DIN/NPN/ PIN | Generic Name | Product Name, Strength & Dosage Form | Unit Price, Unit of Issue | Manufacturer | LCA Price | MAC Price | Interchangeable Products | Coverage Status | |
---|---|---|---|---|---|---|---|---|---|
00444986 | DIABETES SUPPLIES | ACCU-CHEK AVIVA TEST STRIPS |
0.7125 STP |
RDC | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00444985 | DIABETES SUPPLIES | ACCU-CHEK COMPACT TEST STRIPS |
0.7125 STP |
RDC | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00444984 | DIABETES SUPPLIES | ACCU-CHEK GUIDE TEST STRIPS |
0.6813 STP |
RDC | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00444983 | DIABETES SUPPLIES | ACCU-CHEK MOBILE TEST STRIPS |
0.7125 STP |
RDC | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00990024 | DIABETES SUPPLIES | BLOOD GLUCOSE METER |
0.0000 MIS |
XXX | N/A | N/A | NO | RESTRICTED BENEFIT | |
00990072 | DIABETES SUPPLIES | BLOOD KETONE TEST STRIPS |
0.0000 STP |
XXX | N/A | N/A | NO | RESTRICTED BENEFIT/REGULAR BENEFIT | |
00999941 | DIABETES SUPPLIES | BLOOD LETTING LANCET |
0.0000 MIS |
XXX | N/A | N/A | NO | RESTRICTED BENEFIT/REGULAR BENEFIT | |
00444992 | DIABETES SUPPLIES | CARESENS N MULTI TEST STRIPS |
0.5000 STP |
SEN | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00444990 | DIABETES SUPPLIES | CONTOUR NEXT TEST STRIPS |
0.6989 STP |
ADC | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00444989 | DIABETES SUPPLIES | CONTOUR TEST STRIPS |
0.6989 STP |
ADC | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00445004 | DIABETES SUPPLIES | EZ HEALTH ORACLE TEST STRIPS |
N/A STP |
TRH | N/A | N/A | NO | NOT A BENEFIT | |
00444996 | DIABETES SUPPLIES | FIRST CANADIAN HEALTH SPIRIT TEST STRIPS |
0.5000 STP |
ARP | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00444987 | DIABETES SUPPLIES | FREESTYLE LITE TEST STRIPS |
0.6900 STP |
ABD | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00444988 | DIABETES SUPPLIES | FREESTYLE PRECISION TEST STRIPS |
0.6890 STP |
ABD | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00444982 | DIABETES SUPPLIES | GE200 TEST STRIPS |
0.5100 STP |
BNE | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00990058 | DIABETES SUPPLIES | GLUCOSE CALIBRATION SOLUTION |
0.0000 MIS |
XXX | N/A | N/A | NO | REGULAR BENEFIT | |
00999019 | DIABETES SUPPLIES | HUMAPEN LUXURA INSULIN PEN |
N/A MIS |
LIL | N/A | N/A | NO | NOT A BENEFIT | |
00990045 | DIABETES SUPPLIES | INFUSION SETS (TUBING & NEEDLE) |
0.0000 MIS |
XXX | N/A | N/A | NO | REGULAR BENEFIT | |
00990057 | DIABETES SUPPLIES | INSULIN CARTRIDGES / RESERVOIRS |
0.0000 MIS |
XXX | N/A | N/A | NO | REGULAR BENEFIT | |
00999985 | DIABETES SUPPLIES | INSULIN PEN NEEDLES |
0.0000 MIS |
XXX | N/A | N/A | NO | RESTRICTED BENEFIT/REGULAR BENEFIT | |
00999952 | DIABETES SUPPLIES | INSULIN SYRINGES |
0.0000 MIS |
XXX | N/A | N/A | NO | RESTRICTED BENEFIT/REGULAR BENEFIT | |
00999942 | DIABETES SUPPLIES | LANCING DEVICE |
0.0000 MIS |
XXX | N/A | N/A | NO | REGULAR BENEFIT | |
00444994 | DIABETES SUPPLIES | ONE TOUCH ULTRA TEST STRIPS |
0.6943 STP |
LIF | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00444993 | DIABETES SUPPLIES | ONE TOUCH VERIO TEST STRIPS |
0.6943 STP |
LIF | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00445003 | DIABETES SUPPLIES | TYKESS TEST STRIPS |
0.9998 STP |
TTC | N/A | N/A | NO | RESTRICTED BENEFIT/RESTRICTED BENEFIT | |
00999957 | DIABETES SUPPLIES | URINE KETONE TEST STRIPS |
0.0000 STP |
XXX | N/A | N/A | NO | RESTRICTED BENEFIT/REGULAR BENEFIT | |
00999708 | GLUCOSE MONITORING TRANSMITTER | DEXCOM G6 TRANSMITTER |
29.0000 MIS |
COM | N/A | N/A | NO | RESTRICTED BENEFIT | |
00999722 | GLUCOSE MONITORING TRANSMITTER | GUARDIAN CONNECT TRANSMITTER |
599.0000 MIS |
MET | N/A | N/A | NO | RESTRICTED BENEFIT | |
