Maybe, depending on whether you are using a traditional insulin pump or a disposable insulin pump.  The Centers for Medicare and Medicaid Services (CMS) has recognized that some disposable insulin delivery systems may now be covered by a Medicare Part D prescription drug plan when the devices are delivering insulin directly to the body and not otherwise covered by Medicare Part B as durable medical equipment.

An example of such an insulin pump covered by Medicare Part D plans is Insulet Corporation's Omnipod® System. 

(For more information, please see diatribe.org/insulets-omnipod-now-eligible-medicare-coverage).

Non-disposable Insulin Pumps and Medicare Part B coverage.

Traditionally, Medicare Part B covered insulin pumps as durable medical equipment (DME) and the earlier CMS document, "Medicare's Coverage of Diabetes Supplies & Services" notes:

"Insulin pumps worn outside the body (external), including the insulin used with the pump, may be covered for some people with Medicare Part B who have diabetes and who meet certain conditions. Insulin pumps are considered durable medical equipment. “Durable medical equipment” is certain medical equipment ordered by your doctor for use in the home.”

The 2018CMS document also adds, "Medicare Part D covers insulin that isn't administered with an insulin pump."

"Medicare Part B covers external durable insulin pumps and the insulin that the device uses under durable medical equipment if you meet certain conditions."

Disposable Insulin Pumps and Medicare Part D coverage.

In a January 2018 memo, CMS began to expand coverage of insulin delivery systems with new guidance that noted:

"[w]e are issuing this guidance regarding Part D coverage of products used for the delivery of insulin for the treatment of diabetes. With the introduction of new insulin delivery devices to the market, questions have arisen about Part D coverage for these products. Specifically, we have been asked whether newer insulin delivery devices that are not covered under Medicare Part B meet the Part D definition of 'medical supplies associated with the injection of insulin.'"

The CMS guidance continues on to note:

"newer insulin delivery devices in the form of both mechanical and electronic insulin pumps have become available that are not coverable under the Medicare Part B durable medical equipment (DME) benefit.  Consistent with the Part D policy to allow coverage of insulin delivery devices that are 1) directly associated with delivering insulin into the body and 2) not otherwise considered DME under Part B, Part D sponsors may provide coverage of such products under Part D as 'medical supplies associated with the injection of insulin.'"

Question:  How do I find a Medicare Part D plan that covers such a disposable insulin pump?

Unfortunately, with a little bit of work.  Although insulin pumps like the Omnipod® can be prescribed by your doctor, the Medicare Plan Finder (as of 05/28/2024) does not include this insulin pump in their drug data - and so you cannot add this device to your drug list when searching for a Medicare Part D or Medicare Advantage plan.

As a note, our Medicare Part D Drug Finder (Q1Rx.com) will search for drug coverage across all Medicare Part D plans in an area alphabetically or by National Drug Code (NDC) - an 11-digit system to uniquely identify a drug.  However, at this time, although you can get a prescription for insulin pumps such as the Omnipod, there is no data or NDC for this “delivery system” included within our formulary data.  And although, like syringes used for the delivery of insulin, non-DME insulin pumps may be covered by your Medicare Part D plan, you will need to look closely in the plan's printed information or contact your plan's Member Services department to learn more about coverage and cost.

Therefore, it is a little difficult (without contacting every Medicare Part D drug plan in your area) to systematically search for a Medicare Part D plan that covers this device (see the information below for a list of Medicare Part D plans and Medicare Advantage plan covering the Omnipod.

On a positive note, the Omnipod® website provides some additional direction for finding the Part D drug plans (PDP and MAPD) that cover Omnipod and working with a Medicare Part D plan that has not yet added this device to their list of covered drugs.

"Unlike pharmaceutical products, Omnipod will not appear on Medicare's plan finder site since it is a medical device.

Have Medicare do the legwork for you

• Call 1-800-MEDICARE (1-800-633-4227) and speak with a representative [-or]
  
• Search the Medicare.gov plan finder site, using the following instructions:
  1. Make a list of your current medications other than Omnipod.
  2. You can create an account or just enter your zip code and select the plan type (e.g. Medicare Advantage).
  3. Follow the prompts to add all medications. Once all prescriptions are added other than Omnipod, click “done adding drugs”.
  4. Add pharmacy and click “done” - a list of plans will populate. 
  5. Find a plan that looks most suitable, click “plan details” to get contact information for further questions regarding Omnipod coverage."

In short, you can choose the most affordable Medicare Part D drug plan that covers all of your medications and then see if your plan is covering the disposable insulin pump.

If the Medicare plan does not cover the disposable insulin pump, but you wish to join the plan because of the other coverage benefits, then you can work with your Medicare plan through the “formulary exception” process to get a non-formulary item covered.  Asking your drug plan formulary exception means that you are asking your plan to cover a non-formulary drug usually at a fixed higher-tier price.  But, asking for a formulary exception is not always met with immediate success and coverage of the non-formulary drug.  Your plan may reject your request and you may need to appeal any negative decision through several levels.

You can read more about formulary exceptions and the appeals process here:
q1medicare.com/PartD-DrugListExceptionAppealGrievance.php
q1medicare.com/faq/what-is-a-formulary-exception/349/

Examples of Medicare drug plans covering a disposable insulin pump?

At the current time, the Omnipod® System is covered on the following Part D plans under a Tier 2, Tier 3, or Tier 4 copay benefit. These may be the most cost-effective options for your Omnipod prescription (including coverage of the Omnipod® 5 Automated Insulin Delivery System and the Omnipod DASH® Insulin Management System).

Medicare Part D and Medicare Advantage plans covering an Omnipod product

• Aetna SilverScript Plus & Platinum  (Covered, Tier 3)
• AARP MedicareRx Preferred (PDP)  (Covered, Tier 3)
• AARP Medicare Advantage plans  (Preferred, Tier 3)
• Choice
• Choice 1 & 2
• Advantage & Advantage Plan 1, 2 & 3
• Walgreens
• Secure Horizons, Secure Horizons Plan 1 & 2, Secure Horizons Focus
• Cigna- All PDP and Advantage plan offerings  (Preferred, Tier 3)
• Express Scripts Employer Retiree Medicare Advantage plans  (Preferred, Tier 2)
• Premier Access 4 Tier Standard 
  
• High Performance 3 Tier
• Premier Performance 4 Tier Standard
• Humana Advantage plans (Preferred, Tier 3)
• Gold Plus & Gold Plus SNP
• Choice PPO
  
• Community
  
• Wellcare Advantage plans (Preferred, Tier 4)
• Wellcare Medicare Part D (Tier 4)

(Reference: https://www.omnipod.com/is-omnipod-right-for-me/coverage/medicare 08/14/2024)