Coverage For
Dexcom CGM

Details on who is eligible under these programs, who to contact for information and more below.

Have Insurance Questions?

We are here to help. A Dexcom Account Specialist can assist you in determining your benefits for CGM coverage.

Get started by filling out our online form or call us toll-free at 1-844-832-1810.

Who qualifies?

ADP coverage for Dexcom G6 is available for adults and children (2 years and older) living with type 1 diabetes, who are residents of Ontario and have a valid Ontario health card. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6.

To be eligible for coverage, individuals must meet the following Medical Eligibility Criteria:

1. Lives with type 1 diabetes.
2. Meets one of the following:

a) Applicant is unable to recognize or communicate symptoms of hypoglycemia, or independently perform fingerstick glucose testing, owing to their developmental stage or a previously diagnosed cognitive or physical impairment; or
b) Applicant had severe hypoglycemia in the past two (2) years without an obvious precipitant, despite optimized use of insulin therapy and glucose monitoring (at least 4 times/day) which result in one of the following:

i) suspension of the applicant’s driving license; or
ii) hospitalization or emergency room or EMS visit; or
iii) glucagon administration, unconsciousness, or seizure.

3. Applicant demonstrates experience with and commitment to managing blood sugar control and an ability to use CGM safely and effectively by ALL of the following:

a) Applicant demonstrates a commitment to long-term diabetes follow-up through regular assessments by diabetes educators, and prescribers at intervals deemed appropriate by the Diabetes Education Program.
b) Applicant agrees to wear the CGM system full-time.
c) Applicant agrees to share the data components of the Ambulatory Glucose Profile (AGP) with the diabetes health care providers/team such as:

i) percent time in target range, percent time above or below target range, percent time in hypoglycemia; and
ii) visual representation of average 24-hour glucose profile for a 2-week period.

Click here for a complete description of coverage criteria and additional information on the program.

How do I get coverage?

To receive coverage through ADP, you will need to be assessed and followed by a healthcare professional associated with a Diabetes Education Program (DEP) registered with ADP.

Your physician can refer you to a registered DEP clinic or you may choose the clinic yourself based on your needs.

Click here for a list of DEP clinics registered with ADP.

What if I have private insurance?

If you or your child meet the medical eligibility criteria or would have met the medical eligibility criteria before using the Dexcom G6, you should visit an ADP registered clinic for an assessment regardless of your current insurance status.

Individual private insurance plans may differ and are subject to change. At this time, it is anticipated that private insurers already covering Dexcom G6 will expect plan members living with type 1 diabetes will be assessed for ADP funding. To help ensure uninterrupted coverage from your private health plan pending ADP determination, visit your healthcare professional to receive a prescription for Dexcom G6 with the notation "ADP Pending" written on it, to go along with your referral to ADP.

How do I order my CGM supplies?

Following your assessment, you or your healthcare professional should submit your completed application form to us as soon as possible by either email at [email protected] or by fax at 1-844-348-0784. We will provide updates via email on the status of your application throughout the application process.

Once you have been approved, we will contact you to confirm your application status and shipping details. We will then arrange for your Dexcom G6 supplies to be delivered right to your door. A Dexcom G6 Receiver is also available at no cost if you do not have a compatible smart device.

How long will I be covered?

The initial approval duration is two years. To continue receiving ADP coverage, you or your child must meet the Renewal Eligibility Criteria and complete the Renewal Form to confirm your continued eligibility every two years.

Who qualifies?

Dexcom G6 is funded for Albertans living with diabetes under the age of 18 who:

1. Require ongoing use of insulin or an insulin pump when prescribed by a Specialist in Endocrinology or Pediatrics.
2. Are enrolled in one of the following programs:

i. Non-Group Coverage
ii. Low-income programs, including:

• Child and Family Services
• Alberta Child Health Benefit
• Children and Youth Services
• Income Support
• Learners Program
• Alberta Human Services (AISH)
• Alberta Adult Health Benefit

Click here for a complete description of the coverage criteria.

How do I get coverage?

You or your child will need to be evaluated by a Specialist in Endocrinology or Pediatrics to ensure you meet the medical criteria of the program.

The specialist does not need to complete any special forms, they will simply write a prescription for Dexcom G6 if you or your child meet the eligibility criteria.

What if I have private insurance?

Alberta Health’s announcement will not impact private health plan coverage.

How do I order my CGM supplies?

Once you receive a prescription from your specialist, you may take it to your local pharmacy for it to be filled. Your pharmacist will submit your claim and, when needed, coordinate coverage between Alberta Health and your private insurance.

How long will I be covered for?

Once you receive a prescription from your specialist, coverage will continue until you or your child no longer meet the eligibility criteria.

British Columbia Public Coverage

All B.C. residents can register for Fair PharmaCare, an income-based plan that covers eligible drugs and medical supplies. Residents may also be eligible for PharmaCare’s Income Assistance Plan (Plan C) and First Nations Health Benefits Plan (Plan W). Those who meet the clinical criteria set by BC PharmaCare for the Dexcom G6 CGM System will receive coverage according to the rules of their BC PharmaCare drug plan. For more details about BC PharmaCare’s drug plans, please visit their website.

