How to Adjudicate

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Insurance Coverage

Over 90% of insured patients are covered for Omnipod® 5¹. All Omnipod 5 prescriptions are covered only through the pharmacy benefit including Commercial, Medicare Part D and Medicaid. Omnipod is also covered on the Federal Supply Schedule.

 

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Running Prescriptions

When you receive Omnipod 5 prescriptions, it is important to run the Intro Kit before Pods if the patient does not already have the Insulet-provided Omnipod Controller.

Omnipod 5 Intro Kits

Omnipod 5 DexG6G7 Intro Kit Gen 5 package

Omnipod 5 DexG7G6 Intro Kit (Gen 5)

NDC/NRC: 08508-3000-01
One-time only script, no refills, includes:

  • 10 Pods (two 5-packs)
  • Controller
Omnipod 5 Libre 2 Plus G6 Intro Kit package

Omnipod 5 Libre2Plus G6 Intro Kit (Gen 5)

NDC/NRC: 08508-3000-88
One-time only script, no refills, includes:

  • 10 Pods (two 5-packs)
  • Controller

Omnipod 5 Pods

Omnipod 5 DexG6G7 Pods package

Omnipod 5 DexG7G6 (Gen 5)

NDC/NRC: 08508-3000-75
Refill 5-Packs. Prescribed and filled to patient insulin requirements:

  • 2 boxes/month - 30 day supply for a 72-hour change-out
  • 3 boxes/month - 30 day supply for a 48-hour change-out
Omnipod 5 Libre2Plus G6 Pods refill 5-pack

Omnipod 5 Libre2Plus G6 Pods (Gen 5)

NDC/NRC: 08508-3000-42
Refill 5-Packs. Prescribed and filled to patient insulin requirements:

  • 2 boxes/month - 30 day supply for a 72-hour change-out
  • 3 boxes/month - 30 day supply for a 48-hour change-out

If prior authorization is required, please work with the Prescriber to submit the Prior Authorization. Over 95% of completed Omnipod 5 Prior Authorizations are approved when submitted².

1. Reflects coverage for Omnipod 5 DexG7G6 Intro Kit and Omnipod 5 DexG7G6 Pods in commercial channel only. Majority defined as >50%. Source: Managed Markets Insights & Technology, LLC. Data as of April 2025.

2. Represents percentage of Omnipod 5 DexG7G6G6 Intro Kit claims with a 90-day look forward status of filled or reversed among claims with an initial status of Prior Authorization Required. Includes completed PAs only. Based on claims from January 2024 to December 2024. Source: IQVIA PCL

Omnipod 5 is indicated for people with type 1 diabetes, ages 2 years and older and type 2 diabetes in persons 18 years of age and older. Rx only. WARNING: Do not use SmartAdjust™ technology for people under the age of 2 or who require less than 5 U of insulin per day. Please see Omnipod.com/safety for important safety information.

INS-OHS-04-2025-00095 V3.0