INSURANCE COVERAGE FLEXIBILITY FOR THE OMNIPOD® INSULIN MANAGEMENT SYSTEM
Pod Therapy is now more accessible than ever, as it is covered under most private insurance plans through either the: 1) medical benefit and/or the 2) pharmacy benefit. Our coverage flexibility differentiates our insulin management system from other insulin pumps, giving patients and their healthcare team the freedom to determine the best way to receive their Pods. Pod Therapy may also be available through Medicare Part D and Medicaid.
Medical Equipment Benefit
Depending on the patient’s health insurance, Pod Therapy may be available as durable medical equipment. This requires healthcare providers to submit a Certificate of Medical Necessity alongside our Patient Information Form. Patients’ insurance plans will dictate Pod coverage.
The pharmacy channel offers simplified access to Pod Therapy. This avenue may mean less paperwork for healthcare providers and may allow patients to manage their Pod orders alongside their other prescriptions. We currently have access through the two largest Pharmacy Benefit Managers in the nation, and are continuing to expand pharmacy access across the United States. Learn more about how to prescribe Pod Therapy for patients with private insurance plans.
Medicare Part D Coverage
The Centers for Medicare and Medicaid Services (CMS) allow for Pod Therapy to be covered under the Medicare Part D (prescription) program. If your patient’s Part D carrier does not yet include Pod Therapy on their covered formulary list, our Medicare Access team can work with your patient to help them secure a formulary exception. To learn more about beginning this process, our Medicare Access team can be reached at 877-939-4384.
The January 2018 announcement by the Centers for Medicare and Medicaid Services (CMS) confirming Pod Therapy coverage under the Medicare Part D Program may serve as an accelerant to achieving broad Medicaid access for Pod Therapy users.