ISTHB Regulation, Section 73(2)(f) provides authority for coverage of essential diabetic supplies.

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 AE&I 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, needles for insulin pens, insulin pump tubing and syringes
• Test strips for glucose and ketones

The following supplies are not covered:

• Q-tips and rubbing alcohol
• Insulin pumps (unless medically verified that denial will cause a life threatening situation)
  
  Note
  Insulin pumps must be approved by the Health Benefits Exception Committee.

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 1010, Royal Bank Building
10117 Jasper Avenue NW
Edmonton AB   T5J 1W8
Phone: Edmonton and area: 780-423-5722
Toll Free: 1-800-563-0032
Fax: 780-423-3322

PROCEDURE

Payment Method

Alberta Blue Cross (ABC) on behalf of AE&I administers, controls and pays for diabetic supplies for all AE&I clients with a valid AE&I 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 an AE&I health benefit are defined in Regulation as decisions of the Minister, and therefore, not subject to appeal to a Citizen’s Appeal Panel.

Clients requesting diabetic supplies beyond those covered by AE&I may ask for a review of the decision by the Health Benefits Exception Committee.