CGM coverage in Nova Scotia

Nova Scotia provides financial support for sensor-based glucose monitoring systems through the Sensor-based Glucose Monitoring Program and existing Pharmacare programs. Coverage is available for eligible residents living with diabetes who meet specific criteria and may be responsible for an income-based deductible toward costs. On June 3, 2024, Nova Scotia launched the Sensor-based Glucose Monitoring Program to help cover CGM supplies for residents with Type 1 or Type 2 diabetes requiring intensive insulin therapy. This program followed the February 2024 budget announcement that included expanded coverage for diabetes devices.

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

Nova Scotia offers CGM coverage through two types of publicly funded programs. You can choose the program that best suits your personal and financial circumstances.

You qualify if all of the following apply: 

• You are a Nova Scotia resident aged 2 years or older
• You have Type 1 diabetes or Type 2 diabetes
• You use intensive insulin therapy which means at least four insulin injections per day OR use an insulin pump
• Intensive insulin therapy is defined as one or more injections of basal insulin and three or more injections of bolus insulin with a minimum of at least four total insulin injections per day OR insulin pump therapy
• You have a valid prescription from your doctor, nurse practitioner or pharmacist

There are no upper age restrictions. Children, youth and adults aged 2 years and older may qualify if they meet the clinical eligibility criteria. 

You may also access CGM coverage through: 

• Seniors' Pharmacare Program for residents 65 and older
• Family Pharmacare Program for families
• Department of Community Services Pharmacare Benefits Program

These programs may have different deductibles, premiums or copayments compared to the Sensor-based Glucose Monitoring Program. You can only have coverage under one program at a time.

Nova Scotia covers sensor-based glucose monitoring systems that are listed in the Nova Scotia Formulary. Supplies must be dispensed by a pharmacy with a prescription. Currently approved CGM systems include: 

• Dexcom G6
• Dexcom G7
• FreeStyle Libre 2
• FreeStyle Libre 3 Plus

A prescription is required from your doctor, nurse practitioner or pharmacist as part of the coverage approval process.

The Sensor-based Glucose Monitoring Program and Pharmacare programs provide income based coverage for approved CGM components:

• CGM sensors according to program guidelines
• CGM transmitters if required for the device
• FreeStyle Libre readers available at no cost by calling Libre Customer Service
• Dexcom receivers available at no cost for people who do not have a compatible smartphone

Nova Scotia programs cover only the uninsured portion of CGM supply costs. This means:

• If you have private insurance, you must use that coverage first
• The programs act as payer of last resort and cover only the portion not paid by insurance
• Coverage under the Sensor-based Glucose Monitoring Program begins only after you meet your annual deductible

The programs do not cover supplies purchased outside Nova Scotia except under very specific circumstances. There are no reimbursements for sensors purchased before you are registered in a program.

The Sensor-based Glucose Monitoring Program uses an annual maximum deductible based on your adjusted annual family income. The deductible is the amount you must pay before the program begins coverage. There are no premiums or copayments.

Deductible amounts based on household income:

• Less than $60,000 annual household income: No deductible
• Between $60,000 and $150,000 annual household income: $500 to $1,000 deductible

You pay the full cost of supplies at the pharmacy until you reach your deductible. After you meet your deductible, the program pays the remaining cost until the end of the program year.

Payer of last resort model 

All Nova Scotia programs follow a payer of last resort model. You must use any sources of insurance you have including private insurance before the program can begin coverage. This includes insurance plans that require you to submit receipts to your insurance company for reimbursement. 

Pharmacare program costs

If you choose coverage through Seniors' Pharmacare, Family Pharmacare or Community Services Pharmacare instead of the Sensor-based Glucose Monitoring Program, different cost structures apply. These programs may have annual premiums, copayments or different deductibles. Review each program's specific requirements to determine which option best suits your financial needs.

If you do not meet ADP criteria, there are other ways to access CGM technology.

Step 1: Obtain a prescription

Get a prescription for your CGM system from your doctor, nurse practitioner or pharmacist. Your healthcare provider must also complete an exception status request form specific to your chosen program. 

Step 2: Complete registration form

Complete the Sensor-based Glucose Monitoring Program registration form. The form collects information needed to determine your eligibility and annual deductible amount including: Personal information and Nova Scotia Health Card number Diabetes diagnosis Insulin therapy details Household income information 

Step 3: Gather required supporting documents

Check the registration form for details on all required supporting documents. This typically includes proof of income and health card information. 

‍Step 4: Submit application 

Send your completed form and supporting documents by mail or fax or drop them off at Medavie Blue Cross which administers the program. 

Step 5: Wait for approval Registration should take 1 to 2 weeks

It can take longer if more information is needed or if your application has not been filled in correctly. There is no cost to register. 

Step 6: Pick up supplies at pharmacy

Once approved for coverage, you can pick up your CGM supplies from your pharmacy of choice with your prescription. 

‍Annual renewal 

Your coverage through the Sensor-based Glucose Monitoring Program renews automatically in February each year. You should receive a renewal confirmation by mail including any changes to your income provided by Canada Revenue Agency or changes to your coverage. You are responsible for notifying the program if there are any changes to your personal information. 

If you choose coverage through Seniors' Pharmacare, Family Pharmacare or Community Services Pharmacare: 

• Your healthcare provider must complete an exception status request form specific to the Pharmacare program
• Exception status coverage requests are typically processed within 7 to 10 days after submission
• Each Pharmacare program has its own registration process and requirements

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.