New test strips reimbursement terms

Did you know…

As of May 3, 2017, the maximum number of strips that can be reimbursed per 365-day period will be based on the risk of hypoglycemia, i.e. based on the diabetes therapy being used. Three annual maximums are planned.

The new reimbursement terms will apply to people insured under the public drug insurance plan. Please note that private insurance providers and benefits plan administrators may also apply these measures if they wish.

Terms of application

Clinical situation

  • People with diabetes treated through lifestyle changes without prescribed diabetes medication.
  • People with an anomaly to the pancreas resulting in abnormal insulin production (e.g. insulinoma or nesidioblastosis).
  • People with diabetes treated with at least one diabetes drug not including sulfonylurea, repagllnide or insulin.

People with diabetes treated with at least one prescription for sulfonylurea or repaglinide, but do not take insulin.

People with diabetes who are treated with insulin.

SPECIAL CLINICAL SITUATIONS

Depending on the insured person’s clinical situation, the Régie may reimburse additional test trips per 365-day period.


The special clinical situations include:

  • The diabetic patient does not reach the doctor’s recommended blood sugar levels, for three months or more;
  • The diabetic patient has an acute disease (e.g. infection), a comorbidity or underwent a medical or surgical intervention that may influence blood sugar control;
  • The diabetic patient is starting a new drug therapy known for its hypo or hyperglycemic effects;
  • The diabetic patient is at risk for drug interactions that my influence blood sugar control;
  • The diabetic patient’s work situation requires close blood sugar monitoring because hypoglycemia poses a significant safety risk (pilot, air traffic controller, etc.);
  • The patient has non-insulin dependent type 2 diabetes and is planning to become pregnant;
  • The patient has an anomaly to the pancreas resulting in abnormal insulin production (e.g. insulinoma or nesidioblastosis).

consultation tips

It is the responsibility of the patient’s healthcare provider to determine whether the patient is eligible for the reimbursement of additional test strips.

QUESTIONS AND ADDITIONAL INFORMATION

View the publication Avis sur les mesures relatives au remboursement des bandelettes issued by the Institut national d’excellence en santé et en services sociaux (INESSS).

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