Can-US Medical Reciprocity Updated to Allow Insulin Using Diabetics to Operate in US

The Canadian Council of Motor Transport Administrators (CCMTA) has informed CTA of updates to the medical reciprocity agreement between Canada and the US with respect to commercial vehicle drivers who are dependent on insulin for managing diabetes.

The original agreement signed in 1998 prohibited insulin-dependent Canadian domiciled commercial drivers from operating in the United States. Similar prohibitions were in place for US-domiciled drivers not being able to operate in Canada.

Accordingly, the update of the Canada-US medical agreement, removed the prohibition on cross‐border operations for commercial drivers with ‘insulin‐ treated diabetes mellitus’, effective September 9, 2019. The remaining provisions of the agreement are not affected by this amendment.

In response to this change, Canadian jurisdictions are currently undertaking driver licensing system queries to identify diabetes‐related code W licence holders to be able to advise them of the lifting of this prohibition.

CCMTA reports this task will take time to complete depending on jurisdiction. Additionally, Canadian jurisdictions are also at various implementation timelines issuing new drivers licence cards and abstracts without the code W designation.

Affected Canadian commercial vehicle operators are encouraged to contact their respective provincial and territorial jurisdictions directly on the process to remove code W from their licence to allow them to operate in the United States.

For a copy of the letter, please click here: Diabetes reciprocity letter CTA_public

For commercial drivers in Ontario interested in more information on this issue please contact the MTO Medical Review Office at #416-235-1773 or 1-800-268-1481 or by email to for more information.

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