Found this regarding the upgraded G7 BT software/firmware/hardware: David Ahn, MD on Instagram
It seems the upgrade is due to a requirement by Tandem to serve as an iCGM with their pump, but may benefit us all. The video at the link shows the difference in an underlined reference number to tell which G7’s are upgraded. If the guy is right, it will raise the confusion factor until the switchover is complete, if then! Also if the guy is right, the upgrade will be available in the DME channel first, followed by other channels (if the earnings call info is correct and doesn’t change) by Jan 1, 2024.
So I checked my G7 and it has the underlined sentence. Yay!
T1D 53 yrs - my goodness. Think T1D products might be just a little to profitable to develop a cure!
Sorry to bring this discussion back on topic, but I picked up my OmniPod refills Monday, and my co-pay is now $415. So, from $300 to $525 to $415 for a 90 day supply, in one year. Does anyone have any idea what my next refill will cost? I’m on Medicare/Kaiser Senior Advantage. Does Kaiser just make these co-pays up as they go along? My wife told me to pay whatever it costs to prevent late night paramedic visits (I had 2 before OmniPod) or find somewhere else to live! Guess I’m stuck now.
So true!!! I’ve been fighting it for 38yrs now and now that I’m on a pump , I think I’m winning??? Not sure though?? I know my life is easier with it, I don’t have to take 5-6 shots a day. I wish you the best, and if you’re in Canada you can keep all the cold weather there
not sure if this will help, but my copays vary significantly if my prior authorization forms are not up to date, or when i switch from dexcom g6 to g7, etc…might want to discuss with the pharmacy or drs office, but most likely both…the pharmacy is usually easier to speak to someone, but the prior authorisations can greatly affect your prices…
Yes, insofar as the prices in the US are arbitrary. You seem to be transitioning from $100/month to $150/month, but pretty much the way the system works is we get to pay the max permitted for any prescription until the insurance kicks in (“we meet our deductible”, but it’s no longer that) then then insurance pays for it.
It is apparently worse after 65 - I’ve still got a year of bliss (or, at least, understanding) before I go through that transition. The MediCare Parts mean that multiple organizations are in competition to not pay for our health care costs; ideally the commercial ones shunt it back to the CMS.
So far as I have been able to work out so far (and I have a year to go, so I’m pretty laid back ATM) the O5 is a purely prescription benefit and so long as it can be kept that way (like covered under the prescription benefit company) costs will be subject to the prescription benefit max.
2023 (this year): budget $7400 for “prescriptions”, including Omnipod, insulin, and, if you care careful, CGM
2024: you will need $8000
These figures are over-and-above everything else you pay. What this means is that at present Medicare is worse than the ACA for payments in addition to the insurance premium but, for those people who are eligible, it’s way, way better than on the premium (my premium next year is pretty much $12,000).
Just picked up my Omnipod refill, and my co-pay is back to $300. Wonder what it will be next time. $525? $415? Some other totally random amount?
Yeah yeah - I know - insurance/medicare/etc/etc.
The donut hole deal has a large impact. Last year they had a new law that insulin cost must be capped at $35.00 a month. But what wasn’t clear was that the whole cost of insulin paid by you AND your insurance counts against the donut hole.
With pods being pharmacy instead of durable medical, they also count against the donut hole. So if all your meds and insulin and pods are above around $3500, including your insurance contracted amount, part or all of your subsequent orders are in the hole. This means you pay 25% of the entire cost of the pods, but not the insulin. You are capped at $35 a month on insulin, but anything else.
When I went from Medtronic, with DME supplies to OmniPod 5, with pharmacy coverage, my donut hole got was reached more quickly. But I didn’t have to pay 25% of full cost of insulin, just the pods. I wish Omnipod was DME because DME does not count against the donut hole, just Rx.
So with the new year, your copay is back to $300.00. Was the $450.00 charge in 2024? If so, you may have a $150.00 deductible to pay on your first order of the year in addition to your copay.
So Medicare prescription coverage is a three part thing; first we get whatever the rate is from our insurance (Part D I think) then we drop into the hole and pay 25% of the retail (inflated) price then we pay nothing. The latter happens when we reach the “catastrophic” limit, but it’s larger than the ACA “out-of-pocket” limit and, unlike the ACA, only includes “covered drugs”; prescriptions.
With the ACA I budget for the OOP limit plus my premiums; so last year I spent $10,620 on health insurance premiums plus somewhat less than the largest permitted OOP limit ($9100) because I chose my health plan carefully. I also got a refundable tax credit on the money I spent of around $7200 (about what I actually paid for the OOP).
What this means is that from late in 2022 I knew exactly what I had to have in my pocket to stay alive; about $19,000.
It’s becoming more and more clear to me that MediCare is a lot less certain. It might be cheaper but then again it might not. The reduction in premiums is significant but the prescription costs I would have to pay in 2023, $7,400, matches the total costs I did pay in 2023 (after the premium). MediCare is much more complicated.
One thing that is probably still true; go for the cheapest Part D with the highest deductible and budget for the catastrophic.