Who qualifies?

To be eligible for coverage for Dexcom G6 under BC PharmaCare, you must:

• Be registered with Fair Pharmacare, Plan C or Plan W; and
• Have your primary care provider or endocrinologist confirm you meet the provincial clinical requirements; and
• Have your primary care provider or endocrinologist submit a BC PharmaCare Special Authority request on your behalf.

How do I get coverage?

Contact your primary care provider or endocrinologist to initiate the BC PharmaCare Special Authority approval process. If your approval is successful, your future Dexcom purchases will need to be made at your local pharmacy.

What if I have private insurance?

Group and individual private insurance plans in BC are generally designed to supplement coverage provided by Fair PharmaCare. Your private insurance may cover some or all of the cost of your Fair PharmaCare deductible. After you meet your deductible, PharmaCare helps you with eligible costs for the rest of the year. Some or all of your out-of-pocket costs not covered by PharmaCare may be eligible for coverage under your private insurance as well.

How do I order my CGM supplies?

Once your primary care provider or endocrinologist has submitted a Special Authority application. Please confirm that the request has been approved before you bring your prescription to your local pharmacy. Call your prescriber or pharmacist to confirm, or call PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland).

When you present your prescription at the pharmacy, the pharmacist will submit your coverage claim to BC PharmaCare and, when needed, coordinate coverage between BC Pharmacare and private insurance. Please be aware that BC PharmaCare will not retroactively reimburse for benefits purchased before approval of a Special Authority request.

How long will I be covered?

Initially you will be covered for 1 year. After that time, your coverage may be renewed if you continue to require intensive insulin therapy and your healthcare professional recommends that you would benefit from continued CGM use. After than initial 1 year period, coverage may be renewed for 5 years.

Who qualifies for RAMQ coverage?

To receive coverage for Dexcom G6 under RAMQ, you must meet the eligibility requirements for the Public Insurance Plan. In addition, you must be:

• living with type 1 diabetes and aged 2 years or older.

AND, you must have one or more of the following:

• Failure to achieve an appropriate glycated hemoglobin (HbA1c) value despite taking prescribed medications and testing blood sugar regularly; or
• Have experienced frequent episodes of hypoglycemia in the past year despite following a treatment plan; or
• Are not able to recognize or report symptoms of hypoglycemia.

What if I have private insurance?

Private insurance plans must minimally offer coverage for medications covered by RAMQ. Now that Dexcom G6 is part of this list of medications, you should now qualify if you meet the eligibility requirements.

Your private plan may still offer coverage even if you do not meet the eligibility criteria. We suggest you contact your insurer for more details or speak to your pharmacist about verifying your coverage.

How do I order my CGM supplies?

If you are trying to receive coverage under RAMQ or your private insurance plan, Dexcom CGM supplies must now be purchased at your local pharmacy. You will need a prescription from your physician or pharmacist to enable direct billing to RAMQ or your private insurer.

How do I get coverage through RAMQ?

The first step is to tell your physician or pharmacist that you’d like to receive a prescription for the Dexcom G6 CGM System. They will then:

1. Complete an Exceptional Medication Form and submit it to RAMQ for approval.
2. Give you a prescription for Dexcom G6 that you will bring to your local pharmacy.
3. Once you have been approved, the pharmacy will process your order for Dexcom CGM supplies.

How long will I be covered?

Once approved, your initial request is good for six months. After that, your doctor will reassess you and submit a request to continue treatment. Subsequent requests are authorized for 12 months at a time.

Who qualifies?

To receive coverage for Dexcom G6 under the Saskatchewan Drug Plan, you must be:

• Under the age of 18, and

• On intensive insulin therapy, and

• Eligible under the provincial requirements, and

• Have an approved Exception Drug Status Application or a prescription from an approved Designated Prescriber noting that you meet the medical criteria for the Dexcom G6 CGM System.

Who should apply?

We encourage residents of Saskatchewan whose child is under the age of 18, on intensive insulin therapy, and who is eligible under the provincial requirements to contact their pediatric diabetes specialist to initiate the coverage assessment process on your child's behalf.

If for some reason your child does not meet the criteria and your request is denied, you will still be able to seek reimbursement through your private insurance plan.

How do I get coverage?

Contact your pediatric diabetes specialist to initiate the coverage assessment process. If your approval is successful, your Dexcom supplies will be covered in full under the Saskatchewan Drug Plan.

How do I order my CGM supplies?

You will now have the option of purchasing your Dexcom supplies from your local pharmacy or directly from us.

