Switching from Dash on DME (UHC) to T slim

In january of this year I started omnipod dash directly though insulet (I know for everyone else its pharmacy but UHC requires it through DME). I started omnipod 5 4 months ago through pharmacy benefits. I am not super happy with how high the 5 is keeping me so i ended up switching it back to manual mode. I want to try the t slim control IQ but i am getting mixed info on whether or not my insurance will allow it since I got dash through DME. Does any one have a similar experience?

You said you got Dash directly through Insulet but then at the end said you got it through pharmacy. Do you mean you got 5 through pharmacy? In general, if it was covered as a pharmacy benefit you should be able to move to another pump without having to wait out a warranty.

I also have UHC and my particular plan didn’t cover OmniPod Dah or Eros through pharmacy, only DME. They do now cover 5 as a pharmacy benefit. I was looking at switching to O5 a few months ago but due to the high deductible & co-insurance I have the Dexcom would be out of reach for me. It makes no sense to get the Omnipod without Dexcom so I’m stuck with Medtronic.

Yes I did get op5 though pharmacy! I’m going to have my doctors out in the order for t slim and see what happens. I keep getting conflicting info on whether they’ll pay or not.

I think that is the only option.

Here is info about O5. Note it says free controller. If insurance paid for controller + pods, there would be a DME relationship. D means durable. And phone app as controller does not make it DME.
So I think that’s how it is NOT considered DME.

"Take full control of the Pod from the Omnipod 5 App on a compatible smartphone* or use the free controller, included at no additional charge with your first prescription for the Omnipod 5 Intro Kit. "

Have you asked Tandem to do a benefits check? They can send an inquiry to your insurance to see if you’re eligible for a new pump. You may be locked into a multi-year warranty with your DME Dash setup, and not yet eligible for Tandem. Or you might just get the all clear to go forward.

Tandem offers upgrade opportunities to make the switch. It’s not cheap, though. Around $1,000 to basically rent a t:slim for the duration of your existing warranty. And then you need to purchase your next pump at the end of that period, if you want to stay with Tandem. Depending on how much time is left on your warranty, might make more sense to just wait until it expires.

You found a loophole to get the Omnipod 5, since it’s a pharmacy benefit, but usually we’re stuck with our DME pump choices for 4-5 years.