How to prescribe Omnipod® systems

How to Prescribe Omnipod®

For your patients using Multiple Daily Injections, traditional tubed pumps, or the Omnipod® Insulin Management System (also known as Omnipod Eros, Omnipod UST400, the Original Omnipod System, or “Omnipod Classic”)

Send an eRx direct to ASPN pharmacies

You will need to send 2 eRxs (e-Prescriptions). This might mean:

One for the Omnipod® 5 (Gen 5) Intro Kit* and one for the Omnipod® 5 (Gen 5) Pod Refill Pack

*If your patient isn't using Dexcom G6 CGM currently, you will need to write two additional separate prescriptions. One for the G6 Sensor and One for the G6 transmitter*

Or

One for the Omnipod® DASH (Gen 4) Intro Kit and One for the Omnipod® DASH (Gen 4) Pod Refill Pack:

*The Dexcom G6 CGM is sold separately and requires a separate prescription for both the sensor and the transmitter. The G6 CGM is necessary to use Omnipod® 5 in Automated mode. For more information on how to prescribe the Dexcom G6 CGM Click Here

Steps to prescribe

e-Prescribe:

  1. Enter “Omnipod” and/or “Dexcom” in your EHR system.
  2. Select prescriptions for Omnipod® DASH® or Omnipod® 5 including the Intro Kit and Pods.
  3. Select quantity dispensed and number of refills.
  4. Select and submit to: ASPN Pharmacies, LLC
    290 West Mount Pleasant Ave Building 2, 4th Floor, Suite 2400
    Livingston, NJ 07039
    NPI: 1538590690

ASPN Pharmacies will coordinate fulfillment with your patient at the pharmacy of their choice.

For your patient’s Omnipod® prescriptions:

Fax to: 1-877-881-1067

Call in: 1-866-347-0036

For your patient’s Dexcom G6 prescriptions:

Fax to: 1-866-879-8150

Call in: 1-888-489-0221

Prescription Options

Product Description NDC Number Package Contents Quantity Refills Dosing/Rx SIG Instructions
Omnipod 5 G6 Intro Kit (Gen 5) 08508-3000-01 Controller and 11 Pods 1 None Change Pod every 72 or 48 Hours* (Based on total daily insulin usage)
Omnipod 5 G6 Pods (Gen 5) Refill 5-Pack) 08508-3000-21 5 Pods per box 2 boxes One year (Monthly fills) Change Pod every 72 or 48 Hours* (Based on total daily insulin usage)

NOTE: The Dexcom G6 requires a separate prescription and is necessary to use Omnipod 5 in Automated Mode.

Product Description NDC Number Package Contents Quantity Refills Dosing/Rx SIG Instructions
Omnipod DASH Intro Kit (Gen 4) 08508-2000-32 PDM and 11 Pods 1 None Change Pod every 72 or 48 Hours* (Based on total daily insulin usage)
Omnipod DASH Pods (Gen 4) Refill 5-Pack 08508-2000-05 5 Pods per box 2 boxes One year (Monthly fills) Change Pod every 72 or 48 Hours* (Based on total daily insulin usage)
*Clinical rationale must be provided for 48-hour Pod change

An Omnipod Product Specialist is available to help you and your office staff with PAs or appeals, if needed. To contact a Specialist, call 1-866-247-0026.

Your patients may be eligible for a free Omnipod® 5 (Gen 5) Introductory Kit.

Your new to Omnipod® patients who are covered by insurance for Pods may be eligible*** for an Omnipod® 5 (Gen 5) introductory kit at no charge as part of the Omnipod® 5 10-Day Free Trial**** Program. Upon patient enrollment and terms/conditions consent, eligible patients (who are also new to Dexcom) will be directed to request their Free 10-day samples of Dexcom G6 CGM**** by clicking here

See if Your Patients Are Eligible for a Free Omnipod® 5 Introductory Kit

  1. Simply send to e-Rx's for the Omnipod® 5 Intro Kit and Pods to ASPN Pharmacies
  2. Eligible patients may receive a limited supply of Omnipod® 5 products at no cost to them through the program, by agreeing to the program’s terms and conditions.
  3. Patients that are new to Dexcom will be directed to request their free 10-day samples of Dexcom G6 by visiting www.Dexcom.com/SampleOP5.

Before the trial:

An Omnipod® Representative will be in touch to schedule training.

During the trial:

Omnipod® and Dexcom’s dedicated customer support programs at ASPN Pharmacy will communicate ongoing Pod refill and CGM Sensor costs to your patients.

Prescription Specifics

Omnipod® 5 (Gen 5) + Dexcom G6

Requires Dexcom G6 to run on automated mode.

*If your patient isn't using G6 currently, you will need to write two additional separate prescriptions - one for the G6 Sensor and One for the G6 transmitter.*

Omnipod® 5 (Gen 5) Intro Kit– Automated Insulin Delivery System (AID).

