Pump Coverage


After lagging behind other provinces and territories for the past ten years, Alberta has finally implemented an insulin pump therapy program for those with T1D.

Read more about the Insulin Pump Therapy Program

Individuals are recommended to contact their physicians early to obtain a referral to the assessment team as there is an anticipated wait.  Thankfully, the program is extensive in scope and potentially will cover the costs associated with daily care including testing strips and lancets.  Thanks to all of those who strongly advocated to provincial politicians and to the politicos themselves for listening and responding.

 

The use of insulin pumps over multiple daily injections is supported by Kids ‘n’ Us due to research showing reduced A1C’s, reduced hospital admissions, reduced incidences of hypoglycemia, and improved quality of life.  In addition, insulin pump usage will reduce the medical training required by school personnel to provide insulin to a child with T1D at lunch and snack times. 

 

Questions from KidsNUs Insulin Pump Therapy Program Sesssion

Saturday, April 23rd, 2016

 

  1. Why only 20 units/100 days allowed for ketone test strips?

This quantity was established with input from diabetes experts. It was felt to meet the general needs of most patients for ongoing use. If needed, an increase to this limit could be requested by the patient’s diabetes specialist.   Clinical rationale is required for such requests. Typically, additional supply requests are to address ongoing needs as opposed to short-term issues.

 

  1. What is a Serter?

Discussed at conference.

 

  1. Timing…(suggested timeline…) is not our experience. We have been told 18-24 months to get a pump through the stollery.

– Why can’t other people (more people) do pump training? (heated discussion ensues)

– Total count of people in the room concerned about timing is 16 (show of hands)

 

The Assistant Deputy Minister (responsible for IPTP) has raised this issue with AB Health Services. AH will be following up with AHS regarding their assessment and presentation of possible solutions.

 

  1. Of the 50 people who discontinued (mentioned in session), how many were adult/child/senior?

There were 26 discontinuations for IPT plan members who were under 18 (at the time AB Blue Cross received the form). We do not have the breakdown for adults although there are few seniors in the IPTP.

 

     AB Blue Cross is pulling this information for me but, unfortunately, I don’t have it now. I will get this info to you when I receive it.

 

  1. What’s the age breakdown of usage stats? (supplies)

 

 

  1. What can parents do to help IPT; what info can we provide as feedback and what’s the best way to do this?

discussed that KidsNUs and clinicians were good options.

 

  1. I wrote the minister with feedback/questions (as was told) and got a canned response. Clinic says talk to MLA, MLA says talk to Clinic. Trying to advocate but no one is listening.

Communicating with the Ministry and Minister is a good approach. AH meets with AHS regarding the IPTP.

 

  1. In 2010, it was 6 months to get a pump, why does it take so much longer now?

Client demand and increasing numbers of IPTP clients is part of the reason. As mentioned above, AH has raised wait times with AHS, particularly for the pediatric clinics.

 

  1. Is age a factor in the speed of the process of getting a pump? (has 2ish old child who got pump quicker than 18+ months)

While eligibility and clinical criteria have been set, urgency of patient need (for patients of all ages) is assessed and may impact timelines.

 

Processes for pediatric patients generally are more involved (than those for adults) so it may take longer to proceed through all the necessary steps (assessment, training, ensuring processes are in place if children are away from the parents, etc. ) for children..

 

  1. I have a 12 year old, my wife is Cdn/Polish. Polish family is telling us it would be quicker to fly to Poland to get a pump…how to explain to them why we have to wait (etc.)

 

Generally, patients are seen by the clinics on a first come, first served basis.

 

  1. We were pumping before IPT came in. What happens if our pump fails in the one-year gap between the 4-year pump warrantee and the 5-year time limit to get a new pump through the IPT program?

 

The pump manufacturers did not raise any issues with respect to the replacement timelines set for AB’s IPTP.

 

As discussed at the session, it has been the experience that manufacturers support clients, if necessary, during this period. Pumps are operational for several years (i.e., past 4 years). (See #13 below.)

 

  1. Re: Poland. We have it good here, lucky to have pump. But we don’t think it’s fair that one of the requirements to qualify for a pump is the discretion of the Clinic.

 

Eligibility and clinical criteria were set following input from a number of diabetes specialists. All clinics are to follow these criteria. The criteria were developed with the safety of the patient being uppermost. The clinics meet regularly to discuss processes and operational issues for equity in approaches across sites.

 

It is common to have criteria for coverage of expensive technology under publicly-sponsored health benefit plans. Clinicians typically are the ones that assess whether their patients meet these criteria.

 

  1. Re: Concern about pump warrantee gap. Pump reps have an interest in keeping your business, I’m fairly sure, the company would offer you a loaner pump to tide you over if the pump failed past warrantee and before new pump through IPT. It’s in their best business interest to keep you as a customer.

 

  1. Our family has a newer diagnosed (7 wks?) 9 yr old. We were told we have to wait until August before we can talk pump with the clinic…if it’s 18-24 months, why do we have to wait until then?

           

            As mentioned AH has raised the issue of wait times with AHS.