00999710 | GLUCOSE MONITORING TRANSMITTER | GUARDIAN LINK TRANSMITTER (670G PUMP) |
800.0000 MIS |
MET | N/A | N/A | NO | RESTRICTED BENEFIT | |
00999711 | GLUCOSE MONITORING TRANSMITTER | GUARDIAN LINK TRANSMITTER (770G AND 780G PUMP) |
800.0000 MIS |
MET | N/A | N/A | NO | RESTRICTED BENEFIT | |
00999709 | GLUCOSE MONITORING TRANSMITTER SENSOR | DEXCOM G6 SENSOR |
99.6700 MIS |
COM | N/A | N/A | NO | RESTRICTED BENEFIT | |
00999700 | GLUCOSE MONITORING TRANSMITTER SENSOR | DEXCOM G7 SENSOR |
N/A MIS |
COM | N/A | N/A | NO | UNDER REVIEW | |
00999712 | GLUCOSE MONITORING TRANSMITTER SENSOR | GUARDIAN SENSOR |
79.8000 MIS |
MET | N/A | N/A | NO | RESTRICTED BENEFIT | |
00980002 | N/A | PRE-FILLED SYRINGE FOR PALLIATIVE 0 N/A |
1.9418 MIS |
XXX | N/A | N/A | NO | PALLIATIVE COVERAGE |
DIN/NPN/ PIN | 00444986 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | ACCU-CHEK AVIVA TEST STRIPS |
Unit Price, Unit of Issue | 0.7125 |
Manufacturer | RDC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00444985 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | ACCU-CHEK COMPACT TEST STRIPS |
Unit Price, Unit of Issue | 0.7125 |
Manufacturer | RDC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00444984 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | ACCU-CHEK GUIDE TEST STRIPS |
Unit Price, Unit of Issue | 0.6813 |
Manufacturer | RDC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00444983 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | ACCU-CHEK MOBILE TEST STRIPS |
Unit Price, Unit of Issue | 0.7125 |
Manufacturer | RDC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00990024 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | BLOOD GLUCOSE METER |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00990072 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | BLOOD KETONE TEST STRIPS |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00999941 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | BLOOD LETTING LANCET |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00444992 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | CARESENS N MULTI TEST STRIPS |
Unit Price, Unit of Issue | 0.5000 |
Manufacturer | SEN |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00444990 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | CONTOUR NEXT TEST STRIPS |
Unit Price, Unit of Issue | 0.6989 |
Manufacturer | ADC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00444989 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | CONTOUR TEST STRIPS |
Unit Price, Unit of Issue | 0.6989 |
Manufacturer | ADC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00445004 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | EZ HEALTH ORACLE TEST STRIPS |
Unit Price, Unit of Issue | N/A |
Manufacturer | TRH |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 00444996 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | FIRST CANADIAN HEALTH SPIRIT TEST STRIPS |
Unit Price, Unit of Issue | 0.5000 |
Manufacturer | ARP |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00444987 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | FREESTYLE LITE TEST STRIPS |
Unit Price, Unit of Issue | 0.6900 |
Manufacturer | ABD |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00444988 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | FREESTYLE PRECISION TEST STRIPS |
Unit Price, Unit of Issue | 0.6890 |
Manufacturer | ABD |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00444982 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | GE200 TEST STRIPS |
Unit Price, Unit of Issue | 0.5100 |
Manufacturer | BNE |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00990058 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | GLUCOSE CALIBRATION SOLUTION |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00999019 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | HUMAPEN LUXURA INSULIN PEN |
