ADP is a government-funded program that helps cover the cost of devices such as insulin pumps and related supplies. This also includes continuous glucose monitoring (CGM) systems.

The Assistive Devices Program covers 100% of the price of the insulin pump, paid directly to the supplier on your behalf. An annual grant of $2,400 is paid directly to the patient in four equal payments on a quarterly basis. Expect to receive the first $600 grant within 8-12 weeks of starting on the pump. Depending on which pump and/or infusion set you choose, the grant money should cover approximately 80% of the cost for the monthly supplies needed. All pump companies will perform an insurance investigation to determine if any extra costs for supplies will be covered by insurance plans. Original receipts for monthly supplies should be kept for up to two years in the event of an ADP audit.

• You will need to cover the upfront cost of supplies until you receive your ADP grant.

• To maintain eligibility for ongoing funding ($600 quarterly), the Government of Ontario has implemented strict medical criteria which must be met and will be re-assessed on a yearly basis. A renewal letter will be sent directly to you every year. You must send the renewal letter to the Best Centre for our team to review eligibility for the supply grant.

Individuals with type 1 diabetes who regularly attend a Diabetes Education Program and treat their diabetes with multiple daily injections may be eligible for funding for insulin pump therapy.

Eligibility criteria to access ADP program:

• Must be living with type 1 diabetes for at least one year.

• Must have demonstrated a commitment to blood glucose monitoring (4 times/day) or using Libre and scanning at least 4 times/day or using CGM (Dexcom, Medtronic Guardian sensor).

• Must have a good understanding of carbohydrate counting.

• Must participate in an insulin pump education program.

• Must attend regular appointments with approved ADP Diabetes Education Centre (i.e. Best Centre).

Children and youth (18 years old and younger) will be eligible for continued funding of insulin pump supplies if the following criteria are met:

• no more than one episode of DKA within the last 12 months

• adequate frequency of blood glucose monitoring to ensure the safe and effective use of the insulin pump – blood glucose monitoring at least 4 times a day or use of CGM

• adequate frequency of infusion set changes and site rotation to ensure healthy insertion sites – infusion sets must be changed a minimum of every 2 – 3 days

• consistent pattern of effective pump management

• carbohydrate counting and delivery of bolus insulin for all meals

• minimum of 3 clinic visits in the last 12 months.

Adults 19 years of age and older will be eligible for continued funding for insulin pump supplies if they meet the following medical eligibility criteria at the time of the annual renewal:

• continues to demonstrate an ongoing commitment to blood glucose monitoring a minimum of 4 times a day, or use of CGM

• continues to demonstrate successful sick day management

• has demonstrated that they have benefited from Insulin Pump Therapy which is defined by one of the following:

  • improved quality of life

  • improved A1C results

  • reduction in the number of hypoglycemic events

  • reduction in the number of DKA episodes

  • improved management of the “dawn phenomenon”

• has demonstrated a commitment to long term diabetes follow-up through regular assessments by the diabetes educators at the Best Centre every 6 months AND regular follow-up as directed by their physician.

Assistive Devices Program (ADP) will provide coverage for real-time continuous glucose monitoring systems (Dexcom, Medtronic Guardian) for Ontario residents with type 1 diabetes who meet eligibility criteria.

To be eligible for ADP coverage for CGM you must meet the following medical eligibility criteria:

1. Applicant has type 1 diabetes.

2. Applicant meets one of the following.

   1. Applicant is unable to recognize or communicate symptoms of hypoglycemia, or independently perform fingerstick glucose testing, owing to their developmental stage or a previously diagnosed cognitive or physical impairment.

   2. Applicant had severe hypoglycemia in the past 2 years without an obvious precipitant, despite optimized use of insulin therapy and glucose monitoring (at least 4 times/day) which result in one of the following:

      1. suspension of the applicant’s driving licence;

      2. hospitalization or emergency room or EMS visit; or

      3. glucagon administration, unconsciousness, or seizure.

3. Applicant demonstrates experience with and commitment to managing blood sugar control and an ability to use a real-time Continuous Glucose Monitor (rtCGM) safely and effectively by ALL of the following:

   1. Applicant demonstrates a commitment to long-term diabetes follow-up through regular assessments by diabetes educators, and prescribers at intervals deemed appropriate by their ADP-registered Diabetes Education Program.

   2. Applicant agrees to wear the rtCGM full-time.

   3. Applicant agrees to share the data components of the Ambulatory Glucose Profile with the diabetes health care providers/team such as:

      1. percent time in target range, percent time above or below target range, percent time in hypoglycemia; and

      2. visual representation of average 24-hour glucose profile for a 2-week period.

ADP COVERAGE FOR CGM - Instructions for Patients

STEP 1: Click HERE to access the fillable form via the RightSignature document sharing platform.

STEP 2: Patient (applicant) must complete page 1; fill in name and health card number at the top of pages 2, 3 and 4; and sign and date on page 3. NOTE: on page 3, you must check the appropriate box to indicate whether you are the applicant or an agent (parent). If you check agent, fill in name and address. Also, please enter your diabetes doctor’s name in section 4 so that we can forward your form to the correct office for signature.

STEP 3: The completed and “submitted” form on RightSignature platform will be emailed to you, and a copy will be sent to The Best Centre.

STEP 4: The Best Centre admin team will complete the clinic information and forward the form to your PHYSICIAN who will complete section 2 to determine IF you are eligible then will sign section 4. NOTE: your physician may charge a fee for this service.

STEP 5: Your PHYSICIAN will either return the completed form to you, or in some cases, send the completed form directly to the CGM provider (DEXCOM/MEDTRONIC) on your behalf.

STEP 6: If you are submitting your own application, will need to submit the fully completed form to DEXCOM or MEDTRONIC. You can send by email, fax or mail.

MEDTRONIC

Cecil Sarin cecil.sarin@medtronic.com

Melanie Lynch melanie.lynch@medtronic.com

Fax: 866-430-0349

99 Hereford Street Brampton, ON L6Y 0R3

DEXCOM

ca.sales.dc@dexcom.com

Fax: 844-348-0784

501-4445 Lougheed Hwy

Burnaby, BC V5C 0E4

Real Time Continuous Glucose Monitor (rtCGM) Renewal

The renewal forms will NOT need to be completed or signed by your physician.

Ongoing eligibility confirmation is self-reported by the patient, and it is the vendor (Dexcom/Medtronic) that is responsible for sending the completed and signed renewal form to ADP.

STEP 1: ADP will inform the vendor (Dexcom/Medtronic) that a renewal form needs to be completed for you (the patient), 13 weeks before the 2-year initial request was completed and signed by the physician.

STEP 2: Dexcom/Medtronic will send the renewal form to the you via email with instructions to complete and sign.

STEP 3: You will complete and sign the form via Docusign and sends back to Dexcom/Medtronic.

STEP 4: Dexcom/Medtronic will validate that information is complete, and forward the renewal form to ADP.

STEP 5: ADP confirms ongoing eligibility and payments to the Vendor (Dexcom/Medtronic).