Medication: Omnipod® 5 (Gen 5) Intro Kit

Quantity: 1
Days Supply: 30
Refills: 0
Dosing Instruction: As prescribed; use as directed

Users may control the system using a compatible smartphone once they initially log-in and register their dedicated controller*

*Compatible smartphone list includes Samsung: S9, S9+, S10+, S10e, S20, S20+. For a list of compatible devices, visit www.omnipod.com/compatibility*

G6 Sensor and G6 transmitter

Prescription (2):

  1. Dexcom G6 Sensor
  2. Dexcom G6 Transmitter

Quantity: 1 of each

*Dexcom G6 sensor and transmitter are needed to operate the omnipod 5 in auto mode. Omnipod 5 only works with the G6 app on compatible phones – does not work with G6 receiver*

The Omnipod® 5 System does not work with the Dexcom G6 receiver. User must use the Dexcom app on their compatible smartphone

Omnipod® 5 (Gen 5) Refill Pack– Automated Insulin Delivery System (AID)

Omnipod® 5 System cannot be used in Automated Mode without the Dexcom G6 CGM

Medication: Omnipod® 5 G6 Pods (Gen 5) 
Quantity: 2 Days
Supply: 30
Refills: 11
Dosing Instruction: As prescribed; use as directed

  

Omnipod (R) DASH (Gen 4)

Omnipod (R) DASH (Gen 4) Intro Kit

Medication: Omnipod® DASH Intro Kit (Gen 4) 
Quantity: 1 Days
Supply: 30
Refills: 0 Dosing
Instruction: As prescribed; use as directed

Omnipod (R) DASH (Gen 4) Refill Pack

Medication: Omnipod® DASH Pods (Gen 4)
Quantity: 2 Days
Supply: 30
Refills: 11
Dosing Instruction: As prescribed; use as directed

Patients may contact Omnipod directly at 1-800-591-3455, 24/7, 8 am to 8 pm EST. 

Training on the Omnipod® 5 System

For new Omnipod® 5 System users:

In-person or remote training options will be provided by Omnipod® Certified Clinicians to fit the needs of your practice and your patients.

Once your patient receives their product, they’ll receive instructions for creating an Omnipod® ID account with information on onboarding and training next steps.

For your existing Omnipod® users on Dexcom G6 CGM:

We are excited to offer self-guided eLearning training (with HCP consent) that they may complete at their convenience. To enroll these patients in the Omnipod® 5 eLearning training option, simply contact your local Omnipod® ® Representative. If you do not know your Omnipod® Representative, we will help you connect with your Territory Manager by clicking here.

* In-person or virtual training with a Clinical Services Manager is available.

** Eligibility criteria: Subject to program limitations and terms and conditions, the Omnipod 5 10-day Free Trial Program (the “Program”) is open to patients who have a valid Omnipod® 5 and Dexcom G6 prescription andwho have commercial or private insurance, including plans available through state and federal exchanges, for Omnipod 5 Pods. The Program is open to new Pod Therapy patients coming from multiple daily injections or tubed pumps only who have not previously used Omnipod 5, Omnipod DASH®️or Omnipod Insulin Management System. This offer is not valid for participants whose Omnipod 5 or Dexcom G6 prescription is paid for in whole or in part by Medicare, Medicaid, or any other federal or state programs. It is not valid for cash-paying participants or where prohibited by law. A participant is considered cash-paying where the participant has no insurance coverage for Omnipod 5 or where the participant has commercial or private insurance but Insulet determines in its sole discretion the participant is effectively uninsured because such coverage does not provide a material level of financial assistance for the cost of an Omnipod 5 prescription. This offer is only valid in the United States, Puerto Rico, and the U.S. territories. Participants receiving their products through the Durable Medical Equipment or Pharmacy Durable Medical Equipment channel are not eligible to participate in the copay card program. Participants on certain commercial insurance plans may not be eligible. Please contact Insulet Customer Support at 1-800-591-3455 for details.

*** Program Details: A participant shall sign the Try Omnipod 5 Free Trial Acknowledgement through the appropriate platform provided by Insulet. Once Insulet has received the request, the request shall be escalated to Insulet’s pharmacy partner, where a request for a prescription shall be sent to the participant’s healthcare professional. If a valid prescription is received, both for the Omnipod 5 Intro Kit and the Omnipod 5 Pods, the participant’s benefits will be checked by Insulet or its partners. If the patient’s benefits check results in a monthly copay equal to or below two hundred dollars ($200), then Insulet shall issue a one-time only copay card to the participant, for a value equal to the out-of-pocket expenses the participant would have to pay for an Omnipod 5 Intro Kit. If the benefits check result in a copay greater than two hundred dollars ($200), Insulet, or its authorized partners, shall arrange for a one-time dispense of Omnipod 5 Pods at no cost to them, The Omnipod 5 Intro Kit shall be delivered to the shipping address indicated by participant in their Acknowledgment Form. Any estimate date of delivery is given solely for participant’s information and does not constitute a warranty that the Intro Kit will be delivered on said date. Insulet reserves the right to change, amend or rescind this Program, in whole or in part, at any time. *The Omnipod®5 Introductory Kit includes: One (1) Omnipod 5 Controller & Eleven (11) Omnipod 5 Pods. Each Pod can be worn for up to 3 days of continuous insulin delivery depending on the patient’s insulin requirements/HCP prescription. Extra trial Pods beyond 10 days are supplied to support flexibility in insulin regimens and an easy transition from trial to full-time user given the time it takes to both fulfill the new Rx and ship the order. In order to use the Omnipod® 5 System in Automated Mode, the User must also procure a Dexcom G6 Continuous Glucose Monitor System, which is sold separately. For more information about how patients can obtain a 10-day supply of Dexcom G6, please contact Dexcom or click on the following link: http://www.dexcom.com/SampleOP5†For Dexcom’s terms and conditions visit: Dexcom.com/OP5sample

**** In order to use the Omnipod® 5 System in Automated Mode, the User must also procure a Dexcom G6 Continuous Glucose Monitor System, which is sold separately. For more information about how patients can obtain a 10-day supply of Dexcom G6, please contact Dexcom or click on the following link: www.dexcom.com/SampleOP5

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