Hey guys! I have just started on the OmniPod, and I just ordered my first box of pods through EdgePark billed as DME (out of pocket $750 then they will be covered at around 60$ per month per box, and I need two boxes per month); however, the OmniPods are also covered on my prescription drug list as a much cheaper retail pharmacy prescription. I have called everywhere and no pharmacies nearby can get them for me. Does anyone know ANY retail pharmacies that can get the OmniPods? Or a place that can bill as a pharmacy prescription? Much thanks!
I could be wrong, but I thought it was your insurance plan that dictates whether the pods are considered DME or prescription coverage. I have Blue Cross/ Blue Shield through the State of Louisiana and my pods are treated as DME but surprisingly I do not have to pay any type of co-pay. I do know that when I first started on OmniPod, the supplier had to talk to BC/BS a few times to get straight what "code" to use for proper coverage on my plan.
Good luck with podding! :) I hope you have much success. But be patient at first, it takes time to find what works best for you - which sites are best and that sort of thing.
With my insurance place (UnitedHealthcare Choice), it is technically DME. However, the pods are also under my Prescription Drug List for retail pharmacies, and I wouldn’t have to hit my deductible and a flat rate covers whatever I am prescribed (20 pods a month). I have tried talking to UHC multiple times but they keep referring me to Animas and Medtronic for the pods (they don’t understand that they are other pump companies). I was just hoping to find a retail pharmacy that could get them and bill them under my prescription plan. EdgePark said they can’t run it under any other codes for me, so I’m stuck at 300$ a box until I hit my deductible, and the box I already got isnt showing as being applied towards my deductible as of now. 
Thanks for the tip - I will call them first thing in the morning. I'm at my whits end with finding a place to cover them as a prescription instead of DME. :-|
I have two companies out there trying for me now - Liberty Medical and Better Living Now; hopefully one of them can properly bill the pods as pharmacy claims for me. :-)
Hey David, another one to try is "Pumps It" out of Houston, TX. I'm going to switch my pod orders to them on my next reorder because my current supplier is doing some things that seem kind of shady to me (trying to get approval from my insurance for a new pump for me without my knowledge). I get my Dexcom supplies from Pumps It and they've been great.
Thanks for the tip - I tried getting in touch with them, but their sales department always went to voice mail and I would miss the callbacks from the woman. They did seem nice though! :)
I finally found my solution; Better Living Now (based out of NY) was able to run the OmniPods as a prescription instead of durable medical equipment for me! So, I pay $70/mo copay for my two boxes now as a prescription through UHC/Medco; if I did it under DME it would have been $65 for one box ($130/mo) after I met my yearly deductible of $750. It's a lot cheaper under the prescription plan for me.
Better Living Now has been great; I paid extra for overnight Saturday delivery of my pods, but due to an error in their shipping system the pods weren't scheduled to be delivered until Monday (which would have meant two days of shots, which I didn't want to do). I offered to make the four hour drive from PA to their office in NY, and I got ready to go pick them up. However, their OWNER heard about what had happened, had an agent call me back, and made the 4 hour drive himself to bring the OmniPods to me all the way in PA; that was the BEST customer service I have ever received! I would highly recommend Better Living Now to anyone who needs diabetes supplies! It truly WOW'd me - they definitely have a wonderful team over at Better Living Now! :-)
Thank you for this information, David. I was quoted by Edgepark and another company called Diabetes Center owned by Byrom Healthcare. I am looking at the omnipod and dexcom and not finding them directly supplied on the UHC insurance. The price for sensors was more than double from one to the other... makes me want to check and recheck all this information.
Are you still happy with your supplier now?
I order my Dexcom supplies from Foundation Care also.
I order my Freestyle test strips from Byram. They have very good CS.
I run into something similar to this with my Dexcom sensors. My insurance calls them a pharmacy item and computes my deductible one way. Edgepark computes it as DME with a different and lower price and deductible. For me it doesn’t really matter because I always meet my huge deductible and everything is covered 100% after that. But it is confusing when my insurance says I’ve met my deductible, but I know I haven’t because of how Edgepark is computing things.
Awesome information as I am pricing out my pump supplies now! My insurance plan is written as such that Diabetic Supplies are Prescription, BUT Insulin Pump Supplies are DME. FRUSTRATING!! Though I believe when I hit my $1,000 DME deductible then it's covered 100% so long as I use an in-network DME supplier like EdgePark. I am going to ask if Better Living Now is on the in-network list.
Though there are not many patch pump options yet, check this up and coming pump. (www.JewelPUMP.com)
When this finally gets finished and approved it will be miles ahead of what is available now.
I'm still very happy with Better Living Now - they even call me the day that I'm eligible to refill my prescription for the OmniPods! The PDM and CGM itself would be under DME if you got it under insurance, I don't think you'll ever find those under a prescription plan. But the only infusion set that I found on my prescription plan was the OmniPods, which I get 2 boxes per month. In another post I'll include pics of how to check if you can get them under your prescription plan - if you can, I'd highly recommend Better Living Now; I looked for hours and hours for a place that would bill them under prescription plan, Edgepark and other places told me they would only do it under DME for me.
Here's how to check (with United Healthcare) if you can get OmniPods under your prescription list instead of DME (which for me was a lot cheaper and means no deductible):
By the way MEDCO does distribute the pods.. may save you some hassle with going through the outside distributor.
My pods are $180 for 3 months (4 boxes), and they come direct from Medco/Express scripts
My insurance ( Medical Mutual) told me that I could order infusion sets, reservoirs, and MM sensors through Edgepark ONLY. Period. I will check and see how these supplies are considered. I am sure they are not durable medical(DME).
God Bless,
Brunetta
This is great! I have United as well and I’m starting the Omnipod next week. I will be calling them Monday!
Hey David i’my looking for the same thing cheaper Omni pods and Dexcom sensor’s!