Omnipod coverage and United Healthcare


(srscott12) #1

Has anyone else had recent issues with United Healthcare covering Omnipod pod supplies? I’ve worn the Omnipod for 7 of the 8 years I’ve been diagnosed, and it works so well for me. I can no longer get pharmacy coverage and pay the copay for pods, as they’re now considered “non-formulary”. DME costs are outrageous through my insurance (paying $500 or more for a couple boxes of pods).

I know that UHC has Medtronic as it’s preferred pump (another issue entirely for the T1D community), but has anyone had success staying on Omnipod with UHC as an adult patient? I’ve contacted my local Omnipod rep, Insulet corporation, and spoken with many people at UHC, as well as my doctor’s office - feels like I’m running out of options and will be forced to switch to shots or a different pump soon.

I appreciate any suggestions or tips others have had success with navigating the insurance nightmares.


(Dennis J. Dacey, PwD) #2

Hi @srscott12,
I don’t use Omnipod so I can’t directly give you a boost, yet I know many people here have success having that device covered by insurance.

Your DME comment hits the nail on the head - maybe United Health is taking that stance. For instance Medicare can NOT make any reimbursement to beneficiaries for expenses relating to Omnipod because it is a “throw-away” and not durable. Durable must last some length of time.


(Janice) #3

I am having the same problem with Humana, my old co-pay was $291 for 90 days, Humana’s was $621, got a e-mail from Humana today after I questioned my new co-pay is was the $1400 I had to be used for other meds, before I reach the do-nut hole and an additional $562 in cash, their reply was that my new co-pay for 90 days was $1500 and they have made it impossible for any Humana members to get their supplies from any one else, unless you pay cash and don’t use your ins…You can order them from Insulet Corp for $900 for a 90 day supply. Looking for a new Ins. co. Let me know if you get any great leads. Thanks jan


(Joy) #4

Hi Dennis,

If you’re on Medicare, you can now get Omnipod coverage–at least in NY state-- under your Part D plan (assuming you’re not on an advantage plan). Somewhat helpful, but not cheap…about $600 for a 90 day supply as a tier 4 drug. According to the Insulet people, the company is working on getting the category reduced to a tier 3 drug with the hope and that process will begin to roll out in 2019.


(jdsnyc1421) #5

Hello, After reading your e-mail I called UHC directly. My insurance has just changed to UHC, and I am a current Omnipod user. I was told by UHC the same information that you were given. They told me that being a current user of Omnipod, they would cover the supplies. However, If my pump itself broke, I would not be eligable for a new Omnipod Pump. I would have to switch over to ‘Medtronic’, the preferred brand. UHC also told me that I would need to order my Omnipod supplies from a 3rd party vendor.
After this conversation, I called Insulet Omnipod directly, and was given very different informaton. According to Insulet, as of April 2018, Omnipod was now contractred by UHC, and all supplies were covered as well. No 3rd party needed; all supplies could be ordered directly through Omnipod. As well, any future pump itself, would be covered as well through UHC.
I am hoping Omnipod is correct in there information. However, I will not be sure till my next shipment is processed. This won’t occur till next month. So, I can’t be definitive as to what is true, and was is not. But I would suggest calling Insulet directly
Hope this helps. Please update with any further information you may find out. I’ll do the same. Good Luck,
john


(Dennis J. Dacey, PwD) #6

Hi @jdsnyc1421, to me it is kind of obvious that the UNH person was reading from a script - actually the incorrect script for your situation. When UNC said “when your pump breaks” not realizing that OmniPod is a throwaway for short-term use and not durable medical equipment [DME].
Hopefully your formulary exception will last a long time, but with my UNH experience I would not be surprised if it expires at the end of the year. If you are “insured” under an employer self-insured plan that uses UNH as “frontman”, your company risk manager could tell United to continue your OmniPod usage. - Good luck.