Omnipod® HCP:
Medicare Coverage and
Access FAQ’s

To view plans that cover Omnipod, you can visit our website here. Patients can also access coverage information here.

For personalized assistance, you can call 1-800-MEDICARE (1-800-633-4227). Additionally, you can explore plan options online at medicare.gov or shiphelp.org for more help with plan selection.

Starting in 2026, the out-of-pocket (OOP) costs for all covered medications, including Omnipod 5, will be capped at $2,100 annually¹. Additionally, if your patient qualifies for a low-income subsidy or is dual eligible in 2026, their copay will range from $0 to $12.65².

Many Part D plans include Omnipod 5 on their formulary, requiring only a prescription to the pharmacy. For plans that do not yet cover Omnipod, you can submit a Medicare Formulary Exception/Coverage Determination Form to request coverage. To take the guesswork out of how or where to submit the form, our dedicated team at ASPN Pharmacy can eliminate the uncertainty around formulary exceptions, form selection and submission processes.

Every Part D plan is required by Center of Medicare and Medicaid Services (CMS) to have a non-formulary process in place. The formulary exception process allows beneficiaries to request any medication not listed on the formulary to be considered coverage if the physician believes it is the only available option.

Our dedicated phone line for Customer support is 800-591-3455. Our agents are ready to assist with patient inquiries.