1. What is an insulin pump?
- An insulin pump is a small mechanical device (about the size of a pager) that is worn outside the body, often on a belt or in a pocket. It pumps insulin into the body through a narrow tube and very fine needle inserted under the skin.
- The pump is programmed to deliver insulin at a steady rate based on the individual's insulin needs. It also allows the user to administer a top-up of insulin when required (i.e. after meals or high blood glucose readings between meals).
2. What is the Saskatchewan Insulin Pump Program?
- Initially started July 1, 2007, the Saskatchewan Insulin Pump Program helps to ensure that cost is not a barrier to families with children who require an insulin pump to manage their diabetes.
- Effective January 1, 2012, the program has been expanded to provide benefits to individuals 25 years of age and under.
- Inadequate control of diabetes can lead to serious complications affecting the kidneys, heart and eyes which may result in frequent hospitalization and poor quality of life.
3. Who qualifies for the Insulin Pump Program?
- Saskatchewan residents 25 years of age and under who have Type 1 diabetes and require an insulin pump to adequately stabilize their blood glucose levels and who meet the program criteria.
4. Are there residents who are excluded from this program?
- Residents who are eligible for benefits under federal government programs (i.e. Registered Indians who are covered under the Non-Insured Health Benefits program) are not eligible for benefits under Saskatchewan Health's Drug Plan and Extended Benefits.
5. Will there be continued coverage for pumps when a patient turns 26 years of age?
- Only applicants under 26 years of age are eligible. Those who have a pump when they turn 26 will be permitted to keep the pump. However, there will be no further coverage for supplies.
6. Is there any coverage for insulin pumps/supplies for other adults?
- No, coverage for insulin pumps or supplies is not currently available under any other programs.
7. When will this expansion to the program start?
- The expanded Insulin Pump Program will be effective as of January 1, 2012.
- Coverage will be provided effective from the date the application is received by the Saskatchewan Aids to Independent Living program of Saskatchewan Health.
8. What benefits will be available under the Insulin Pump Program?
Individuals who qualify under the program will receive:
- Insulin pumps free of charge (up to a maximum of $6,300) through the Saskatchewan Aids to Independent Living (SAIL) program of Saskatchewan Health. One pump will be provided, if required, every five years up to the age of 25.
- Insulin pump supplies as benefits under the Drug Plan through Saskatchewan pharmacies. For those who have Special Support coverage, the cost of supplies will be based on the family deductible and/or co-payment.
- Applicants 17 years of age and under who are beneficiaries under the Supplementary Health program, the Family Health Benefits program or certain programs under SAIL will receive their insulin pump supplies free of charge.
- For applicants between the ages of 18 and 25 who are beneficiaries under the Family Health Benefits program, the cost of supplies will be based on the deductible and/or co-payment under that program.
- Applicants between the ages of 18 and 25 who are beneficiaries under the Supplementary Health program or certain programs under SAIL will receive their insulin pump supplies free of charge.
9. What are the criteria for coverage of an insulin pump?
- Use of an insulin pump as a medical necessity must be recommended by an endocrinologist or another specialist physician who is associated with a regional health authority diabetes program and who has experience with insulin pump management in individuals 25 years of age and under who have Type 1 diabetes.
- The applicant must be assessed by a regional health authority diabetes program, participate in a diabetes education program and meet specific medical criteria.
- The applicant must also participate in a regional health authority insulin pump information program.
10. Will the new program apply to Saskatchewan residents when recommended by an out-of-province physician and/or diabetes education centre?
- Yes, as long as the applicant has met Saskatchewan's program criteria and an application has been made by an endocrinologist or another specialist physician licensed to practice in Canada and who has experience with insulin pump management in individuals 25 years of age and under.
11. How does one apply for coverage of an insulin pump and supplies?
- An application must be submitted on behalf of a patient by a regional health authority diabetes program/specialist following screening, assessment, and patient participation in a diabetes education program and a pump information session.
- Contact the Saskatchewan Drug Plan and Extended Benefits Branch in Regina at 787-7121 or toll-free at 1-800-667-7581 if you have any questions.
12. What is the cost of insulin pump supplies?
- The cost of supplies averages about $250/month. Clients may qualify for assistance towards the cost of supplies through the Special Support Program, the Supplementary Health program, the Family Health Benefits program or certain programs under SAIL.
- To receive financial assistance through the Special Support program, pump supplies must be purchased from a pharmacy. Saskatchewan Health cannot reimburse patients for pump supplies purchased directly from pump suppliers.
13. What supplies will be included in the coverage?
- The supplies for which coverage will be available include infusion sets, cartridges/reservoirs, insertion devices, Skin Prep and IV Prep wipes.
- Accessories (e.g. skins and cases) as well as batteries will not be a benefit under the Insulin Pump Program.
- Beneficiaries of the Supplementary Health program or Family Health Benefits program who are 17 years of age and under who are also registered on the Saskatchewan Insulin Pump Program will receive pump batteries, cartridge/reservoir replacement caps and battery replacement caps free of charge.
14. How are pump suppliers selected?
- There are currently three suppliers who sell insulin pumps covered under the Saskatchewan Insulin Pump Program. Choice of a pump will be at the discretion of the applicant/family in consultation with the regional health authority diabetes program. At this time, the pumps currently available are all priced similarly.
15. What if an applicant desires a more expensive pump?
- The SAIL program will pay up to $6,300 for a pump. Any incremental cost would be the responsibility of the applicant/family.
16. What if an applicant is started on a pump and then realizes it is not appropriate for their needs?
- The pump suppliers will provide up to a three month trial for a new applicant. If an applicant decides to discontinue the pump at the end of the trial, it will be returned to the supplier.
- During this trial period, pump supplies will also be provided by the pump supplier at no cost to the applicant.
17. What are the warranty provisions by the pump supplier?
- Once the pump is delivered by the supplier and paid for by SAIL, the applicant/family is considered to be the owner of the pump. It will be the responsibility of the applicant/family to obtain any required pump service.
- The applicant/family should contact their pump supplier to inquire about the availability of extended warranty provisions.
- Currently all participating companies provide a four year warranty. They will provide replacement pumps within 24 hours if applicants experience a problem with a pump.
18. Will an insulin pump be replaced that is lost or wilfully damaged?
- Saskatchewan Health will not provide coverage for a second pump in the case of wilful damage.
- The warranty policies of the pump suppliers also may not include loss or wilful damage.
- Applicants/families are advised to pursue other avenues of insurance to cover loss of a pump.
19. Will my private insurer/employer plan pay for my insulin pump/supplies?
- There are a number of third party insurers. It is unknown whether they will provide assistance with any of the cost of supplies or for insulin pumps for those who do not qualify under the Drug Plan. It is the responsibility of the applicant to contact their third party insurer.
