INTENT

To provide coverage for essential diabetic supplies, to ensure health and well being, when no other source can provide the needed items.

POLICY

All Community and Social Services recipients who receive prescription drug coverage through a Health Benefits Card, or an Alberta Child Health Benefits Card, or a Learner Health Benefits Card receive coverage for diabetic supplies. The client presents their health benefits card to the pharmacy and Alberta Blue Cross (ABC) adjudicates the claim on-line.

Insulin and non-insulin using diabetics receive:

• Blood glucose strips
• Lancets and penlets
• Blood monitoring devices with a doctor’s authorization. This is limited to a one-time benefit not to exceed $70.00
• Glucose calibration solution when required to monitor accuracy of monitoring device

Insulin using diabetics receive:

• Injection supplies: needles, syringes and needles for insulin pens
• Glucose test strips

The following supplies are not covered:

• Q-tips
• Rubbing alcohol
• Insulin pumps
  
  Note
  Individuals with type 1 diabetes mellitus may apply for insulin pumps and insulin pump supplies through the Alberta Health Insulin Pump Therapy (IPT) program. Individuals must be assessed at an Alberta Health Services approved Diabetes Insulin Pump Clinic to receive coverage under the IPT program. More information on the IPT program is available on the Alberta Health website. 

The Canadian Diabetes Association provides client education tools (for example, brochures for healthy eating). Clients interested in their services can call or write:

Canadian Diabetes Association
Suite 100, West Chambers Building
12220 Stony Plain Road
Edmonton AB   T5N 3Y4
Phone: Edmonton and area: 780-423-1232
Toll Free: 1-800-226-8464
Fax: 780-423-3322

PROCEDURE

Payment Method

Alberta Blue Cross (ABC) on behalf of Community and Social Services administers, controls and pays for diabetic supplies for all Community and Social Services clients with a valid Community and Social Services health benefits card.

Vendors send their claim forms to:

Alberta Blue Cross
10009-108 Street
Edmonton, AB   T5J 3C5
Fax: 780-498-8883

EMP 0018 Payment Authorization and Invoice is used to pay for diabetic supplies in the following rare circumstances:

• If a Health Benefits Card has not yet been issued or a dependant was added to the file after the card was issued and the service is urgently required before the next card is received. 
• For One-Time Issue recipients (client sub-type 81 and 82).

The EMP 0018 Purchase Authorization and Invoice:  

• Is issued to the vendor of the diabetic supplies
• Is forwarded by the vendor to Alberta Blue Cross for payment,
• Has no dollar amount, 
• Is used only for products on the Interactive Drug Benefit List, or approved by the Health Benefits Exception Committee.

Service Description for Diabetic Supplies

The appropriate Goods Code, Need Code and Description for diabetic supplies must be included on the EMP 0018 Purchase Authorization and Invoice. The period in the description must be the same as the Period of Assistance on the EMP 0018 Purchase Authorization and Invoice, and must cover the dates of service on the vendor’s claim form.

Health Benefits Exception Committee

Decisions regarding diabetic supplies provided as a Community and Social Services health benefit are defined in Regulation as decisions of the Minister, and therefore, not subject to appeal to an appeal panel.

Clients requesting diabetic supplies beyond those covered by Community and Social Services may ask for a review of the decision by the Health Benefits Exception Committee.