Unit Price, Unit of Issue | N/A |
Manufacturer | LIL |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | NOT A BENEFIT |
Details |
DIN/NPN/ PIN | 00990045 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | INFUSION SETS (TUBING & NEEDLE) |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00990057 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | INSULIN CARTRIDGES / RESERVOIRS |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00999985 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | INSULIN PEN NEEDLES |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00999952 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | INSULIN SYRINGES |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00999942 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | LANCING DEVICE |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00444994 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | ONE TOUCH ULTRA TEST STRIPS |
Unit Price, Unit of Issue | 0.6943 |
Manufacturer | LIF |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00444993 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | ONE TOUCH VERIO TEST STRIPS |
Unit Price, Unit of Issue | 0.6943 |
Manufacturer | LIF |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00445003 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | TYKESS TEST STRIPS |
Unit Price, Unit of Issue | 0.9998 |
Manufacturer | TTC |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00999957 |
Generic Name | DIABETES SUPPLIES |
Product Name, Strength & Dosage Form | URINE KETONE TEST STRIPS |
Unit Price, Unit of Issue | 0.0000 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT/REGULAR BENEFIT |
Details |
DIN/NPN/ PIN | 00999708 |
Generic Name | GLUCOSE MONITORING TRANSMITTER |
Product Name, Strength & Dosage Form | DEXCOM G6 TRANSMITTER |
Unit Price, Unit of Issue | 29.0000 |
Manufacturer | COM |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00999722 |
Generic Name | GLUCOSE MONITORING TRANSMITTER |
Product Name, Strength & Dosage Form | GUARDIAN CONNECT TRANSMITTER |
Unit Price, Unit of Issue | 599.0000 |
Manufacturer | MET |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00999710 |
Generic Name | GLUCOSE MONITORING TRANSMITTER |
Product Name, Strength & Dosage Form | GUARDIAN LINK TRANSMITTER (670G PUMP) |
Unit Price, Unit of Issue | 800.0000 |
Manufacturer | MET |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00999711 |
Generic Name | GLUCOSE MONITORING TRANSMITTER |
Product Name, Strength & Dosage Form | GUARDIAN LINK TRANSMITTER (770G AND 780G PUMP) |
Unit Price, Unit of Issue | 800.0000 |
Manufacturer | MET |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00999709 |
Generic Name | GLUCOSE MONITORING TRANSMITTER SENSOR |
Product Name, Strength & Dosage Form | DEXCOM G6 SENSOR |
Unit Price, Unit of Issue | 99.6700 |
Manufacturer | COM |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00999700 |
Generic Name | GLUCOSE MONITORING TRANSMITTER SENSOR |
Product Name, Strength & Dosage Form | DEXCOM G7 SENSOR |
Unit Price, Unit of Issue | N/A |
Manufacturer | COM |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | UNDER REVIEW |
Details |
DIN/NPN/ PIN | 00999712 |
Generic Name | GLUCOSE MONITORING TRANSMITTER SENSOR |
Product Name, Strength & Dosage Form | GUARDIAN SENSOR |
Unit Price, Unit of Issue | 79.8000 |
Manufacturer | MET |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | RESTRICTED BENEFIT |
Details |
DIN/NPN/ PIN | 00980002 |
Generic Name | N/A |
Product Name, Strength & Dosage Form | PRE-FILLED SYRINGE FOR PALLIATIVE 0 N/A |
Unit Price, Unit of Issue | 1.9418 |
Manufacturer | XXX |
LCA Price | N/A |
MAC Price | N/A |
Interchangeable Products | NO |
Coverage Status | PALLIATIVE COVERAGE |
Details |