Updating Prescription Drug Coverage to include Continuous Glucose Monitors and Other Changes to the Extended Health Care Plan

Sun Life has a longstanding commitment to supporting the prevention and management of diabetes. To make it easier for plan members to access the diabetic supplies they need, we’ve harmonized coverage for Continuous Glucose Monitoring systems (CGMs). CGMs will be covered under the Drug Benefit of your Extended Health Care (EHC) plan effective March 1, 2026, instead of the Medical services and equipment* provisions.

This change aligns with recent market trends for CGMs, including more competitive pricing, improved functionality, and expanded public coverage.  This allows us to simplify coverage and enhance support for plan members with diabetes while also managing costs to ensure plan sustainability.

In harmonizing this coverage, we are clarifying those terms that apply to either or both drugs and supplies.

What’s Changing

Effective March 1, 2026, we’ll make these changes to your EHC plan:

• All CGMs, including both intermittently scanned and real-time sensors, receivers and transmitters, will be covered under Prescription drugs with a combined maximum.
• The new provision will also refer to “clinical criteria” in place of “insulin use” for persons with diabetes.  The current CGM provision will be removed from your EHC plan under Medical services and equipment*.
• With this contract change:
  • Plan members with a pay-direct-drug card will have their claims seamlessly processed in real-time at the pharmacy of their choice.
  • The same clinical criteria will apply to all CGM products ensuring consistent treatment for members with diabetes.
  • We’ll assess eligibility by leveraging the information in our Pharmacy Benefits Manager’s system.
  • Plan members taking non-insulin diabetes medications will also be eligible to have CGM claims reimbursed.  Currently, persons with diabetes must use insulin before we’d repay them for a CGM expense.
• Minor updates will be made to general terms describing coverage, but these do not affect what’s covered under your EHC and Prescription drugs.
• References to supplies no longer include drugs. When provisions are relevant to drugs, we’ll list “drugs” as well as “supplies”.
• We’ve made changes to clarify that supplies covered under Prescription drugs will be treated in the same way as drugs.  To support this change, we’ll update:
  • Prescription drugs to expressly refer to supplies with Product Identification Numbers (PINs), and to clarify coverage for diabetic supplies.
  • the Prior Authorization Program to expressly include supplies.
  • Other health professionals allowed to prescribe drugs* to not only include supplies but to also allow Sun Life to reimburse drug and supply expenses when pharmacists, in providing pharmacy services, recommend and dispense certain drugs and supplies.
  • Drug evaluation to include supplies and allow Sun Life to conduct ongoing assessments of:
    • newly approved drugs and supplies         
    • currently covered drugs and supplies
    • drugs and supplies that we cover in the future when they undergo or are affected by a change relevant to our eligibility criteria.

You’ll find our contract changes here:

New contract wording – English.

New contract wording – French.

Communication to Plan Members

Impacted plan members will receive a communication from Sun Life advising them of the change and what it means for them.

For more information about these changes, please see our Frequently Asked Questions.

Sun Life is here to assist your plan members in better managing their diabetes to live healthier lives.

This Focus Update is an important document and amends your Sun Life Group Benefits contract(s), starting on March 1, 2026. After this date, we'll update your contract and booklet at your next plan revision.

Questions? We’re here to help.

Please contact your Sun Life Group Benefits representative.

 

 

*Headings based on Sun Life’s current standard contract wording.