CGM coverage in Manitoba

Manitoba provides coverage for continuous glucose monitoring systems (CGMs) through the Manitoba Pharmacare program for Manitobans with diabetes who meet specific clinical criteria. Effective March 14, 2023, Manitoba expanded coverage to include all eligible Manitobans with Type 1 or Type 2 diabetes, removing previous age restrictions. Both real-time CGM systems and flash glucose monitoring systems are covered for eligible residents.

To learn more about which CGM systems are available across Canada, visit Our Guide to Continuous Glucose Monitors in Canada.

Manitoba Pharmacare CGM coverage requires meeting specific clinical criteria based on your insulin use. All applicants must be Manitoba residents eligible for Manitoba Health coverage. 

Type 1 or Type 2 diabetes with intensive insulin therapy: You may qualify if you have Type 1 or Type 2 diabetes and are currently using both basal and bolus insulin, or you use an insulin pump. These are the clinical criteria used by Manitoba Pharmacare to determine eligibility for Advanced Glucose Monitor (AGM) coverage. 

Manitoba does not have age restrictions for CGM/AGM coverage. People of all ages who meet the eligibility criteria can access advanced glucose monitors through Manitoba Pharmacare. You must be enrolled in Manitoba Pharmacare to receive coverage. If you are not currently enrolled, you can apply through one-time enrollment or annual application. Coverage is available to eligible Manitobans whose prescriptions are not covered by other provincial or federal programs.

Manitoba covers both real-time continuous glucose monitoring systems and flash glucose monitoring systems that meet Health Canada safety standards. These devices are referred to as advanced glucose monitors (AGMs) in Manitoba.

Currently approved CGM/AGM systems include: 

• Dexcom G6
• Dexcom G7
• Abbott FreeStyle Libre
• Abbott FreeStyle Libre 2
• Medtronic Guardian Sensor 3
• Medtronic Guardian Connect transmitter kits

These devices are available through your local pharmacy. Although Manitoba policy does not require a prescription for AGM coverage, most pharmacies do require a prescription to dispense CGM devices such as Dexcom and FreeStyle Libre.

• CGM transmitters and sensors according to maximum allowable quantities within each benefit year
• FreeStyle Libre readers according to the approved replacement schedule
• Dexcom receivers for individuals who do not have a compatible smartphone

Accessories such as batteries, insertion devices, or adhesive removers are not listed as funded items, meaning they are not covered. Lost or stolen equipment, misuse-related damage, and smartphones are also not covered.

• Dexcom G6: Up to 5 transmitters and 45 sensors per benefit year 
• Dexcom G7: Up to 45 sensors per benefit year 
• Dexcom receivers: Covered for individuals who do not have a compatible smartphone 
• FreeStyle Libre and Libre 2: Up to 33 sensors per benefit year 
• Medtronic Guardian Sensor 3: Up to 65 sensors per benefit year 
• Medtronic transmitter kits: Up to 1 transmitter kit per benefit year

👉 For the most current approved devices and quantities, review the Manitoba Drug Benefits and Interchangeability Formulary.

The application process for Manitoba Pharmacare CGM coverage is straightforward and occurs through your pharmacy when you have a valid prescription. Manitoba does not require pre-approval or Exception Drug Status (EDS) application for CGM coverage, making it one of the easiest provinces for accessing these devices.

Step 1: Enroll in Manitoba Pharmacare 

If you are not already enrolled in Manitoba Pharmacare, you must enroll first. You can choose between one-time enrollment (which eliminates the need to reapply annually) or annual application. Manitoba Pharmacare determines your annual deductible based on your adjusted family income.

Step 2: Obtain your CGM system from your pharmacy

While Manitoba government sources state that a prescription is not required for coverage, pharmacies generally require a prescription to dispense CGM devices such as Dexcom or FreeStyle Libre. Your healthcare provider will confirm that you meet the clinical eligibility requirements based on your insulin use (both basal and bolus insulin or insulin pump therapy).

Step 3: Have your pharmacist verify eligibility and submit your claim

Take your prescription (if required) to your local pharmacy. Your pharmacist will verify your eligibility by checking your drug utilization history to confirm you meet the insulin use requirements. No pre-approval or special authorization is required; claims are processed directly through the pharmacy system.

Step 4: Meet your Pharmacare deductible 

Advanced glucose monitors are subject to Manitoba Pharmacare deductibles. You will need to pay out-of-pocket for your CGM supplies until your annual Pharmacare deductible has been met for the year. Once your deductible is met, Manitoba Pharmacare will cover your CGM costs. Manitobans receiving Employment and Income Assistance will receive advanced glucose monitors at no cost without a deductible.

Step 5: Receive your CGM system 

Once your claim is processed, your pharmacy will provide your CGM system and supplies according to the quantities approved for your benefit year. Coverage continues as long as you meet the eligibility criteria. Your Pharmacare deductible resets annually on April 1 of each benefit year. Coverage will continue automatically as long as you meet eligibility criteria and remain enrolled in Manitoba Pharmacare.

👉 For application forms and details, visit the Ontario ADP website or speak with your registered Diabetes Education Program.

If you do not meet the criteria for Manitoba Pharmacare CGM coverage, there are other ways to access CGM technology.

Private insurance: Many employer and private insurance plans provide coverage for CGM systems, including both real-time CGM and flash glucose monitoring. Eligibility criteria vary and are often less restrictive than Pharmacare. Check your policy for device coverage and limits. If you have both private insurance and Manitoba Pharmacare, your pharmacist will coordinate coverage between both plans, with Pharmacare typically covering costs after your private insurance. 

‍Out-of-pocket costs: You can purchase CGM systems directly without insurance. Costs vary by device and usually include the transmitter or reader if needed, plus ongoing sensor costs that generally range from 250 to 400 dollars per month.

Managing your supplies and staying connected with your diabetes care team is important for safe and effective CGM use. The Endor Health app supports ongoing communication with your care team so questions about your CGM data or therapy can be addressed promptly. The app also provides convenient home delivery of insulin, prescription items, and CGM sensors at no added cost, helping reduce the risk of missed refills or last minute pharmacy visits.

The information in this article is for educational purposes only and should not replace advice from your healthcare provider. Always consult with your diabetes care team before making changes to your diabetes management.