Coverage Map

• Coverage for insulin pumps is provided through Saskatchewan Aids to Independent Living (SAIL) Insulin Pump Program. Patients must:
  • Have Type 1 diabetes
  • Have demonstrated ongoing and sustained practice of the following diabetes-related activities for a minimum of six (6) months prior to the insulin pump trial:
    • Blood glucose monitoring four (4) or more times per day or appropriate use of a continuous glucose monitor (CGM) or flash glucose monitor (FGM).
    • Consistency and accuracy in carbohydrate counting.
    • Ability to self-assess and take action based on blood glucose results.
    • Safe and effective management of hypoglycemia and hyperglycemia.
    • A commitment to long-term diabetes follow-up through regular assessments occurring at least annually (every 12 months) by a diabetes education program, diabetes educator, or their authorized specialist physician.
    • Expressed expectations or goals that are in line with potential outcomes of pump therapy.
    • No unacceptable burden of diabetic ketoacidosis as determined by a diabetes education program, diabetes educator, or their authorized specialist physician.
    • Consistent A1C monitoring at an interval of approximately every three (3) to six (6) months, or as deemed appropriate by a diabetes education program, diabetes educator, or their authorized specialist physician.
    • Those age less than 18 years:
      • There is demonstration of involvement of a parent(s)/guardian(s) in diabetes management. Child/youth/family has completed all steps of the Saskatchewan Pediatric Endocrinology and diabetes education program: Insulin Pump Assessment Process, part of which includes attendance at a Pediatric Diabetes Pump Information Session or completion of the Is Pump Therapy for Me? online modules and quiz.
    • Those age 18 years and older:
      • There is demonstration of involvement of the candidate in their personal diabetes management. The candidate has been assessed through the SHA diabetes education program process.
      • If a SHA diabetes education program requires further assistance and deems it appropriate for their client, patients may access educational training through a SAIL registered provider who is a Certified Diabetes Educator (CDE)® and also a certified insulin pump trainer, if instructed to do so by an SHA diabetes program.
  • Have completed an insulin pump trial for a period of up to three months that confirms:
    • the medical appropriateness of the insulin pump; and,
    • an adequate level of knowledge to operate the pump, and that safe use of the device has been achieved as confirmed by a certified pump trainer to the satisfaction of the SHA diabetes educator or the SAIL Registered CDE®.
  • Have eligibility certified by an SHA diabetes educator or a SAIL Registered CDE® who contributed to the assessment of the criteria; and,
    • For those less than 18 years:
      • Have eligibility certified by a pediatric licensed specialist (pediatric endocrinologist or pediatrician with diabetes expertise) who is associated with a SHA pediatric diabetes education program and has experience with insulin pump management in children.
    • For those aged 18 years and over:
      • Have eligibility certified by an endocrinologist or another specialist physician who is associated with a SHA diabetes education program and who has experience with insulin pump management.
  • Have completed the Client (parent/caregiver) Consent and Authorization and Confirmation of Responsibility on the Insulin Pump Program application.
• Additional Information: https://www.saskatchewan.ca/residents/health/accessing-health-care-services/insulin-pump-program

Initial Criteria

For pediatric patients with diabetes (or meet criterion ‘c’ specifically below) who are under 18 years old and meet ALL of the following criteria:

• 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;
• Patient and/or caregiver demonstrates the capacity to use the CGM/FGM appropriately;
• Patient and/or caregiver demonstrates a reasonable understanding of what the CGM/FGM can do and how it can benefit their care; and
• Patient and/or caregiver affirms a willingness to use the CGM/FGM properly and to use the data from this technology to make safe and effective diabetes management decisions.

In addition, patients must also meet ONE of the following:

1. Approved for the Saskatchewan Insulin Pump Program (NOTE: The Saskatchewan Insulin Pump Program policy will determine when patients are eligible for a new insulin pump funded by the Saskatchewan Insulin Pump Program.; OR
2. On both basal AND bolus insulin; OR
3. Have hyperinsulinism requiring frequent blood glucose monitoring.

Initial approval duration: One year

Renewal criteria

Coverage may be continued if ALL of the following are met:

• Patient remains under the age of 18;
• Patient has routine follow up with their diabetes care team and remains 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 involved with pediatric diabetes management;
• Patient and/or caregiver continues to demonstrate the capacity to use the CGM/FGM appropriately;
• Patient and/or caregiver continues to demonstrate a reasonable understanding of what the CGM/FGM can do and how it can benefit their care; and
• Patient and/or caregiver continues to affirm a willingness to use the CGM/FGM properly and to use the data from this technology to make safe and effective diabetes management decisions.

Coverage may also be discontinued upon notification from the care provider that the CGM/FGM criteria is no longer met by this patient.

Renewal approval duration: One year

Initial Criteria

For pediatric patients with diabetes (or meet criterion ‘c’ specifically below) who are under 18 years old and meet ALL of the following criteria:

• 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;
• Patient and/or caregiver demonstrates the capacity to use the CGM/FGM appropriately;
• Patient and/or caregiver demonstrates a reasonable understanding of what the CGM/FGM can do and how it can benefit their care; and
• Patient and/or caregiver affirms a willingness to use the CGM/FGM properly and to use the data from this technology to make safe and effective diabetes management decisions.

In addition, patients must also meet ONE of the following:

1. Approved for the Saskatchewan Insulin Pump Program (NOTE: The Saskatchewan Insulin Pump Program policy will determine when patients are eligible for a new insulin pump funded by the Saskatchewan Insulin Pump Program.; OR
2. On both basal AND bolus insulin; OR
3. Have hyperinsulinism requiring frequent blood glucose monitoring.

Initial approval duration: One year

Renewal criteria

Coverage may be continued if ALL of the following are met:

• Patient remains under the age of 18;
• Patient has routine follow up with their diabetes care team and remains 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 involved with pediatric diabetes management;
• Patient and/or caregiver continues to demonstrate the capacity to use the CGM/FGM appropriately;
• Patient and/or caregiver continues to demonstrate a reasonable understanding of what the CGM/FGM can do and how it can benefit their care; and
• Patient and/or caregiver continues to affirm a willingness to use the CGM/FGM properly and to use the data from this technology to make safe and effective diabetes management decisions.

Coverage may also be discontinued upon notification from the care provider that the CGM/FGM criteria is no longer met by this patient.

Renewal approval duration: One year

Listed

Can be prescribed by any doctor. Cost will be fully or partially covered according to the terms of the public drug plan.

Restricted

Only available to those who meet eligibility criteria and receive prior approval from the drug benefit plan. Cost will be fully or partially covered according to the terms of the public drug plan.