“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.” And 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."
"[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.'"
"Unlike pharmaceutical products, Omnipod will not appear on Medicare's plan finder site since it is a medical device."At the current time, the Omnipod® System is covered on the following Part D plans under a Tier 3 and Tier 4 copay benefit. These may be the most cost-effective options for your Omnipod prescription
Part D coverage for Omnipod® 5 Automated Insulin Delivery System:
- Cigna- All PDP and Advantage plan offerings (Preferred-Tier 3)
- Humana Gold, Community, and Choice Advantage Plans (Preferred-Tier 3)
- Aetna SilverScriptPlus (Preferred-Tier 3)
- Elixir- All plan offerings (Non-Preferred-Tier 4)
- Wellcare- All PDP and Advantage plan offerings (Non-Preferred-Tier 4)
- MedImpact Medicare (Non-Preferred-Tier 4)
Part D coverage for Omnipod DASH® Insulin Management System:
- AARP MedicareRx Preferred (PDP) and MedicareAdvantage (Preferred-Tier 3)
- AARP Medicare Advantage Plans 1, 2, 3 (Preferred-Tier 3)
- AARP Medicare Advantage Choice (Preferred-Tier 3)
- Cigna- All PDP and Advantage plan offerings (Preferred-Tier 3)
- Humana Gold, Community, and Choice Advantage Plans (Preferred-Tier 3)
- Aetna SilverScriptPlus (Preferred-Tier 3)
- Elixir- All plan offerings (Non-Preferred-Tier 4)
- Wellcare- All PDP and Advantage plan offerings (Non-Preferred-Tier 4)
- MedImpact Medicare (Non-Preferred-Tier 4)
(https://www.omnipod.com/is-omnipod-right-for-me/coverage/medicare 08/08/2023)