Diabetes equipment and medication refund

In Québec, it is mandatory to be covered, at all times, by a drug plan.

• If you are eligible for private or group insurance, you must register for it.
• Otherwise, you have to be registered to the Public Prescription Drug Insurance Plan of the Québec health insurance plan (RAMQ).

RAMQ

When medication is covered or refunded by RAMQ, it does not mean it is free. You must pay a contribution of the prescribed price. Contribution includes:

• A monthly deductible (a maximum of 23$ per month)
• A part of the co-insurance (a maximum of 100$ per month or 1200$ per year).

*Exceptions are to be made for people under 18, on social insurance or those who receive the guaranteed income supplement. See RAMQ website for more information.

Private or group insurance

Every private insurance plan has to at least offer a coverage equal to the public plan.

Some private insurance plans offer more coverage than RAMQ and refund partially or the full amount of the monthly deductible and the co-insurance part.

Taxes deduction for medical fees

Every year, you can register the unrefunded portion of your medication on your tax report, whether you are insured by RAMQ or a private or group insurance. You could be allowed a tax deduction for medical expenses. Therefore, keep your receipts.

Strips

Strips reimbursement changes depending on your diabetes treatment.

An added number of 100 strips can be prescribed by your doctor or pharmacist in the kind of situations where you need a more frequent follow-up such as a change in medication, blood sugar targets not reached during more than 3 months, an acute disease or a surgical intervention.

Glucose meter (glucometer) and lancing device

The glucose meter and the lancing device are provided by your pharmacist when you buy 100 strips or more, whether they are refunded or not. If you do not buy strips, you will have to pay for the glucose meter and the lancing device. Some companies offer a test kit that you can directly order on their website.

If your equipment breaks, some companies offer the replacement for free. Contact them for more information.

Lancets

Lancets are not refunded. The cost of 100 lancets is around 10 to 20$.

Almost every diabetes management medication is covered.

Il existe des critères pour le remboursement de certains médicaments. Votre médecin en tient généralement compte avant de vous prescrire ces médicaments.

There are criteria for the reimbursement of certain medication. Your doctor usually takes this into account before prescribing you these medicines.

Some medicines are considered as “exceptional medication”, your doctor will need to fill a refund application. The reimbursement can take a few weeks to be accepted.

Two continuous glucose monitors are reimbursed in Québec. However, there are some requirements to be allowed a reimbursement. Your doctor will have to fill a form to justify the refund application. Private or group insurance plans sometimes have a wider coverage than the RAMQ concerning continuous glucose monitors.

Freestyle libre & Freestyle libre 2

These are the following eligibility criteria:

• Living with diabetes and being 18 years old or more
• Having 3 insulin injections per day or wearing an insulin pump
• And fill one or several of the following criteria:
  • Did not reach the hemoglobin A1C (HbA1c) targeted even with an adequate follow-up of the treatment plan
  • Living frequent hypoglycemic (low blood sugar) episodes even with an adequate follow-up of the treatment plan
  • Having difficulties to recognise or notify hypoglycemic symptoms.

Freestyle libre 2 is available for every child who is 4 years old and more and living with type 1 diabetes, without any eligibility criterion.

Dexcom G6 et G7

Eligibility criteria are the following:

• Living with type 1 diabetes and being 18 years old or more
• And fill one or several of the following criteria:
  • Did not reach the blood glucose (sugar) level (HbA1c) targeted even with an adequate follow-up of the treatment plan
  • Living frequent hypoglycemic (low blood sugar) episodes even with an adequate follow-up of the treatment plan
  • Having difficulties to recognise hypoglycemic symptoms.

Dexcom G6 and G7 is also available to every child from 2 to 17 years old with type 1 diabetes, without any eligibility criterion.

Other systems/device 

Other continuous glucose monitors are not covered.

Insulin and associated equipment

Most insulins are reimbursed, except:

• Rapid-acting insulin Fiasp
• Insulins that were replaced by biosimilar insulins, like Lantus, Novorapid and Humalog. For more information, see our article on the subject.

Needles are reimbursed.

When insulin is reimbursed, the refunded equipment includes:

• Pre-filled pens
• Reusable pen cartridges
• Vials for insulin pump or syringe.

Reusable pens are not reimbursed. They can however be offered by your pharmacist when buying insulin cartridges.

Some products may be exceptions, ask your pharmacist for more details.

Glucagon

Intranasal glucagon is reimbursed.

There is a program available for people under 18, living with type 1 diabetes, that gives them access to insulin pumps. This program refunds the purchase of an insulin pump and the necessary equipment to use it. To be eligible to this program, you need to meet several clinical criteria and be reassessed every year. For more information, see the access program to insulin pumps.