Omnipod 5 coverage with Aetna

Hey all,

I signed up for the Omnipod 5 waiting list and received an email from Insulet on May 2nd telling me it’s now available for prescription for me.

So I had my endo write a prescription to my mail-order pharmacy (CVS/Caremark), but so far Aetna isn’t covering it and it also seems like CVS/Caremark isn’t stocking it. Having my endo file a prior authorization request and we’ll see where it goes.

Anyone else in the same boat? What’s your experience been?

Let’s support one another and help get this covered.

Thanks!
Mark

If employer plan, can you check with your employer HR/Benefits group? They may be able to answer if/when the newer podds would be added for coverage, and ensure CVS would be set up to process.

1 Like

I got the same email and was super excited until I saw that Aetna/Caremark wasn’t covering it yet. Caremark updates their formulary quarterly with the next update scheduled for July. In the meantime, I got a prior authorization submitted and approved. The process was done the same day. Distributors are just getting the product in now so shipping will be delayed. Costco mail order confirmed that they do have them in stock and is processing orders as of today.

2 Likes

I just received the email. It contains a link back to Insulet to check for insurance coverage.

1 Like

i was recently upgraded from mdi to the omnipod dash, and after speaking to a very knowledgeable insulet representative, he informed me that although the 5 was cleared by the fda, the software engineers are having a little trouble with ios, android 12, and right now, they are only available to the clinical trial groups…he said many samsung phones work, but only on android 11, and they wont release the 5 until its fixed…he also said when its fixed, all users will be able to upgrade…if you dont want to wait, the dash works well, and the dash pdm with the calorie king carb counter built in is nice

1 Like

@roger5: the point is they are inviting docs to write prescriptions. I suggest you try phoning back and asking what the status is now, I’m not going to do that because they just told me.

1 Like

thanks for the info, i would except i am starting to get acclimated with androidaps…probably will try to incorporate the watch tomorrow, as i only now discovered you have to build the wearos apk also, but there’s not much to gain for me with the 5, however, the looping apk build, nightscout required stuff can seem overwhelming to many, so im glad the 5 should be out soon…i may call insulet to see if there’s any progress

Quick update: Aetna approved my prior authorizations for both the starter kit and the pods.

The bad news is that CVS/Caremark, my mail order pharmacy, still doesn’t have them in stock, so the order is on hold. :man_facepalming:

2 Likes

I found I had to shop around when the Dash pods were introduced. It wasn’t a negative experience, I ended up using a pharmacy that is 276 miles away and they have been much, much, better than my local branch of the same pharmacy chain. They FedEx me Dash pods overnight, whereas my local took over another pharmacy and now has mile long queues every day…

I’ve also found that, in the US, using just one pharmacy is a major tactical error; I use three, two local and the remote one. When the local Walgreens when AWOL I simply transferred everything they had to WalMart. When WalMart goes AWOL guess what will happen.

Anyone know if Medicare is covering them?

According to Insulet, yes. You can call Insulet and give them your info and they will check coverage.
Health Insurance Coverage for the Omnipod® 5 Automated Insulin Delivery (AID) System | Omnipod

Yea I did that 4 days ago when I received the email from them that it was now available. It sent me to their site to upgrade and I filled it out and now it still says ‘Your benefits investigation is still in progress. We will reach out to you by phone or email when your results are ready.’

1 Like

Yep, me too; it’s a PITA that the information is not available on my normal “poddercentral” log in; as a result I just resubmitted it all again until I found where the darned site was on salesforce (most known for their lack of security :frowning: )

John58 on FUD reports Insulet saying, “They are running 1 to 2 weeks behind with their followups”, so I’m not expecting any news for a while. I’d say be patient, but that would be hypocrisy.