The New Brunswick Insulin Pump Program needs this 2-page confirmation before covering an insulin pump, pump supplies, or both for a client with type 1 diabetes. A diabetes specialist records recent A1c results and diabetic ketoacidosis episodes and confirms the client manages diabetes safely. The client applies separately online with household income documents, and the client's share of costs depends on income.
A diabetes specialist, meaning an endocrinologist, internal medicine physician or pediatrician, completes Section 3 and signs with their licence number. Sections 1 and 2 record the client, whether they are a new or existing pump user, and the pump or supplies requested.
Download the current version from the source each time; forms change without notice.
Confirmation of Medical Eligibility for Pump and Supplies Coverage
Confirmation d'admissibilité médicale à la couverture de pompes et fournitures
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Only a diabetes specialist: an endocrinologist, an internal medicine physician or a pediatrician. The specialist prints their name, signs, adds their licence number and confirms the client has type 1 diabetes and meets the program's medical criteria. If the client also wants CGM coverage, the same specialist must approve both requests.
No. New Brunswick removed the age cap, so people older than 25 can apply. Applicants must be Canadian citizens or permanent residents with a valid New Brunswick Medicare number and have type 1 diabetes, and the specialist must confirm the medical criteria on this form.
Yes, a portion. NBIPP covers only uninsured costs, and the client's share depends on household income, household size, the device chosen and other insurance. The client pays their portion directly to the approved vendor, which bills the province for the rest. Devices come only from vendors on NBIPP's approved list, not community pharmacies.