Omnipod DASH® Health Insurance Coverage

Available Through the Pharmacy

The Omnipod DASH® System is the ONLY full-featured Insulin Management System in the U.S. that is widely available at your patient’s local pharmacy. 

As we strive to reduce the burden for people living with diabetes and your practice, we are certain the pharmacy channel is the best way to help your patients obtain Omnipod DASH®, with less hassle and less financial impact. Why are we so certain?  Here are the reasons. 

Accessible

  • Available nationwide through retail and mail order pharmacy, including major retailers like CVS and Walgreens.  

  • For the majority of Omnipod DASH® customers, the co-pay through the pharmacy is less than $50 per month.

  • The average monthly patient out-of-pocket cost for the Omnipod DASH® System is lower than an MDI insulin delivery regimen.2 

  • Personal Diabetes Manager at no charge, included with the first box of Pods.3 

  • If you are a pharmacist:  Omnipod DASH® is available through major wholesalers such as AmerisourceBergen, Cardinal, and McKesson. 

Simple For You and Your Patients

  • NO contract, NO commitment, NO obligation.  

  • The ability to electronically prescribe with no c-peptide and less paperwork 

  • Convenience for patients to pick up their Pods and insulin at the same place they pick up their other medications 

  • Easy upgrade to newer Omnipod® technology regardless of existing pump contract when new product is available and covered by insurance4 . It is our OmnipodPromise™ to you and your patients. 

Our Partners

Walgreens

CVS Pharmacy

 

Getting Your Patient Started on Omnipod DASH®

New Omnipod® Patients

How do I get my patient started? 

  1. Fill out the Patient Information Form
  2. Write a prescription and send it to us or your patient’s local pharmacy
  3. Set up a training session

Current Omnipod® Patients

Current Omnipod® Patients

  1. Write a prescription and send it to us or your patient’s local pharmacy  
  2. Set up a training session 

Try a 30-Day Free Trial5

If you have patients who are uncertain about trying a tubeless, pump-based insulin management system for the first time or who are considering switching from another pump but are hesitant about the change, Omnipod® offers a simple free trial through our 30 Days of Freedom program. You can direct interested patients to our Free Trial* form. 

Medicare Coverage

All Medicare Part D patients  have access to the Omnipod  DASH® System

  • Coverage for your patients with both Type 1 and Type 2 diabetes - No C-peptide test required 

  • Streamlined electronic prescribing process, which may reduce paperwork and expedite the Pod initiation process 

  • For the majority of Omnipod DASH® Medicare customers, the co-pay through the pharmacy is less than $50 per month6 

  • Write a prescription and let you patients try Omnipod DASH® for 30 days and unlike DME, no switching restrictions  

If your patient requires a Medicare formulary exception, reference how to complete the Medicare Exception process for the Omnipod DASH® System here

Dual Eligible and Low-Income Subsidy Patients 

The Centers for Medicare and Medicaid Services (CMS) announced that the Omnipod® System and Omnipod DASH® System may now be covered under the Medicare Part D Program. This may serve as an accelerant to achieving broad access to the Omnipod® System and Omnipod DASH® System to people on Medicaid. The Omnipod® products are covered benefits within select State and Managed Medicaid programs. 

Did You Know?

Dual eligible and low-income subsidy patients are subject to a copayment between $0 to $3.95 for generic products. Omnipod DASH® is considered a generic product under Medicare part D.7

If you need assistance please call our Medicare Access Team at 877-939-4384

References:

1. Calculated based on a consumption of ten (10) Pods per month. Majority defined as at least 70% of patient co-pays under $50 per month. 131,049 paid claims between January 1st, 2020 and December 31st, 2020, both for commercial plans and Medicare, were analyzed. Actual co-pay amount depends on patient’s health plan and coverage, they may fluctuate and be higher or lower than the advertised amount on a monthly basis. Source: Data on file.

2. Estimated total monthly out-of-pocket for Omnipod DASH® System regimen is $72, versus $84 to $85 for MDI regimens. Omnipod DASH® System out-of-pocket cost based on the co-pay cost for rapid-acting insulin vial, Pods and alcohol wipes. MDI out-of-pocket cost based on the co-pay cost of rapid-acting and long-acting insulin vials (or LAI Pen and RAI Pen in the case of an MDI Pen regimen), alcohol wipes and syringes or needles (in the case of an MDI Pen regimen). MDI regimen co-pays based on 3 daily injections. All Omnipod DASH® estimates based off both commercial and Medicare paid claims between January 1st, 2020 and December 31st, 2020. Does not include any OOP related to CGM/BGM supplies. For illustration purposes only, actual co-pay amount depends on patient’s health plan and coverage. Source: Data on file.

3. Subject to co-pays as required by insurance coverage.

4. Only available for users with valid prescription and coverage through their pharmacy benefit. Upgrades subject to user’s insurance coverage.

5. To be eligible for 30 Days of Freedom Trial Program, you must complete and sign Program Enrollment and Personal Information Forms and may be required to submit additional documentation. Patients must have been prescribed Omnipod DASH for an FDA-approved indication. For new Pod Therapy patients coming from multiple daily injections or tubed pumps only. Free Omnipod DASH trial program is not available to beneficiaries of Medicare, Medicaid or other federal health care programs, or to members of certain commercial health plans. You agree not to sell, trade, return for credit or seek insurance reimbursement for the PDM or free Pods. After the 30-day trial, your out-of-pocket cost for Pods will depend on your insurance coverage. Other restrictions may apply. Cancel at any time. 30 Days of Freedom Trial Program terms and conditions are subject to change.

6. Average calculated based on a consumption of ten (10) Pods per month. Majority defined as at least 70% of patient co-pays under $50 per month. 56,012 paid claims between January 1st, 2020 and December 31st, 2020 for Medicare plans were analyzed. Actual co-pay amount depends on patient’s health plan and coverage, they may fluctuate and be higher or lower than the advertised amount on a monthly basis. Source: Data on file.

7. https://www.cms.gov/files/document/lis-memo.pdf

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