I am curious if anyone has started using the Twiist insulin pump combined with FreeStyle Libre 3 Plus CGM and algorithms from Tidepool/Loop? If not what is the general opinion of FreeStyle Libre 3 Plus? I have only known Dexcom.
I just submitted my information for a benefits review to see if I’m covered.
Thanks,
Andy
Please share their response. I really want to know what “available in select areas” means. Have you seen our big Twiist thread? Twiist Pump
The Libre 3 plus is a good enough CGM. Dexcom sensors seem to respond to changes quicker and be less inaccurate below 80 mg/dL. The Plus version of the Libre is first change to the sensor, the part under your skin, since Abbott released the original Libre. Since it less than a year old we still haven’t seen much data comparing the plus to the previous version.
Are you on Medicare yet? I remember you getting ready. I don’t think they are medicare ready yet. Choosing to sell a tubed pump through the pharmacy channel may be a choice to delay access to people on Medicare while they ramp up production, their sales and their support teams
In the last 3 or 4 months I was able to connect with a Sequel Twiist rep on a phone call. She responded to my pointed repeated email questions regarding the actual meaning of a “pharmacy benefit” with respect to Medicare DME coverage. Up to this point I had seen no writing from Sequel specifically about this.
The rep was polite and invested in answering my questions. She verified that “pharmacy benefit” meant that the company targeted commercial insurance coverage only (no Medicare) at least at the introduction of the Twiist hardware.
I expressed disappointment and the rep seemed empathetic. I had shared with her that I was one of the people who spent 6-12 months as part of the Tidepool study that paved the way for FDA certification of Tidepool Loop. This, of course, enabled Sequel to integrate Tidepool Loop into its design.
I expressed that while Sequel could choose to market to whatever market segment it preferred, I wished it would bring along the Medicare cohort as soon as it could. I just wish that these companies did not make it such a mystery!
Of course, I understand these start-up companies and the regulatory challenges that they face. I accept that people like me will need to be patient with this process.
I had a chat with a Twiist sales rep who had no insight into when they will be approved for Medicare coverage. He told me if I join the waiting list they will notify me when that coverage is added, so I did. Also, he mentioned Cigna pharmacy benefit is an insurer that covers Twiist (non Medicare). Coincidentally Cigna is one if the few Medicare Part D plans that covers Omnipod.
All in all I think its a good thing that Twiist will eventually be a Medicare Part D prescription covered pump. With the $2000 oop annual max a high deductible Part D plan would be a reasonably affordable way to use Twiist. Certainly comparable in cost to using Omnipod.
Except for how will they pay for infusion sets?
I’m sure it’s just like the Omni pod. I get them from the pharmacy. They are much cheaper than through durable medical. And I can always just show up to get a box of pods pretty much anywhere.
I think pharmacy benefit is the way to go.
My tandem was running $126 every 3 months. And that’s on top of the cost of the pump which was $6000, so for me it was $1500 with durable medical.
I wish dexcom sensors were sold through pharmacy.
The Twiist is on my list. My Tandem warranty is up in November. I’m hoping by then, it will work with the G7 and they will have clarification on Medicare coverage. I’m not retired, but probably will be in the not too distant future. If the G7 is not onboard by then, I might switch to the Libre 3+ or, more likely, take another cycle on the t:slim.
Except pharmacies dont have infusion sets. The rep was suggesting the Cleo and kept reminding me they do not auto inject.
Yea I haven’t looked into the twist. I assumed it was tubeless like omnipod. So yea I doubt infusion sets will be in pharmacies anytime soon. It seems like a scam we can’t just buy infusion sets and have them be interchangeable between pumps since they are so similar.
When I switched from Medtronic REVEL to Tandem Tslim, I could used the infusion part, but I couldn’t use the tubing. But it was ok because the infusion portion is the part that fails most. But I threw away a lot of tubing
Thank you for responding. I am not on Medicare and won’t be for some time. I had written before in anticipation of one day moving in that direction in an attempt to plan. I am always skeptical of new products so wanted to see what others think and if anyone had tested the waters yet.
Tim, I receive my Dexcom sensors and transmitters via the pharmacy through my commercial insurance plan.
I’ve occasionally seen infusion sets on drug benefit formularies. Coverage will take time but can happen. The usual problem of covering one brand but not another is part of why I’m not a fan of pumps as pharmacy items. Considering most pharmacies are locked into one of 3 distributors and your benefits might lock you into particular pharmacy there’s more potential limitations. How expensive are infusion sets without insurance?
@Timothy the Twiist uses the old luer lock infusion sets. There’s a list of compatible sets in the manual.
Update: Twiist can use either Humalog or Novolog. There were some previous posts suggesting only Humalog could be used. I also asked the Sequel rep about supplies for the Twiist pump. ALL of the supplies will be covered under pharmacy benefits. Initially the supplies will be dispensed by Byram pharmacy but the goal is to get other pharmacies participating in the near future. The Freestyle Libre 3 can come from any pharmacy.
I have purchased Dexcom (G6 and G7) from Costco pharmacy, so based on those repeated experiences, Dexcom is available through pharmacies.
I am in the process of getting Twiist through Medicare.
At first, my Part D plan denied the claim because Twiist wasn’t in their formulary; they suggested Omnipod as an alternative. I previously used Omnipod and had evidence in the form of receipts, so those receipts were included in the appeal. The Plan D provider authorized Twiist very quickly (last week) after getting the appeal. I’m now waiting to see how to actually get the pump.
My goals for seeking the Twiist include:
Purely my speculation, but I think Sequel focused their insurance efforts on largest plans first. For example, UnitedHealthcare included Twiist in March 2025 and updated their guidance in June: https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/drugs-pharmacy/commercial/h-p/PA-Med-Nec-Omnipod-5.pdf
Thanks for navigating the Part D coverage, please keep us posted!
I’m curious about the process to get Medicare Part D coverage for Twiist, did you start with a Prior Authorization request? When I’ve phoned Sequel their sales people have described the process as a Medicare exception which sounds more onerous…my next call will be to Cigna (my Part D insurer) but not confident they will provide a reliable answer.
Please keep us in the loop as to your experiences with Twiist and Libre 3 Plus. My insurance (Excellus of western NY) denied coverage so now a rep. from Sequel is looking at it in more detail to see if there is a work around.
I got hooked up yesterday, changing from Omnipod 5. I’ve always been tubeless so getting used to the tubing, but I’m happy with the pump’s performance so far. My prescription insurance is through TrueScripts and paid $0 to get started.
I’m at a breakthroughT1D event this, Saturday 8/23 morning and there’s a couple of Twiist people with a table. Anyone got questions? Probably got till noon, it’s 8:34 now
I too get my Dex 7 sensors at the pharmacy through prescription, CVS.