Limits
Patients managing diabetes with insulin – 3,000
Patients managing diabetes with anti-diabetes medication with high risk of causing hypoglycemia (- glyburide, gliclazide )- 400
Paatients managing diabetes using anti-diabetes medication with low risk of causing hypoglycemia – 200
Patients managing diabetes through diet/lifestyle therapy only (no insulin or anti-diabetes
medications) – 200
**Including but not limited to metformin, sitagliptin phosphate monohydrate, saxagliptin, acarbose, rosiglitazone, pioglitazone, linagliptin, liraglutide, empagliflozin or dapagliflozin
Override
There may be exceptional clinical circumstances where patients may require additional
test strips. When a patient has reached their limit of available test strips in a 365-day
period, two intervention codes are available for pharmacists. Documentation to support
the application of each intervention code is required. Pharmacists must keep this
information on file at the pharmacy for not less than two years for audit purposes.
1. Override/intervention code “NF – Override – Quantity Appropriate”
This intervention code may be used for patients who require more than 200 test
strips in a 365-day period, because they had claims for insulin and/or anti-diabetes
medications (at high risk for hypoglycemia) in the previous six months, that were
not reimbursed under the ODB program. The identified anti-diabetes medications
that were reimbursed by private drug insurance plans or paid by the patient, must
be documented and readily available for audit purposes.
2. Override/intervention code “MG – Override – Clinical Reasons”
This override code will allow for 100 additional test strips to be reimbursed for
patients who have been directed by a healthcare professional to monitor blood
glucose levels more frequently for a specific clinical reason. Documentation must
include the reason for exceeding the recommended frequency of monitoring and
the name of the referring healthcare professional and Ontario College of
Pharmacists (OCP) ID number