The November 2008 announcement by the BC Premier and the BC Minister of Health that the province will fund insulin pumps—as well as related supplies—for children with type 1 diabetes aged 18 years and under has allowed greater access to this medical device for those patients who meet the medical criteria for pump therapy. The new program funds pumps (and associated infusion sets and reservoirs) through the Ministry of Health Services’ Special Authority process; the actual cost of the pump is therefore affected by your Fair PharmaCare deductible, co-pay and family maximum, as well as by any private insurance you may have. For this reason, it is important to ensure that your family has signed up for Fair PharmaCare, to ensure you are maximizing the benefit you receive.
In February 2014, PharmaCare pump coverage was extended to those aged 25 years and under.
A number of years ago, BC Children’s Hospital established a set of eligibility criteria for children for pump therapy, including the demonstration of an understanding of insulin action and insulin dose adjustment, the ability to do advanced carbohydrate counting, and a realistic understanding of the pros and cons of pumping. As well, PharmaCare stipulates that patients need to be testing their blood sugars a minimum of 4 times a day (including lunchtime and some overnight checks) and have access and agree to comprehensive age-appropriate diabetes education by an interdisciplinary diabetes healthcare team.
As before, the decision to begin on a pump must be made individually with your Endocrinologist and the diabetes healthcare team at BC Children’s, as that is the only way he or she will agree to sign the necessary paperwork to have the pump funded by Fair PharmaCare and/or by private insurers. Only then will an appointment be made to come in and start on the pump. If your child’s Pediatrician signs the form for you, then he or she will be responsible for organizing and initiating the pump training and insulin dosing.
Please note that we may have a short waiting list to start pump therapy at BC Children’s Hospital, due to limited nursing resources (all pump starts and most follow-up are done outside of clinic hours). The new pump funding program does not at present provide for more pump training time. But this time does give families an opportunity to complete the extensive “homework” required to begin on a pump (which includes reading a portion of a manual on pumping, instituting carbohydrate counting at home, completing an online virtual pump course, and watching the video which comes with the new pump).
Families with extended benefits may need to complete paperwork for your insurer. The pump company representatives should be able to assist you with the paperwork for your insurer.
Funding for subsequent pumps: BC Pharmacare has laid out the following criteria for funding for subsequent pumps, in adition to the criteria for a first pump, as described above: (1) the current pump must be out of warranty; (2) it must be at least 5 years since the last PharmaCare-funded pump; (3) patients must have two A1C values of 9.0% or less, one within a month of application, the second 4–6 months prior); and (4) there must be no more than one episode of diabetic ketoacidosis in the 12 months before the application.
For more information about the process of obtaining a pump, please see our handouts:
Online resources from the
BC Ministry of Health website: