Coverage Under Medicare Part D

Medicare Part D offers several benefits to you and your patients. 

Open Enrollment is Now! Oct 15-Dec 7
Helping your patients get coverage through Medicare Part D allows them to secure preferred coverage for medications for the coming year.

How Help Your Patient Determine Where Omnipod is Covered on Medicare Part D?
FIRST: Go to medicare.gov or call 1-800-MEDICARE to find the plan that best covers your patient’s medications

THEN CHECK FOR OMNIPOD: Omnipod is designated as a medical device. This means that you cannot search for “Omnipod” when looking for plans. Once a plan is found that best suites the patient, click on the plan details to get the best number to call for that plan. Call to check for Omnipod coverage.

What if Your Patient is Not Covered Under Medicare Part D and wants to get started NOW?
If your patient has a Medicare Part D plan that doesn’t cover Omnipod they can still gain access via the formulary exceptions process. Please follow these steps:

  1. Send a Prescription to the patient's pharmacy – If formulary exception is needed the pharmacy will send a PA request for coverage determination
  2. Coverage Determination can be completed on CoverMyMeds or ePA portal of choice
  3. Once approved the pharmacy will process the claim

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