Blood Glucose Test Strips

Questions and Answers

• What are the reimbursement limits for blood glucose test strips under the Ontario Drug Benefit (ODB) program?
• How does the ministry know how many test strips I am eligible for?
• How will I know how many test strips I have left?
• What if I need more test strips than my reimbursement limit?
• What are the exceptional circumstances under which additional strips would be allowed?
• Can my pharmacist provide me with a prescription refill for extra strips?
• Can I receive an exemption for additional test strips more than once in a 365-day period?
• If I need additional strips, will there be an impact on my annual allotment for the next 365-day period?
• What if I start a new diabetes medication that might change my limit in my current 365-day period?
• What can I do if I have not received my test strips allotment but the pharmacist says my claim has been rejected?
• What is MedsCheck for Diabetes?

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What are the reimbursement limits for blood glucose test strips under the Ontario Drug Benefit (ODB) program?

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.

The chart below shows how this is determined:

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?

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. This is based on how you manage your diabetes, which is determined based on your prescription records for the past 180 days. 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). The 365-day period is a rolling period based on the date you are filling your prescription for test strips.

For example:

If you fill your prescription on January 1, 2022, the ministry will check your pharmacy claims and prescription receipts history between January 2, 2021 to December 31, 2021 (i.e. the lookback period) and determine the number of test strips you are eligible to receive on January 1, 2022. 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.

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 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.

How will I know how many test strips I have left?

By following the prescribed testing practices determined by your health care provider, you should have enough to last an entire 365-day period. Speak with your pharmacist for more information.

It is also important that you fill your test strip prescriptions at a single pharmacy to facilitate proper tracking of your allotment.

What if I need more test strips than my reimbursement limit?

The established reimbursement limits for test strips are set at a higher level than the minimum levels suggested by the Canadian Diabetes Association. Additional information is available from the Canadian Diabetes Association Self-Monitoring Blood Glucose (SMBG) tool.

It is understood that there may be exceptional clinical circumstances where you require more frequent testing. 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.

What are the exceptional circumstances under which additional strips would be allowed?

Patients may require more frequent testing for a variety of reasons. Some common reasons for which an individual may require more frequent testing include, but are not limited to, the following:

• Patient has experienced acute illness or infection that affected blood glucose control over a sustained period of time
• Issues related to drug interactions which have impacted blood glucose control
• Patient has gestational diabetes
• Patient has an occupation that requires strict avoidance of hypoglycemia (e.g., pilots, air-traffic controllers, critical positions in railways)
• Patient is not meeting glycemic targets for 3 months or greater.

Can my pharmacist provide me with a prescription refill for extra strips?

No. Blood glucose test strips are designated listed substances as defined by the Ontario Drug Benefit Act (ODBA) and require a prescription by an Ontario physician or nurse practitioner in order to be eligible for reimbursement under the ODB Program. Prescriptions and prescription extensions by pharmacists for blood glucose test strips are not eligible for reimbursement under the ODB program.

Can I receive an exemption for additional test strips more than once in a 365-day period?

Yes. Additional test strips may be distributed to patients in accordance with their needs as a patient, provided that any exceptional circumstances related to their condition are confirmed with a physician and noted on each prescription issued for the patient.

If I need additional strips, will there be an impact on my annual allotment for the next 365-day period?

No. Additional test strips distributed to patients for exceptional clinical circumstances will not have an impact on the allotment of test strips for the patient within the next 365-day period.

What if I start a new diabetes medication that might change my limit in my current 365-day period?

The ministry’s HNS will adjust your annual test strip allotment automatically. Talk to your pharmacist if you have any questions about your new annual reimbursement limit.

What can I do if I have not received my test strips allotment but the pharmacist says my claim has been rejected?

Your pharmacist can determine the overall annual allotment for test strips by assessing your diabetes therapy in the past 180 days and the number of strips already reimbursed under the ODB program in your current 365-day period. It is important that you fill your prescriptions at a single pharmacy to facilitate proper tracking of your allotment. Please inform your pharmacist if you have filled test strip prescriptions at more than one pharmacy.

If there is a discrepancy, the pharmacist can contact the ministry’s ODB Helpdesk on your behalf for support.

What is MedsCheck for Diabetes?

MedsCheck for Diabetes is for patients who are diagnosed with either type 1 or type 2 diabetes. Ontarians with a valid Ontario Health Card living in Ontario who are living with diabetes are eligible for an annual 20-30 minute consultation, whether they are managing their diabetes through diet, medication, or both.

The MedsCheck for Diabetes program is an annual medication review provided by a community pharmacist at your local pharmacy. The program includes training on the use and disposal of diabetes-related supplies; education and advice on medication adjustments; discussion of the impact of lifestyle changes; and referral to a Diabetes Education Program and to other health professionals if required.

Because patients living with diabetes may have other medical conditions, pharmacists may provide advice on overall therapy management as well as for diabetes. Pharmacists may also provide additional Diabetes Education Follow-Up services if needed as part of the program. Speak to your pharmacist or visit www.ontario.ca/medscheck for more information. You may also call the ServiceOntario Infoline at 1-866-532-3161.

Blood Glucose Test Strips