CGM Coverage with BC Pharmacare
Does BC PharmaCare† provide Dexcom CGM coverage?
Yes, Dexcom G7 and Dexcom G6 coverage is available for qualified individuals.
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), At Home Program (Plan F) and First Nations Health Benefits Plan (Plan W). Those who meet the clinical criteria set by BC PharmaCare for Dexcom G6 or Dexcom G7 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 or Dexcom G7 under BC PharmaCare, you must:
- Be registered with Fair Pharmacare, Plan C, Plan F 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.
Do I need a prescription to get Dexcom CGM?
Yes, you will need a valid prescription for Dexcom G6 or G7. You can obtain this from your primary care provider or your endocrinologist.
If you are switching from Dexcom G6 to Dexcom G7, you should obtain a new prescription for Dexcom G7 from your prescribing healthcare professional.
What do I need for coverage approval?
Contact your primary care provider or endocrinologist to initiate the BC PharmaCare Special Authority approval process. Once approved, your future Dexcom purchases will need to be made at your local pharmacy.
How long will I be approved for?
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.
Where can I get my Dexcom CGM supplies?
Once your primary care provider or endocrinologist has submitted a Special Authority application. Please confirm the request was approved before you bring your prescription to your local pharmacy. You can either check the status in Health Gateway, call your prescriber or pharmacist, or call PharmaCare at 1-800-663-7100 or 604-683-7151 (from the Lower Mainland) to confirm.
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 benefits purchased before approval of a Special Authority request.
Will I have any out-of-pocket costs?
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.
For any remaining out-of-pocket costs, the Dexcom G7 Patient Benefit Program assists in reducing or even eliminating up to 20% of out-of-pocket costs.* Download a copy of the program certificate below, which can be redeemed at your pharmacy with a valid Dexcom G7 prescription.
Do you have questions?
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.
*Based on reasonable upcharge, mark-up and customary pharmacy dispensing fee.
† Best available information as of June 14, 2024. Subject to change.
† Best available information as of June 14, 2024. Subject to change.