I just found out that my private insurance through my work, who uses CVS/Caremark, has recently approved 100% coverage on both the Omnipod DASH an Omnipod 5 once released!
This will save me a lot of money because I currently have to use my DME benefit which is a 20% copay after a $700 overall deductable per year.
I myself can’t wait to try the Omnipod 5. I’m also tempted to switch to dash to try the new dev branch of Loop which now semi works with Dash. Tempted to anyway. Not sure I wan to run a dev branch that requires reqular updates.
Great news! As an Omnipod Classic guy since diagnosis over 10 years ago, I have been looking forward to the 5 for years, only to be told last month that they no longer will be covering the Dash or the 5. Sad times. I was so set on the closed loop that I just made the jump to Tandem. Smart pump with tubes > dumb pump tubeless so far a week in. Maybe one day I’ll be able to join you and get the best of both worlds!
Since he mentioned it is an employee plan, knowing which insurance company won’t help. In general, employee plans offer more, to insure more healthy and productive employees !!
out of curiosity, were you speaking to your insurance provider, or your omnipod durable medical supplier? if its the former, i am sad to hear rhat, the latter, however, means you have to call yoir insurance asap and find out more information… the omnipod reps told me their goal is the pharmacy benefit similar to a glucometer and test strips which were durable medical in the 60s, 70s, and 80s…
The test strips I had even in the 80s were just color strips and you compared them to a color chart after putting blood and wiping and timing.
Those were the first strips I was aware of for blood. There was no durable equipment at that point. They were paid like any prescription. For me it was 10% copay for all drugs at that time but things were priced more reasonably.
I got my firstportable machine in 1988 that used a pen like meter with strips similar to todays. It was call exachtech. That was when my benefit switched to durable equipment which was also 10% copay so it didn’t matter to me. Before that I had a heavy gluco meter that was too big and heavy to carry around. I just tested at home
Since then the strips got cheaper and insurance changed a lot.
Gone are the 90% indemnity plans. Where often they would waive the copay at hospitals.
It’s a bigger difference for people on Medicare because the charges are so different.
Now I hardly use strips because I have a dexcom and I trust it most of the time
I have a weird plan by WebTPA administered by Aetna. But my prescription drug plan is by CVS. THey added both Omnipod DASH and Omnipod 5 at the same time but OM5 wasn’t available to be ordered until recently. I have the dash right now and may move to OM5 but just not sure when. I’m really not a fan of having to cary another PDM.
I am very fortunate in that someone at HQ in southern California must be really fond of diabetics or one himself/herself, because ever since I started working for AAA there has always been a special carve out for diabetes whereby supplies under the prescription side are covered 100% no copay. That means I get my Dex G6, now Omnipod DASH, Novolog vials, Fiasp pens, etc. for no additional cost. That’s why I stay working there to tell you the truth! The job itself and the pay isn’t all that great.
Hi @BradP,
Regarding your post on March 4, 2022:
“CVS/Caremark, has recently approved 100% coverage on both the Omnipod DASH and Omnipod 5 once released!”
On June 13, 2022, CVS Caremark denied my coverage (and appeal) of the OMNIPOD 5 G6 MIS PODS. It is completely insane that they approved the OMNIPOD 5 G6 INTRO KIT (which comes with pods) but not the PODS. I am wondering if CVS Caremark is in fact covering your OMNIPOD 5?
Thanks,
Joe
My doc had to do a prior auth but was able to get both covered 100% no copay for both the intro kit and pods. My first order of pods should be here tomorrow actually. Each contract is different, though, so just because my private work insurance covers it under caremark doesn’t mean all caremark plans are covered.
@BradP - Thanks for the info. CVS Caremark is still giving me the runaround (as of July 7). My endocrinologist has submitted priory auth and medical necessity forms but still no luck. I submitted a Request for External Review on July 1. I’m also working with an Insulet Customer Advocate to held navigate the CVS/Insurance Provider vortex. Cheers, Joe
Wondering if you had any luck getting Caremark to cover it. We are currently in the same situation and have been denied twice. I am so frustrated and don’t know what to do.
My doc had to put through a prior auth but that was pretty much instantly approved. I think it helps that I have work for a very large employer (AAA) with thousands of employees, so we have very good coverage. Having a good PBM like Caremark is only one piece of the puzzle .There are many formularies and some are better than others. Sorry you are having so many issues.
Hi Sarah, No luck. I’ve spent literally months trying to get Caremark to cover either the Omnipod 5 or even the Omnipod DASH. I think the real problem lies with Insulet. They changed their policy to where they only supply via pharmacies, not medical devices. My insurance will cover diabetic supplies via medical but not pharmacy. I’m now exploring if I can get the DASH through non-traditional methods. I’ve given up on getting the O5. So frustrating
