start

Just two steps

It's so easy. You fill out the forms. We'll take care of the rest.

step
1

Download these 2 forms and complete them with your doctor or Certified Diabetes Educator (CDE).

Patient Information Form (218 KB PDF) or fill in online.
Certificate of Medical Necessity (81 KB PDF)

step
2

Send a single fax with the forms and a photocopy of your insurance card (front and back) to our confidential fax line at 877.467.8538 or mail them to:

ATTN: Customer Care
Insulet Corporation
600 Technology Park Drive, Ste 200
Billerica, MA 01821

Once we receive your paperwork, we will work with your insurance provider to determine your benefit coverage. Then, we'll contact you to confirm your prescription and arrange for shipment of your Omnipod® Insulin Management System. It's that easy.

Questions? Call us at 1.800.591.3455.

For assistance in gaining prior authorization for FreeStyle® test strips for use with the PDM's integrated blood glucose meter, please call FreeStyle Test Strips Customer Assistance1 at 1.877.654.9975.

1The Patient Access Program is not available to beneficiaries of Medicare, Medicaid or other federal or state healthcare programs or residents of Massachusetts.