Product Details

FreeStyle Libre 2 Sensor

Reader Kit And Sensor Kit

Flash Glucose Monitoring System - Sensor


DIN/PIN/NPN

09858147

Manufacturer

Abbott Diabetes Care Ltd.

Formulary Listing Date

2021-11-30  

Unit Price

NA

Amount MOH Pays

91.0000

Coverage Status

Flash Glucose Monitoring System

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

Interchangeable Products

NO  

LU Clinical Criteria

NO  

Requirements

FreeStyle Libre 2 Sensor

Reimbursement Criteria and Maximum Reimbursed Quantity:

All ODB eligible recipients on insulin therapy for diabetes who have a valid prescription from a physician or nurse practitioner for CGM sensors and/or a CGM reader/receiver designated on the Formulary are eligible to receive the prescribed ODB-funded CGM sensors and/or reader/receiver.

Patients who meet the reimbursement criteria are eligible for a maximum reimbursed quantity of 33 sensors over the course of a 365-day period.

Please refer to the Ontario Drug Programs Reference Manual for more information related to CGM systems (e.g., pharmacy billing procedure, HNS response codes and messages).

EAP Criteria

  NO

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