Insulet started a limited market release in the United States on the day of its FDA clearance announcement. That involves a group of preselected individuals — beta testers, if you will — who get first dibs on the new Omnipod 5. Insulet plans to learn what it can from those early adopters, and integrate their learnings into training processes and customer service protocols for the broader rollout around the country.
While there’s no word on how long this initial limited launch will last, Insulet’s CEO said during the February 2021 investor call that it had expected to be in limited launch mode for most of the year if they got FDA clearance in the first half of the year. If that still applies, we could see a broader rollout of Omnipod 5 toward the end of 2022 or even early 2023.
Insulet will offer an upgrade program called OmnipodPromise, which allows new and existing customers to start on the Omnipod DASH and then upgrade to Omnipod 5 at no additional cost once insurance coverage is available.
Only sold at pharmacies
You’ll buy the Omnipod 5 directly through the pharmacy, as it’s not covered as DME the way most other expensive diabetes technology is generally categorized. The good news is that for many people, using their pharmacy benefit coverage rather than relying on DME is a plus, since DME often brings higher deductibles and coinsurance costs.
Yet, this could prove to be problematic, as not all insurers are willing to cover insulin pumps — even the Omnipod patch pump — as a pharmacy benefit. They insist on DME coverage, and that may mean that some will not have access if Insulet isn’t able to secure DME channel coverage.
“My insurance won’t cover Omnipod through pharmacy,” T1D Jill Lockhard in Arkansas told DiabetesMine. “I wasn’t able to upgrade to the DASH because of this. I badly need the Omnipod 5! My A1C hasn’t been the best the last 2 years due to the stress of working on the frontline with COVID.”
Others in the online community echoed these concerns, pointing out their disappointment that Insulet isn’t acknowledging the insurance reality for many people. Insulet responds that it will work with diabetes care teams on insurance appeals, but that isn’t good enough for those who’ve found insurance barriers on pharmacy coverage.
“Hoping this will medically bill as DME because we do not have pharmacy coverage,” Kansas D-Mom Janalin Hood told Insulet in an online comment. “I cannot stand to think of bearing full cost of our favorite pump, or more likely being forced to switch to a tubed pump for our son.”
Another interesting point: Some in the online community note how the Omnipod 5 name could cause some confusion in the pharmacy channel, given that all Pods come in 5-packs.
When asking about the new closed loop system, pharmacists and insurance companies who aren’t familiar with the technology could mistake that for Omnipod DASH 5-packs. That means it may require more attention when placing an Omnipod 5 order to ensure the correct product is being requested.
This content was originally published here.