I know there has been a lot of discussion about Medicare and pump coverage, however what I would like to know is if anybody knows WHERE (I’m in New Jersey) I get my Omnipods from, now that I’ve found out that US Med can no longer supply them, as they do not have a contract with Medicare. I cannot get any consistent info from Medicare - Part D reps tell me I need to talk to Part B reps, and Part B reps told me I could get them at Walgreens (!) which of course was incorrect.
Additionally, to switch over, do I just need my endo to write a new script and send it to Medicare and it is taken care of, just like any other prescription? (With the exception of perhaps needing a few blood tests…)
Check and see whether there is a Walgreens Community Pharmacy that you can use. That is how I got my pods for the few months that I used Omnipod on Medicare. I did it through mail order with them. It wasn’t my neighborhood pharmacy. Also I would think someone at Insulet could help you.
And @Luis3 is correct that pods are only covered under Part D pharmacy benefits with Medicare.
I’m no help, but the Part D Medicare rep is dead wrong. OmniPods are only covered under Part D. Other pumps such as Tandem and Metronics are covered by Durable Medical Equipment Part B.
It’s a pain, but try calling the Part D people again and maybe you will get a more knowledgeable rep.
The examples that were previously provided were never intended to be an exhaustive list of products that could be covered under Part D. Instead, they represented our understanding of the types of medical supplies associated with the injection of insulin that were available at the time. Since that time, newer insulin delivery devices in the form of both mechanical and electronic insulin pumps have become available that are not coverable under the Medicare Part B durable medical equipment (DME) benefit. Consistent with the Part D policy to allow coverage of insulin delivery devices that are 1) directly associated with delivering insulin into the body and 2) not otherwise considered DME under Part B, Part D sponsors may provide coverage of such products under Part D as “medical supplies associated with the injection of insulin.” https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Medical-Supplies-Associated-with-the-Injection-of-Insulin.pdf
If they can make it more to understand, they would. Sounds like it is composed by a committee of baboons.
I get my “old” Omnipod with the PDM thru my BCBS secondary as part of their Medicare Part B supplemental coverage. I order pods myself directly from Insulet. They bill BCBS directly who covers them as durable med equip as they did before I started Medicare. Medicare covers the PMD as a glucometer (go figure) if I have to buy a new one (once every 5 years).
The new DASH pods are covered under Medicare Part D only. Insulet chose this path when Medicare balked at the “no tube” issue (what is that itty bitty tube sticking in me from the pod?). Even though Medicare doesn’t over my pods, it pays for my insulin under Part B because insulin used in a pump is covered under part B. Insulet has no plans to further persue getting DASH covered under Part B as durable medical equipment.
It is ENORMOUSLY confusing under Medicare!! As you have found you get bounced between the med equipment customer service and the pharmacy benefits customer service. My BCBS plan is covering DASH starting in 2022 but with a $500/yr copay for the DASH pods from their mail away prescription provider, Caremark. I’m sticking with the old pods and PDM for now. Insulet plans to continue to manufacture the old pods and PDM.
So suggest you speak with the Insulet Medicare rep and see if you can pin down details. Always be specific if you are talking about the old Omnipod system or DASH.
Insulet helped me get set up with Walgreens Community Pharmacy in NJ for eros pods under part D pharmacy benefit. (Walgreens Community Pharmacy does mail-order of 3-month supplies, they are at 973-413-2169.)
There’s a “Community, a Walgreen’s Pharmacy” in Trenton that I’ve been getting my Dash from (under Part D) by mail order for about 2 years. Set it up with my Insulet rep and now they just auto-ship my pumps to me in PAnevery 3 months.
