Omnipod Cost Help


#1

My Girlfriends’ son has Type 1 DB, all this is very new to me so please bear with me.
She and I happen to be on the same INS, when we have Health INS A, she would pay 150$ for a 3 month supply.

We now are on Health INS B due to employer changing carrier and now she has to pay 795$ for a 3 month supply.

MY question is where can we go to get the omnipod or something very similar to it for lower cost? Are there any Omnipod like pumps that are just as good out there? The only other pump the Health Ins B is covering is a belt worn pump. Which is something her and her son would like to avoid. So they are choosing to pay the 795$ bill. I am just looking to see if she has another option as the Health Ins is not giving her any…


#2

Is it possible the new plan has a deductible, and old plan did not? With deductible, you pay 100% until you have spent up to the deductible amount. Then price might drop to what it has been, for example 20% of cost before deductible is met.


#3

I think Insulet has some financial assistance programs, but you do have to be purchasing supplies direct from them and not a supply house.


#4

Troubling, but not uncommon. She may need to shop around for a job with a better insurance plan for this particular situation. Its the pits.


#5

So sorry that this is happening 2u. Do you perhaps have an AAA office nearby? I work for them and they have EXCELLENT healthcare benefits, including 100% paid for diabetes supplies of all types! I get my insulin, omnipods, Dexcom G6 supplies, strips, etc. at 0 cost. I’m totally spoiled I know.


#6

I believe she is buying direct from Omnipod and our INS is not carrying these any longer.
They only cover this belt worn device, which looks to be super uncomfortable.
Being that she is buying direct from Omni deductible is not a factor although you are right.
BUt even still the deduc, is about 3k so i dont think she would hit it by end of year.


#7

I will absolutely be looking into insult, to see if they are a viable option.


#8

She has been with her company over 13 yrs i dont believe she would be willing to leave.


#9

thank you all for the info!!


#10

Omnipod supplies fall under the insurance category of “non-durable” medical supplies because you throw them away every three days. That makes them relatively expensive because insurers will tend to cover “durable” medical supplies more readily. Not sure how to work around that.


#11

My HMO puts pods and now Libre sensors into the DME category. I have to pay 30 percent after deductible is met. It really is expensive. They just decided my Libre sensors should never have been allowed under pharmacy benefit so they are not going to let me buy them locally anymore after April. And…they are not going to let me buy 14 day sensors between now and April.