What is the experience with medicare coverage for Omnipod? I have part D and a supplement, but Omnipod is not on the formulary and Iam told it is not on most Medicare Part D formularies. I have appealed, but i wonder what the experience is for Omnipod on Part D coverage?
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Insulet can help you find the plans/companies that cover it.
I am on Medicare, with a supplemental Gap type policy. (Provided by my husbands past employer). Optum RX is the Part D supplier, but only manages it for my supplemental. My pods are covered. But it’s my plan that decides the coverage, not Optum RX. My insulin is under Part D too because Medicare says the pods fall under Part D. Insulet doesn’t plan on trying to change that.
While Medicare has certain guidelines, I gather the plans have a lot of leeway in choices of what they cover under Part D. It might be we cover these 3 insulins. As long as they offer some choices of insulin they fall within the guidelines. So you have to find the plans that cover what you want. The pods are decidedly Part D.
But Insulet is supposedly helpful with finding the Part D plans that cover pods.
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This Insulet website shows the list of Part D and Advantage plans that cover OmniPod: Medicare | Insulin Pump Therapy | Omnipod
I have AARP Medicare Rx Preferred (PDP) and have no issue getting OmniPod Dash.
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I pay for Aetna Silverscript Plus though I have low income subsidy. They cover pods and I get them every three months using Adapt. I pay $11 for three months.
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I have Medicare and supplemental secondary insurance. I was on Omnipod5 but went off because of cost (out of pocket $380 a month). I have since found out it would have dropped to $143 a month because I am in the donut hole. When I went off the pod I started using the G7 and LOVE it. More accurate and fast start up, but back to Novato’s and Lantus pens. My BS was better on the pump. I will consider going back to OmniPod for 2025 depending on cost. What a circus this is. Good Luck
Ok, so I have medicare part B and D. My doctor did what we thought was correct and sent the pod script to the part D provider. The provider rejected the script and said they wanted a prior authorization. My doctor sent the PA and it was approved in Part D.
Well not so fast. The script has to be received after prior authorization. Ok, so we send the script and of course they have a PA but still no script.
Now on the issue of Dex, they got the script and PA at the same time. The script was approved, but the PA was not. Finally OptumRX told me to submit the sensor the part B provider with a PA.
Is the sensor Part B? and Is the Pods Part D?
rick
Yes
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Yes, as @CJ114 said, CGM’s are Part B and Omnipods are Part D. Because Omnipod is Part D, your insulin for it will be Part D too.