Hello, I am new to this forum thing. I have never done this before but I am completely worn out fighting Medicare on the OmniPod Insulin Pump coverage issue. But I have found a possible way and a possible move to get a foot in the door and for the program to look at the OmniPod differently. Follow my logic, hopefully it makes some sense, and see if the outcome is as clear to you as it is to me. There are several hurdles to overcome. I will try to outline and debunk the the issues that I am aware of one by one.
PDM- technically the PDM is covered by Medicare in many cases because it has a built in blood glucose meter that is covered by Medicare. So when the doctor issues the prescription for the PDM, it is listed as a glucose meter and thus follows Medicare rules.
POD- the pod is considered disposable and therefore not durable medical equipment. However, the delivery system from any pump system is “disposable.” The reservoir is a one time use product, therefore disposable. The infusion set is again, one time use and therefore disposable. If the logic is followed, the delivery system for the OmniPod system follows the same lines as the reservoir and the infusion set. Medicare seems to have no difficulty paying for the disposable parts of the current allowed pumps. The difficulty seems to be with the definition of “disposable” and this argument appears to cover it.
Cost- Minimed Pump- Cost of $7,000 dollars. With a 5 year warranty this means the pump cost a total of $116.67 per month to own. Supplies are as follows. 3ML Reservoir package of 10 costs $39 dollars. 1 package of 10 lasts 1 month approximately. 23 Inch Infusion Set for the pump in a package of 10 costs $139 dollars. 1 package of 10 last approximately 1 month. Total cost per month for the Minimed Insulin pump system equals $294.67.OmniPod- The ONLY recurring monthly cost of the OmniPod system is the Pods themselves. The cost of a package of 10 Pods is $299 per month. No other supplies are necessary with the OmniPod System. A new PDM will be an additional cost in the future of approximately $499 dollars. A onetime fee. The new PDM is guaranteed for 4 years. Adding a cost of $10.40 per month to the $299 bringing the total cost of the OmniPod to $309.40 per month. Also take into consideration the savings produced by the insulin savings per month. As I at one point personally used the OmniPod, I have medically documented evidence that proves that my insulin usage dropped by 35% vs the MiniMed pump system. Giving a +/- of 10%, that savings of insulin costs for Medicare could be huge. Thus actually saving money allowing the diabetics the opportunity to use the OmniPod covered by Medicare. Medicare would save the following money if I were allowed to switch to the OmniPod.
MiniMed Insulin Pump system cost per month = $1890+$116.67+$39+$119=$2164.67
OmniPod Insulin Pump system cost per month = $1172+$10.40+$299=$1481.40
Total Savings equals $683.27
That is one Diabetic. Multiply that by the thousands of diabetics currently covered by Medicare and being denied the OmniPod. The taxpayer savings is enormous!!!
What we need is every diabetic that wants the OmniPod as a possible option for diabetes care to be covered by Medicare to contact their Senator and Representative and show them the change and why this antiquated law must be changed. I cannot do this myself! I need assistance. I have been fighting this for 18 months. I have made ground but need help.
Please let me know if this makes sense! Comment any questions and I will sincerely try to answer.