This letter was authored by Breakthrough T1D Canada President and Chief Executive Officer Jessica Diniz. She is cosigning this letter with eight individuals working in health and research. It was published in Le Devoir on February 26, 2026.
In Quebec, thousands of adults living with type 1 diabetes (T1D) face a persistent and unjustified inequity in access to care. In 2026, while every other Canadian province reimburses insulin pumps for people of all ages, Quebec’s public drug insurance plan still excludes adults diagnosed after age 18. This barrier is not based on medical evidence—it is based solely on age at diagnosis.
More than 40,000 adults in Quebec live with T1D, and approximately 14,000 of them are excluded from insulin pump reimbursement simply because their diagnosis occurred in adulthood. This exclusion is particularly difficult to justify when nearly 70% of new T1D diagnoses occur in adults. Type 1 diabetes is not a childhood disease, yet Quebec’s program continues to treat it like one.
An illogical and costly budgetary decision
The age‑based exclusion is unsupported by science or epidemiology. In May 2022, the Institut national d’excellence en santé et en services sociaux (INESSS) recommended extending insulin pump coverage to adults of all ages. Despite the strength of this recommendation, the Ministry of Health and Social Services has not implemented it, largely for budgetary reasons.
But the financial argument does not withstand scrutiny.
An insulin pump costs about $6,300, must be replaced every five years, and requires several thousand dollars in annual supplies. For adults excluded from coverage, this represents tens of thousands of dollars in out‑of‑pocket expense. The result is a financial barrier that forces many to go without a technology recognized as the standard of care—one associated with better glucose control, fewer complications, and improved quality of life.
From a public finance perspective, a gradual expansion of coverage is predictable and manageable. With approximately 14,000 newly eligible adults and roughly 1,850 new adult diagnoses each year, the rollout could be phased in over five years. Once fully implemented, the annual cost is estimated at $30–$32 million—comparable to what other provinces already invest for universal pump access.
Savings and reduced hospitalizations could be on the horizon
Critically, extending insulin pump coverage would generate savings within just a few years. Research clearly shows that insulin pumps reduce hospitalizations for diabetic ketoacidosis and severe hypoglycemia and help prevent or delay chronic complications affecting the kidneys, heart, eyes, and nervous system—conditions that place a heavy burden on both patients and the healthcare system.
The reduction in emergency visits and acute care, combined with the prevention of long‑term complications, would translate into significant cost avoidance for Quebec.
Several organizations have already urged the government to act on the INESSS recommendation and eliminate the discriminatory age limit on pump coverage. As Quebec approaches a new electoral cycle, it is time to bring this issue back to the forefront.
A responsible, effective, and equitable choice
Maintaining an age‑based barrier to insulin pump access ultimately costs more than adopting a modern, evidence‑based, equitable program aligned with the rest of Canada. Ending this unjustified exception would finally allow Quebecers living with T1D to receive the same quality of care available elsewhere in the country.
Quebec remains the only province in Canada with an age‑based restriction. Correcting this inequity is not only fair—it is fiscally responsible, medically sound, and urgently needed.
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Jessica Diniz, President and CEO
Breakthrough T1D Canada
The following have cosigned this letter:
Susana Lazaro, President and CEO
Diabète Québec
Nathalie Kinnard, Director General
Diavie
Guillaume Gagnon, Chair of the Board
Fédération des associations de personnes diabétiques du Québec (FAPDQ)
Vanessa Bourque Leclerc, Chair of the Board
Diabète Bas-St-Laurent
François Forest, President
L’Association québécoise des diabétiques de type 1 (AQDT1)
Martin Paré, Lyne Moreau, co-representatives
Coalition for Ending Age Based Discrimination in Access to Insulin Pumps for Insulin Dependent People with Diabetes.
Dr. Rémi Rabasa-Lhoret
Endocrinologist, Montreal Clinical Research Institute (IRCM) and the University of Montreal Hospital Center (CHUM). Director, Diabetes Clinic and the Metabolic Disease Research Unit at IRCM. Full Professor, University of Montreal.
Lynn Cameron
Volunteer living with type 1 diabetes
