistance Act;
  • Have a valid PEI Health Card;
  • Filed your most recent income tax return;
  • Are diagnosed by a medical practitioner or nurse practitioner as having diabetes;
  • Are reliant on an insulin pump or multiple daily injections of insulin (i.e. 3 or more) to manage your diabetes; and 
  • Have a signed Special Authorization form from your medical practitioner, nurse practitioner or certified diabetes educator.

When am I eligible for coverage?

Once approved, your eligibility will start from the date noted on your approval letter/email and will continue until June 30th, 2023.   

How do I apply?

For your first application you must submit by mail a completed PEI Glucose Sensor Program Initial Family Contribution Assessment and Release of Information form to the Glucose Sensor Program Administrator, Health PEI, 16 Garfield Street, Charlottetown, PE, C1A6A5. You can download and print the application form from the website or pick up a copy at your local Health PEI Diabetes Education Centre.

Within this initial application form, there is a one page Special Authorization document that requires completion by your medical practitioner, nurse practitioner or diabetes educator. Please ensure it is complete and signed prior to submitting your application.

In subsequent years you can renew either on-line or via paper form.

How long am I eligible for benefits under the Glucose Sensor Program?

You are eligible for benefits up to a maximum of one year, or the portion of the year, after your approval, until June 30th. Benefits will cease annually on June 30th.  To avoid interruption in coverage, you must re-apply by July 1st each year. You can reapply any time in the 3 months prior to that deadline (i.e. April 1st to June 30th annually). At the time of reapplication your income tax for the preceding year must have been filed with the Canada Revenue Agency.

Coverage will be continued as long as you continue to meet the eligibility criteria noted above.

What is covered?

The following list details the glucose sensor supplies that are eligible for coverage under the PEI Glucose Sensor Program:

  • Abbott Libre or Libre 2 sensors:  Wear time is 14 days. Two sensors can be dispensed from your pharmacy every 28 days. Maximum number of sensors per year =26 sensors.  Free reader (where required) is available by contacting Libre customer service.
  • Dexcom G6 sensor:  Wear time is 10 days. Three sensors (i.e. one box) can be dispensed from your pharmacy every 30 days.  Maximum number of sensors per year = 39 sensors. The Dexcom transmitter (1 transmitter every 3 months) is available at no cost from your pharmacy. A receiver (where required) is available at no cost by contacting Dexcom Customer Service. 
  • Medtronic Integrated (CGM) Guardian Sensor (3) or Guardian Connect CGM:  Wear time is 7 days. Five sensors (i.e. one box) can be dispensed from your pharmacy every 35 days. The maximum of sensors per year = 55 sensors. Free transmitter (1 per year) is available at your pharmacy.

How will I receive my glucose sensors?

Once enrolled for benefits under the Glucose Sensor Program, you must purchase your sensors in person through any PEI community pharmacy to receive them at the reduced cost.

How will I know which sensor is right for me?

Feel free to discuss your options with your health care team. You are also encouraged to view the features of the various sensors on their websites:

View the Glucose Sensor Comparison Chart for some key features of glucose sensors available under the program.

What will it cost?

Out of pocket cost will be based on household income and the existence of private health insurance.

Scenario 1): For those without private health insurance the out of pocket expense is as outlined below:

  • Household income:  $0 to $20,000
    • Co-payment per dispense:  $0.00
  • Household income:  $20,001 to $40,000
    • Co-payment per dispense:  $10.00
  • Household income:  $40,001 to $50,000
    • Co-payment per dispense:  $20.00
  • Household income:  $50,001 to $100,000
    • Co-payment per dispense:  $60.00
  • Household income:  $100,001 or greater
    • Co-payment per dispense:  $80.00

Scenario 2):  If you have private health insurance that provides partial coverage for glucose sensors, your co-payment will be either 20% of a standard copay (listed below) or the amount remaining after payment by your private insurance, whichever is less:

  • Household income:  $0 to $20,000
    • Co-payment per dispense:  $0.00 or cost remaining after payment by your private health insurance
  • Household income:  $20,001 to $40,000
    • Co-payment per dispense:  $2.00 or cost remaining after payment by your private health insurance
  • Household income:  $40,001 to $50,000
    • Co-payment per dispense:  $4.00 or cost remaining after payment by your private health insurance
  • Household income:  $50,001 to $100,000
    • Co-payment per dispense:  $12.00 or cost remaining after payment by your private health insurance
  • Household income:  $100,001 or greater
    • Co-payment per dispense:  $16.00 or cost remaining after payment by your private health insurance

What happens if my sensor falls out or stops working? Can I get a replacement sensor at my pharmacy?

Under the Glucose Sensor Program, replacement sensors are not available through your local pharmacy.

If your sensor has to be replaced early for whatever reason (falls out, stops working etc.) you can get a replacement sensor by calling your sensor company’s Customer Service line. They will ship your sensor directly to you at no cost. 

Will I get a refund for sensors I already purchased prior to being eligible for benefits under the Glucose Sensor Program?

Coverage is not retroactive and you will not be reimbursed for sensors you have already purchased.

On the application, how do we define Household?

A household is a person, the person’s spouse (if the person has a spouse) and any dependants

  • No person may be considered to be part of more than one household
  • Spouses shall be considered part of the same household unless otherwise confirmed

How do we define “Dependant”?

A dependant is a child of a person or the person’s spouse who is 

  • Under 19 years of age and does not have a spouse or
  • Is 19 years of age or over but under 25 years of age, is a full-time student and does not have a spouse
  • A dependant may only be a member of one household

How do we calculate Household income?

Household income is the total income of the persons in a household, other than any dependants, calculated on the amounts reported on the person’s income tax return for the preceding tax year as filed with and verified by the Canada Revenue Agency, calculated as follows:

  • Line 15000 (total income) less
    • Line 21000 (split income)
    • Line 21400 (child care expenses)
    • Line 22000 (support payments made)

Can I apply my out of pocket co-pay expenses to the “household cap” for the PEI Catastrophic Drug Program? 

No, out of pocket expenses paid for the glucose sensors cannot be applied to the Catastrophic Drug Program “household cap”. 

What if I am already enrolled in the Insulin Pump Program (for those under age 25 years with type 1 diabetes)?

Islanders under the age of 25 years who are currently registered for benefits under the Insulin Pump Program and who wish to enroll in the Glucose Sensor Program:

  • You will need to renew your IPP application between now and June 30. Please complete the combined application for both programs:  PEI Insulin Pump Program and Glucose Sensor Program Initial Family Contribution Assessment and Release of Information form  
  • Annually, only one application will be required to register for both the Insulin Pump Program and the Glucose Sensor Program.  This application must be received by June 30 for benefits to continue under both programs. You can reapply any time in the 3 months prior to that deadline (i.e. April 1 to June 30 annually). At the time of reapplication, please ensure your income tax for the preceding year is filed with the Canada Revenue Agency.

Who can I contact if I have further questions?

Glucose Sensor Program / Insulin Pump Program
16 Garfield Street
Charlottetown, PE  C1A 6A5 

Telephone: (902) 213-4825 or 1-833-335-0538 (toll free)
Email:  diabetesadminofficer@ihis.org
 

Published date: 
May 26, 2022
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