CGM Coverage with Saskatchewan Health
Does Saskatchewan provide Dexcom CGM coverage?
Yes, both Dexcom G6 and Dexcom G7 are eligible benefits under the Saskatchewan Drug Plan.
To receive coverage for Dexcom CGM under the Saskatchewan Drug Plan, you or your child must be under the age of 18 and have a prescription and an approved Exception Drug Status Application noting that you meet the below requirements:
- Under the care and management of a pediatric endocrinologist, pediatric diabetes specialist, pediatric metabolic physician or certified diabetes educator within the Saskatchewan Health Authority who is working with a pediatric diabetes specialist, and
- Individual and/or caregiver demonstrates the capacity to use CGM appropriately, and
- Individual and/or caregiver demonstrates a reasonable understanding of what CGM can do and how it can benefit their care, and
- Individual and/or caregiver affirms a willingness to use the CGM properly and to use the data from this technology to make safe and effective diabetes management decisions.
- And meet ONE of the following:
- Approved for the Saskatchewan Insulin Pump Program, or
- On both basal AND bolus insulin, or
- Have hyperinsulinism requiring frequent blood glucose monitoring.
For a complete description of provincial requirements, please visit: https://formulary.drugplan.ehealthsask.ca/Bulletins/Bulletin-0239-Apr-2024.pdf
Do I need a prescription to qualify for coverage?
Yes, you will need a valid prescription.
What do I need to get coverage approval?
Residents of Saskatchewan whose children are under the age of 18, on intensive insulin therapy, and who are eligible under the provincial requirements should contact their pediatric diabetes specialist to initiate the coverage assessment process on their child's behalf.
Requests initiated by approved designated prescribers within the diabetes care teams simply need to add a notation on the prescription that your child meets the above criteria.
Other prescribers will need to complete an Exception Drug Status Request Form that can be submitted by telephone for an immediate response, or by email, those submitted by email at [email protected] with the subject line ATTN: rtCGM request and allow a minimum of 72 hours for a response.
Exception Drug Status Request Forms submitted by telephone will receive an immediate response, those submitted by email will take a minimum of 72 hours for a response.
How long will I be approved for?
Once approved, initial coverage for Dexcom CGM is valid for 1 year. Subsequent requests are authorized for 1 year at a time and may continue until the user is 18 years of age.
Download the Application Form:
What if I have private insurance?
If the you or your child is approved for coverage through Saskatchewan Health, you will be covered in full and your Dexcom CGM supplies will be billed directly to Saskatchewan Health by your pharmacy. Coverage through Saskatchewan Health will stop when you or your child turns 18. At that time, we recommend you contact your insurance provider to inquire about coverage moving forward.
Where can I get my Dexcom CGM supplies?
If approved, you can purchase your Dexcom CGM supplies from your local pharmacy.
Will I have any out-of-pocket costs?
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.
Secondary insurance plans may also work with your primary medical plan to help cover gaps in cost, services, or both. Check with your secondary insurer for details.
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.