Patient has an occupation that requires strict avoidance of hypoglycemia (e.g., pilots, air-traffic controllers, critical positions in railways).Issues related to drug interactions which have impacted blood glucose control.Patient has experienced acute illness or infection that affected blood glucose control over a sustained period of time.Some common reasons for which an individual may require more frequent testing include, but are not limited to, the following: Patients may require more frequent testing for a variety of reasons. What are the exceptional circumstances under which additional strips would be allowed? Your physician may prescribe you an additional 100 test strips at a time if it has been determined that you need more test strips for exceptional circumstances. It is understood that there may be exceptional clinical circumstances where you require more frequent testing. Additional information is available from the Canadian Diabetes Association Self-Monitoring Blood Glucose (SMBG) tool.
The established reimbursement limits for test strips are set at a higher level than the minimum levels suggested by the Canadian Diabetes Association. What if I need more test strips than my reimbursement limit? It is also important that you fill your test strip prescriptions at a single pharmacy to facilitate proper tracking of your allotment. Speak with your pharmacist for more information. How will I know how many test strips I have left?īy following the prescribed testing practices determined by your health care provider, you should have enough to last an entire 365-day period.
If you use more test strips than the expected reimbursement limit in a 365-day period, you should speak to your diabetes health care provider to ensure you are testing appropriately. Please speak to your doctor or pharmacist about the number of test strips that you are eligible to receive in a 365-day period. If your annual maximum allotment is 200 test strips and you have already received 100 test strips during the lookback period, then you are only eligible to receive 100 test strips when you fill your prescription on January 1, 2022. Note: your test strip allotment may change during this period based on changes to your anti-diabetic medication. the lookback period) and determine the number of test strips you are eligible to receive on January 1, 2022. If you fill your prescription on January 1, 2022, the ministry will check your pharmacy claims and prescription receipts history between Januto Decem(i.e. The 365-day period is a rolling period based on the date you are filling your prescription for test strips. It is important to note that this 365-day period is not based on the calendar year (i.e., January 1 to December 31) or benefit year (i.e., starting August 1). This is based on how you manage your diabetes, which is determined based on your prescription records for the past 180 days. Through your pharmacy, the Ministry’s Health Network System (HNS) will track and automatically determine the number of blood glucose test strips that you are eligible to receive in a 365-day period. Remember that under the rules of the Ontario Drug Benefit (ODB) program, you may be asked to pay a small deductible amount and a fee for each prescription filled Learn more > How does the ministry know how many test strips I am eligible for?
The chart below shows how this is determined:Īnti-diabetic drugs with higher risk of causing hypoglycemia (low blood sugar)Īnti-diabetic drugs with lower risk of causing hypoglycemia (low blood sugar)ĭiet/lifestyle therapy only (no insulin or anti-diabetic drugs) The number of blood glucose test strips that you are eligible to receive in a 365-day period is determined based on how you manage your diabetes.
What are the reimbursement limits for blood glucose test strips under the Ontario Drug Benefit ( ODB) program?
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