Omnipod DASH only available via pharmacy benefit?!

My Omnipod will soon be out of warranty and I was looking to upgrade to a system that is (or will) soon be compatible with a closed-loop system.

I saw that the Omnipod Dash (released April 2019) was just FDA approved as an ACE device, meaning that it will soon be able to integrate other devices (like Dexcom CGM) via Bluetooth, opening the door eventually to Tidepool integration and eventually their own Omnipod Horizon closed loop system (currently on track for late 2020 release).

I called Insulet with a bunch of questions about this future technology (mostly, will I be able to seamlessly step up from the Dash to Horizon when it’s available) and what I found out was troubling.

Apparently the DASH system is ONLY covered through the pharmacy benefit. It does not have any DME medical codes-- only an NDC (National drug code) assigned to it, 08508200005. This means it can only be dispensed through pharmacies. This was an intentional decision made by Insulet.

Well, my mail order pharmacy on my self-pay plan is my local hospital pharmacy (we do not work with Express Scripts, etc.) and they have no idea how to process this. Their supplier supposedly doesn’t even stock this item. This has effectively stopped me from pursuing this upgrade track.

For those of you who have experienced the freedom of tubeless pumps, you’ll understand when I tell you that I’m extremely hesitant to have to go back to thinking about where my tether is all the time. I can wake up, roll out of bed, and not worry about anything. I can shower without thinking about it.

Having said this, the closed loop automation would override the convenience of a tubeless system for me. Can anyone speak to the quality of pump automation or potential future developments (maybe if you’ve been on a clinical trial) and share your experiences here?

Thanks!

Question: Why not try out Loop since your out of waranty? Just curious. I had to get a used Mac laptop. That was the most expensive part. Do you use Dexcom? I have found the pump automation in Loop to be very, very good. I am using the same Omnipod pump as you are currently using. It takes a bit of time to setup and gather supplies. But, the performance is good. What Dex model are you using? You could be, potentially, setup on closed loop in a month. You have to read everything and you have to be confident that you can setup good basal settings.
https://loopkit.github.io/loopdocs/

Comment: I spoke with my insurer today and they got rid of the durable vs non-durable categories. Strange. Also, I recently got pushed into pharmacy for Dexcom, but not my old Omnipod. Also strange. I think I could continue through a supplier, but the pharmacy was cheaper. Also, they get their money upfront. You can’t just not pay them and still get supplies, so there are risks there.

Other comment: There is only one pharmacy (that I know of) - there might be two - in the entire area that I can purchase at. Its a bit of a drive.

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Thanks for taking the time to reply. I am using Dexcom G6. The short answer as to why I haven’t tried Loop is that the last Apple product I owned was an Apple //e in 1983 (and I suspect that won’t work in this case). I currently use a Google Pixel 2XL phone. Maybe I should look into a super old, inexpensive Apple product that can get me up and running… I hadn’t really considered that until now. Out of curiosity, how much did your Apple laptop cost? In general, what do the total out-of-pocket expenses look like?

A cheap Chinese knockoff iPhone SE was $100. Sprint plans availible for $30 per month. I kept my Android running as my primary phone. The iphone is my pump controller, primarily.

The Mac that I bought used at a local used Mac store needed an Operating System of Mojave or later (Documentation link: https://loopkit.github.io/loopdocs/build/step1/). The guy gave me a deal. It was $400 or $500. So, expensive. But, way cheaper than a new one. You could borrow someone’s Mac to do the installation. But, it might take you a week. And, if something goes wrong and you need to reinstall the program, you will have to do a lot of work over again.

I didn’t buy mine here, but these guys are totally trustworthy, just to get an idea of prices. Looks like they have some for $400. If your near a big city, there will be stores for refurbished Macs. https://www.microcenter.com/product/610178/macbook-air-mmgf2ll-a-early-2015-133-laptop-computer-pre-owned---silver

Worth it. Totally worth the money I spent for the system automation.

Do you really need a cellular plan? If I just want it strictly for looping, can’t I just use wifi?

OK so I’ve been looking into this.

As for the cost, it’s $150 for the Rileylink, $60 for a used iPhone 5S on swappa, and it appears you also need an ongoing $99 annually for a paid Apple developer account, or the Loop app explodes every 7 days and you have to rebuild the whole thing. Is this right? Plus the cost of a used Macbook?

The cost for all this is not insignificant if you’re not an apple person already outfitted with the Mac and iPhone.

I was in same boat with Omnipod upgrade to Dash and beating around bush with insurance, and decided to go Loop with current version of Omnipod. Was a great decision and has worked out very well. There’s another thread on here discussing this that I started. Best of luck whatever way you go!

You don’t have to have a cellular plan. Your correct. I forgot about the developer plan.

The cost bummed me out too. But, I didn’t add it all up until I was too deep to turn back. I was moving forward no matter what.

I felt better that it was a one time cost for equipment… I send $500 for Omnipod and Dexcom supplies every 3 months anyway. So, it seemed comparatively inexpensive. But, its something you really have to think about. Kinda depends how urgently you need/want a closed loop system. Have you had time to look into t:slim yet? I kind think that gets released first.

Anybody know how long until the commercial system is out? It will run on a Samsung Galaxy phone.

Here’s what I id for loop:

  • Laptop: Used virtual machine to run Apple OS for no cost.
  • Rileylink: $150 each. Bought 2 so I have one as backup.
  • Apple Developer: $99/year+tax. You can do free, but then you hae to rebuild every 7 days. Else 1 time per year unless you do upgrades.
  • I already get Omnipods and supplies free from my insurance, so no cost there.
  • iPhone: SE 32gb used on ebay with 2 year squaretrade warranty about $150. Best model for 2nd phone in my opinion.

You DO NOT need a cell plan to use this, but if you want it to upload to nightscout or have followers, then you would.

Sprint has a $30/month special with unlimited data but it only lasts a year. I find that really if all you do is update loop it is <1 GB per month.

So I changed to Mint (Tmobile reseller) 8GB for $10/moth when you do 6 months then $25 I believe if you do 1 year. May switch to something else at that point.

Absolutely LOVING looping. Went from a 6.4 to 5.8 in 3 months! My SD is much improved as are my lows.

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Thanks very much for this detailed breakdown of how you loop. Very helpful.

I just received word from my insurance they they are officially NOT covering Dash pods through the pharmacy benefit. (My advocate says they’ve asked for reconsideration, but I’m not optimistic )

I’ve started considering going over to the t:slim, but I’ve just begun getting my pod supplies covered at 100% (previously 80%) and I think with the savings I can now justify splurging for the RileyLink, used iPhone, etc.

Thanks again to everyone for the suggestions.

Still going strong on loop with same set up but now my pods have a $700 overall deductible per year and 10% copay as they are no longer covered under prescription side due to an insurance change in January through my employer. All my other supplies are 100% through my prescription though so I guess that’s not too bad. I get my insulin, backup pens, Dexcom G6 with 2 transmitters (my endo writes for 2 transmitters every 90 days so I have an emergency backup) and Victoza all free.

You get two transmitters every 90 days? You must be accumulating quite a supply.

Never hurts to have a backup. My last fight with Omnipod was too close for comfort. Had to ask friends for loaners while I got everything sorted out. Never ever again!