The Omnipod® System is Now Eligible for Medicare Coverage

On January 5th, 2018, the Centers for Medicare and Medicaid Services (CMS) released a statement confirming that the Omnipod® System may now be covered under the Medicare Part D Program. This announcement enables us to begin contract negotiations with Part D carriers to cover the Omnipod® System effective January 1, 2019. In the meantime, patients may be able to obtain coverage immediately for the Omnipod® System by following the formulary exemption process.

Formulary Exception Process

The Medicare Part D law includes a formulary exception process, which is an avenue for Medicare Part D beneficiaries to obtain products that are not formally covered by their Part D prescription drug plan. Until the Omnipod® System is officially covered by your patients’ Medicare prescription drug plans, this will be the only way for them to receive insurance reimbursement.

Step 1: Download and complete the Medical Coverage Determination Request Form from the CMS website
Step 2: Sign and submit the completed Medical Coverage Determination Request to your patient’s Part D insurance carrier
Step 3: Upon confirmation that your request has been approved, contact Insulet Corporation at 877-939-4384 to arrange delivery.

By law, Part D insurance carriers must provide you notice of their decision within 72 hours of receiving a standard request. In the event that your request is approved, it may be reimbursed as higher tier. This would mean a higher out of pocket cost for your patients than the preferred coverage Insulet Corporation is attempting to secure for Medicare beneficiaries by January 1, 2019.