The New Brunswick Insulin Pump Program (NBIPP) assists with the costs associated with insulin pumps and continuous glucose monitoring (CGM) for New Brunswickers living with Type 1 diabetes who are medically eligible. NBIPP also assists with the costs of CGM for those living with Type 2 diabetes on intensive insulin therapy requiring three (3) or more insulin injections per day. The client (or parent/guardian) is responsible for paying part of the costs of equipment and supplies, based on their household size and total income.
Effective October 16th, the NBIPP moved to a payer of last resort payment model which means that all other health insurance coverage options must be used before applying for coverage.
- Who is eligible?
- What are the medical eligibility criteria?
- What is included?
- How do I apply?
- How is the client contribution determined?
- Who is considered a dependant?
- How is the household size determined?
- How much will be covered?
- How does my private health insurance work with this?
- Is there a renewal process?
- What is not covered by this program?
- how will the devices/supplies be distributed to me?
- What help is available if I cannot afford the insulin and blood glucose test strips?
- Where can I learn more about the New Brunswick Insulin Pump Program?
Potential clients must have a valid New Brunswick Medicare number and meet the medical eligibility criteria.
2. What are the medical eligibility criteria?
For pump and pump supplies:
- If client is starting pump therapy, the client has not had more than two (2) episodes of diabetic ketoacidosis (DKA) in the previous six (6) months OR if client is a current pump user, the client must not have had more than one DKA during the past year.
- The client is regularly followed by the diabetes care team and the care plan is reviewed at least 2 times per year.
- The client (or parent/guardian) has sound knowledge of how to manage diabetes including carbohydrate counting, site rotation, sick day management, etc.
- The client (or parent/guardian) is appropriately self-monitoring blood glucose, at least 4 times/day, recording results on paper or online and agrees to continue to do so.
- The client (or parent/guardian) agrees to attend a pump orientation, offered by a certified pump trainer.
- The client has appropriate family support (if applicable).
For continuous glucose monitoring:
- The client is regularly followed by the diabetes care team and the care plan is reviewed at least 2 times per year.
- The client (or parent/guardian) has sound knowledge of how to use sensor technology appropriately, including using the data from this technology to make safe and effective diabetes management decisions.
- The client (or parent/guardian) agrees to share sensor information with the client’s diabetes care provider/team to optimize diabetes management.
- The client (or parent/guardian) agrees to complete a CGM start orientation offered via web-based learning, virtual or in-person instruction by a CGM-trained vendor representative.
- The client (or parent/guardian) agrees to advise the NBIPP office if they discontinue use of their sensor technology.
All devices and their related basic operating supplies on the approved vendors list are eligible for coverage.
For pump and pump supplies:
Step 1: Your Pediatrician, Endocrinologist or Internist must complete the Confirmation of Medical Eligibility for Pump and Supplies Coverage form with you. Your specialist must then submit the completed form directly to the NBIPP business office by email at [email protected].
Step 2: Complete the Application for Pump and Pump Supplies Coverage form. This form will collect information on insurance coverage (if applicable), household income and household size that is used to determine financial eligibility and client contribution amount. You must submit the completed form, along with supporting documentation directly to the NBIPP business office by email at [email protected].
For continuous glucose monitoring:
Step 1: Your health care provider who supports the management of your diabetes must complete the Confirmation of Medical Eligibility for Glucose Monitoring Sensor Coverage form with you. Your health care provider must submit the completed form directly to the NBIPP business office.
Step 2: You must also complete the Application for Continuous Glucose Monitoring Sensor Coverage form. This form will collect information on health insurance coverage (if applicable), household income and household size that is used to determine financial eligibility and client contribution amount. You must submit the completed form, along with supporting documentation directly to the NBIPP business office.
Note: If you are applying for both insulin pump and/or pump supplies and continuous glucose monitoring sensor coverage, both applications must be approved by the same Endocrinologist, Internist or Pediatrician. You will be required to complete the Application for Pump and Pump Supplies Coverage form as well as the Application for Continuous Glucose Monitoring Sensor Coverage form. This is applicable to new and existing NBIPP clients.
5. How is the client contribution determined?
The client contribution is based on the total household income, household size and health insurance coverage (if applicable). Applicants must provide copies of the Notice of Assessments from the Canada Revenue Agency for the most recent taxation year for all members of the household that contribute to the household income.
With the exception of dependants, household income considers all incomes of members of a household that are related by birth, common-law union, marriage, or adoption. All incomes that contribute to the household income must be reported.
6. Who is considered a dependant?
A dependant is:
- A child of a person and/or a person’s spouse/partner living in the same household who is under 19 years of age and does not have a spouse;
- An individual between the ages of 19 years and 24 years who is a full-time student and does not have a spouse. The student may reside outside of the parental home while attending school.
- A child, grandchild, parent, grandparent, brother, sister, uncle, aunt, niece, or nephew of a person and/or a person’s spouse/partner living in the same household who depends on them for reasons of physical or mental impairment, and who meets the criteria for the Canada Caregiver Credit under the federal Income Tax Act;
- A child for whom child support is paid to another parent is considered a dependant of the paying parent, regardless of their primary family home.
7. How is the household size determined?
Household size considers those supported by the household income. This includes all members living in a household who are related by birth, common-law union, marriage, or adoption and all children for whom child support is being paid, regardless of their primary home. Parents may include children younger than 25 years old if they are full-time students and do not have a spouse.
The program may cover up to 100 per cent of the cost of pump, pump supplies and continuous glucose monitoring sensor. It is a sliding scale, taking into account the household size and income after taxes and private health insurance coverage (if applicable).
9. How does my private health insurance work with this?
Please check with your private health insurance provider before applying for coverage. Each insurer must provide you with details on the coverage for the selected pump, pump supplies and continuous glucose monitoring. This information is needed to complete the application form and is considered when calculating the amount that will be covered by the program.
10. Is there a renewal process?
All applicants must reapply each year by completing the Confirmation of Medical Eligibility for Pump and Supplies Coverage form and/or Confirmation of Medical Eligibility for Glucose Monitoring Sensor Coverage form, and the Application for Pump and Pump Supplies Coverage form and/or the Application for Continuous Glucose Monitoring Sensor Coverage form.
11. What is not covered by this program?
Insulin, blood glucose test strips and batteries are not covered by the program.
12. How will the devices/supplies be distributed to me?
Clients receive their device and supplies directly from the vendor. Clients/families pay their financial contribution for pumps, supplies and sensors directly to the vendor. The remaining costs are billed to the province by the vendor.
13. What help is available if I cannot afford the insulin and blood glucose test strips?
If you are experiencing financial difficulty due to the cost of health-related expenses such as insulin and blood glucose test strips, talk to your diabetes clinic team. They may be able to help you identify where to ask for financial assistance.
14. Where can I learn more about the New Brunswick Insulin Pump Program?
For more information on the New Brunswick Insulin Pump Program, you can contact the program’s administrator by:
- Telephone at 1-855-655-5525 (Toll free)
- Email: [email protected]