New criteria for reimbursing glucose test strips

The Québec Ministry of Health (Ministre de la Santé) has changed the way RAMQ reimburses glucose test strips that measure capillary glycemia (blood sugar levels measured by pricking the end of a finger).

RAMQ used to reimburse the number of test strips that doctors prescribed. However, since May 3rd, 2017, the number of test strips reimbursed in a 365-day period is now determined by a person’s risk of hypoglycemia; in other words, based on treatment.

For now, this method applies only to diabetics insured by RPAM, the public medical insurance plan (Régime public d’assurance médicaments). Private insurance companies and benefit-plan administrators have the option of adopting these measures, or not.

How many test strips are now reimbursed?

Hypoglycemia risk based on treatment Number of test strips reimbursed per 365-day period

No risk of hypoglycemia

Diabetics treated with lifestyle changes with no prescription for an oral or injectable antidiabetic

Diabetics with at least one prescription for an antidiabetic that does not include a sulfonylurea, repaglinide or insulin.

200 test strips

Moderate risk of hypoglycemia

Diabetics with at least one prescription of a sulfonylurea: gliclazide (Diamicron®), glimepiride (Amaryl®), glyburide (Diabeta®) or repaglinide (GlucoNorm®), but not insulin.

400 test strips

High risk of hypoglycemia

Diabetics treated with insulin.

3,000 test strips

In some cases, a health professional monitoring a person with diabetes may request a supplemental number of reimbursed test strips (100). Such patient situations may include:

  • Not reaching target glycemia levels for 3 or more months;
  • A medical condition affecting glycemic (blood glucose) control;
  • Starting a new antidiabetic medication;
  • A professional situation requiring increased glycemic control;
  • Planning a pregnancy.

Pregnant women with diabetes are entitled to 3,000 reimbursed test strips.

Why the change?

The goal of these new measures is to optimize the use of resources and contain health-care costs. Moreover, Québec was the only province in Canada without rules in place for reimbursing test strips. 

Evidence suggested that a significant number of people with diabetes were not making optimal use of test strips. To overcome this problem, the Ministry of Health initially asked INESSS, the National Institute for Health and Social Services (Institut national d’excellence en santé et en services sociaux) to produce a document for health professionals on the optimal use of glycemic self-monitoring for people with type 2 diabetes not being treated with insulin (click here for the full document, in French only).

Diabetes Québec collaborated in this project. Since the dissemination of this guide did not produce the expected results, the Ministry of Health asked INESSS to present recommendations for the reimbursement of test strips for all categories of diabetic patients.

How did they decide how many test strips to reimburse?

The Ministry of Health based its new reimbursement criteria on the recommendations of INESSS. INESSS produced a detailed report (click here for the full report, in French, with an English summary) that included an analysis of the use of test strips in Québec and other provinces, as well as a review of the literature pertaining to the optimal use of glycemic self-monitoring. Thus, the INESSS recommendations are consistent with the Canadian Diabetes Association Clinical Practice Guidelines. For more information about self-monitoring of blood glucose, see our article on the subject.

Following the implementation of these new criteria, Diabetes Québec sent a letter to the Ministry of Health requesting that the number of supplemental test strips be determined by the attending physician on a case by case basis and not fixed at 100.

The RAMQ has produced informational documents for insured individuals and health professionals:

For insured individuals, click here.
For physicians, click here (In French only) .
For pharmacists, click here (In French only).