I recently started using Omnipod after MDI for 40 years. I was always turned off by the tubing of traditional pumps and wearing it on my belt for the world to see. That’s why I never wanted to use a pump before. After the introductory offer and initial training with Omnipod, my Medicare part D is hell bent on denying me for any more pods. My choices are to return to MDI or go on a Tandem, or the like. I have tried every which way to get around it. Switching part D isn’t really an option because it came as part of my retirement package. To switch is just going to cost more money.
I really liked the Omnipod. It was totally liberating.
Ask Omnipod if they have suggestions. While I’m paying $60 a month for my part D plan, Im getting 90 day and change every two day supplies for $11. There may be something you can do to locate a deal. I guess if you cannot change part D then maybe even look at the Mobi under part B? I think it has options for a short piece of tubing?
I think I posted this somewhere the other day, but my husband is on $10k per month chemo pills and paid Aetna Silverscript $21 for the year. I took the info off Insulet’s site and they said this was a provider of Omnipod 5 coverage plus Cigna and Humana and a few others.
. Now I’m paying $60 something per month for the premium (where his payment was done with a single $21). I use Adapt for supplies. They informed me of the best price for 90 day supplies, and that’s what I got. (I do have low income on my part D but I get lost explaining it all so I’m sorry if I confused you. With his cancer I am forever more trying to figure things out and I do get burned out on copays etc.)
I feel like you deserve hardware that works for you and to have your freedom after 40 years. How much more money will it cost you to keep it? It might be worth more than money.
Can your Doc write a letter of medical necessity to force them to cover it? I believe they have some professional obligation to do this. Docs have done this for me before. If they won’t, maybe there’s a better Doc out there. Insurance companies should not be dictating treatment. They are not Doctors.
Read your Part D policy, just because some customer service agent says it isn’t covered doesn’t mean it is so. I have had to quote chapter and verse to ins. co. and say this is our contract, live up to it. If you can’t wade through it, see if you can assistance at your local senior center or SHIPS. Good luck!
Hello, I ran into the same difficulty of high expense for OmniPod which I love because I can swim laps with it on and maintain my basal insulin! My solution is to have a prescription for 90-day OmniPod thru Part D but also use the Tandem tSlim X2 pump because it comes at no cost to me and learn to deal with the tubing! I use the OmniPod infrequently when I am in the water a lot or must avoid tubing getting in the way of some activity.
So sorry to hear. Had to fight for Omnipod 5 new G6/G7 pods with commercial insurance. They just flat out lied that there was a plan exclusion and the claimed we had other coverage. As another commenter said, read plan terms and have your dr. advocate. My next hurdle was putting a Novo Nordisk insulin in the pod - none available. That company appears to be in free fall. So Humalog is the only choice. I hope your Dr can convince Medicare that better BG management justifies this.
Find a Part D plan that covers Omnipod. (See below, Insulet lists the plans on their website.) Then make sure it covers other prescriptions you need. Then check the premium and deductible, double check everything with the formulary of that plan and decide if it’s worth it to sign up for that Plan D in open enrollment. The premiums for these Part D plans are not too high considering drug prices etc.
I doubt that any other process of trying to get Omnipod coverage on Medicare will succeed. The method listed above is what many if us have already done…it works, tried and true.
I experienced a similar situation with my Omnipod a few years ago when at the beginning of the year, my insurance no longer covered it. My endo’s office took care of the appeal for me, and while it took a while (and I did run out of pods and therefore had to go back on shots for a few weeks), it was successful in the end and I got no issues from them after that. So definitely see what your doctor is willing to do for you. But I also like the idea of checking with Omnipod to see if they can help. They WANT people to have their product, so they may be more likely to help than you think. Best of luck!
What you’re saying about not wanting to be tethered to a tube is exactly why I didn’t use a pump for 20 years (I’ve had t1d for almost 40 years now). Tubing or not (I’ve used Omnipod as well as other tubed pumps) it has been a life changing experience. Now with hybrid closed loop (HCL), it’s a no brainer. I say whatever hesitation you have about tubing will be insignificant compared to the benefits of HCL. You might find (like me) that while being tubeless is convenient, it’s really not so hard adapting to a tubed pump.
Also, many people fill their Omnipod through the pharmacy benefit which does not at all interfere with the 4 year warranty period of traditional pumps. You can probably have (and use) both, it’s not an either/or situation. Get on a HCL traditional tubed pump while you battle it out with Medicare for the Omnipods. That way at least you’re getting the benefit of HCL while the Omnipod situation resolved, and maybe you’ll even begin liking a tubed pump.
I will say that when my Omnipod PDA unexpectedly failed during a trip abroad, and I had to return to MDI, I lost a lot of faith in it. With no way to bolus without the PDA, I could have been stuck but fortunately I had brought emergency backup Lantus and Humalog with me.