To receive reimbursement through the Saskatchewan Drug Plan you will not be able to make purchases through the online Dexcom Store or our Subscription Program. However, we will be able to set up recurring shipments if you’d like to call in to order. If you have been approved under the provincial plan and would like to continue ordering from us directly, please contact our Customer Service team at [email protected] or 1-844-832-1810 (Mon-Fri 8am-7pm CST) to ensure we have everything we need to directly bill the province.

You are able to submit a claim for nine (9) G6 sensors and one (1) G6 transmitter every 90 days. If the quantity of your claim exceeds this approved limit by the Saskatchewan Health program you will be required to cover the additional costs.

Who qualifies?

People living with Type 1 diabetes who are 25 years of age or under and meet all the following criteria:

1. Are either:

i. Currently approved for the Manitoba Pediatric Insulin Pump Program (MPIP) administered by the Winnipeg Regional Health Authority (WRHA) through the Child Health Program’s Diabetes Education Resource for Children and Adolescents (DER-CA); OR
ii. On both basal AND bolus insulin.

2. Under the care and management of a Manitoba endocrinologist, diabetes specialist, or metabolic physician, and has routine follow-up with their diabetes care team;

3. Individual and/or their caregiver demonstrates the capacity to use the CGM system appropriately;

4. Individual and/or their caregiver demonstrates a reasonable understanding of what the CGM system can do and how it can benefit their care;

5. Individual and/or their caregiver agrees to use the CGM system properly and to use the data from this technology to make safe and effective diabetes management decisions.

For complete provincial program details, click here.

How do I get coverage?

If you believe you or your child meet the program criteria, contact your endocrinologist or diabetes specialist. They will be able to assist in determining eligibility and provide you with a written referral.

What if I have private insurance?

All individuals who qualify for Pharmacare coverage should enroll to in the program, even those with private insurance.

When enrolled in Pharmacare and eligible for CGM coverage:

• Your pharmacist will direct bill Pharmacare first, which will determine if you have reached your annual deductible amount.

• If the deductible is not met, Pharmacare will not pay and the claim will charged to your private insurance plan.

• If the deductible is met Pharamcare will cover 100% of costs.

How do I order my CGM supplies?

Once you have a prescription from your endocrinologist or diabetes specialist and your request for coverage has been pre-approved by Pharmacare, you will be able to order your Dexcom CGM supplies from your local pharmacy.

Unless you have private insurance, you will be required to pay out-of-pocket until your Pharmacare deductible has been met for the year. Manitobans receiving Employment and Income Assistance will not be required to pay any out-of-pocket costs.

How long will I be covered?

The initial approval duration is one year. Coverage may be continued annually if the program criteria continue to be met.

Who qualifies?

All Yukoners living with type 1 diabetes will now have access to fully funded continuous glucose monitoring.

How do I get coverage?

Yukoners living with type 1 diabetes who meet the benefit criteria must register with the Chronic Disease and Disability Benefit program at 1-867-667-5092. People aged 65 or older can contact the Pharmacare program at 1-867-667-5403.

How do I order my Dexcom CGM supplies?

Those approved will have the option of purchasing their Dexcom supplies from their local pharmacy or Dexcom directly.

To order from Dexcom directly, please contact our Customer Service team at [email protected] or 1-844-832-1810 (Mon-Fri 9am-6pm PST) to ensure we have everything we need to directly bill the territory.

Where can I find more information on the Yukon program?

For more information, click here.

Who qualifies?: NIHB program members ages 2 to 19 years old who are on intensive insulin therapy are covered in full under the program. Intensive insulin is defined as taking short-acting insulin three or more times per day.
How do I get coverage?: Your doctor or pharmacist can apply for coverage on your behalf by contacting the NIHB Drug Exception Centre at 1-800-580-0950. After completing and submitting a Limited Use Request form, your healthcare provider will be able to update you on the status of your approval.
How do I order my CGM supplies?: Once your coverage is approved by the NIHB Drug Exception Centre, your pharmacist will be able to order your Dexcom CGM supplies to your local pharmacy. Your pharmacist can confirm your coverage is in place and bill the cost of your supplies directly to the NIHB program.
How long will I be covered?: Coverage approvals are long-term and do not require resubmission.

For people living with T1D or T2D on fast-acting insulin

Most Private Insurers
Cover Dexcom CGM*

Have insurance questions? We are here to help. A Dexcom Account Specialist can assist you in determining your benefits for CGM coverage.

Get started by filling out our online form or call us toll-free at 1-844-832-1810.

Let Us Help

*Dexcom Data on file, 2021. Individual benefits may vary by policy and plan.

Coverage For
Dexcom CGM

Have Insurance Questions?

Ontario Public Coverage

Alberta Public Coverage

British Columbia Public Coverage

Quebec Public Coverage

Saskatchewan Public Coverage

Manitoba Public Coverage

Yukon

NIHB

Most Private Insurers
Cover Dexcom CGM*

Coverage For Dexcom CGM

Have Insurance Questions?

Most Private Insurers Cover Dexcom CGM*

Coverage For
Dexcom CGM

Most Private Insurers
Cover Dexcom CGM*