I have been battling Caremark for the past few weeks about coverage of the Omnipod 5 for my daughter. We recently switched insurance and it was covered previously. I have had our endo submit an appeal to the denial and we received that back today that they won’t even look at the appeal. I am so confused! Our regular insurance is UMR and I can see the Omnipod Dash is covered. Why wouldn’t the Omnipod 5 be covered as well? Sooooo frustrating. I have also been on hold with the Omnipod for the past hour and fifteen minutes and still no answer.
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Have you confirmed that Omnipod 5 is on the formulary for YOUR new plan. May be Caremark, Express Scripts or other. But each plan can have different formulary even though both are Caremark. If you have logon access to review your specific plan formulary, confirm if O5 is there, or call your insurance.
Some cover as pharmacy, some as DME. Plan decides.
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