Here is an email from Insulet regarding Omnipod 5 updated app and pods:
"Omnipod 5 will soon feature an enhanced algorithm including a new, lower 100 mg/dL Target Glucose, designed for more time in range.
In the next few days, your Omnipod 5 app will give you the option to install a software update. When prompted, follow the instructions on your Omnipod 5 app screen to install the update. It should only take a couple of minutes. If you experience any trouble updating the app, reference our How-to Guide.
New features require compatible Pods
Once you complete the update, and have compatible Pods, you will be able to access the new features. Pods compatible with Dexcom G6/G7 and manufactured after January 1, 2026 support the new 100 mg/dL Target Glucose setting today. The full algorithm enhancements suite is available with compatible Pods, marked with a black dot and R1 notation in the upper right corner of the Pod box or tray lid.
Compatible Pods will be in an upcoming refill
Continue getting your Pods as you do today - no new prescription is needed. Compatible Pods are shipping to pharmacies and will be included in an upcoming refill as availability broadens this summer.
Thank you so much for being a valued Podder®! We’re so excited to bring this new technology to the community.
Questions? We’re here to help!
Visit Omnipod 5 FAQs to learn more about the new update and Pod compatibility or call our Product Support team at 1-800-591-3455 Option 1.
Just found out via LnL Newsletter that Omnipod 5 should be operable via DIY Loop and Trio by the end of the summer. A new component of the software in Loop and Trio has been in the works for a while and is able to control Eros, Dash, and O5 pods. Testing is being conducted by a select group now; testing will be expanded to those using the dev version of both software packages shortly, and as long as the testing doesn’t determine something wrong, then it will widen to all comers. If you’re interested in check out Omnipod 5 — Open-Source AID.
HEY! A new box of pods I just opened allows me to set the target glucose to 100! So it looks like the rollout is already happening. I thought I’d be waiting for weeks. It seems to be working great, as far as I can tell. (I had just gotten my prescription refill last week.)
Update ref the Omnipod 5 and Loop/Trio compatibility: The AID software side has moved to wider availability! It’s been in closed testing for quite sometime and is now available to “experienced Loop and Trio users” for download and wide testing! If you’re not an experienced Loop or Trio user and ready to rebuild the AID on short notice it’s best to hold off for wider testing to be completed (a few weeks at least, the dev’s are not promising any timeline and that’s for good reasons). You can follow the progress at: Log in | Zulip on Loop ZulipChat.
my insurance is not covering this upgraded pod. They are saying it is a different product. Here we are mid year and I am being suddenly charged a $2800 copay instead of my normal $140 or so. What is happening? Can they suddenly do this without ever notifying me? I found out when I went to pick up my prescription
Yeah, insurance is tricky and it bites us in the bum with monotonous regularity. Many of us have lots of experience with this kind of stuff, well, most of those of us who are in the US. I’ll just make general comments because the truth, such as it is, depends on each of our circumstances:
I believe they can change the forumlary, so change whether Omnipod is allowed or not, mid-year. It’s kinda extreme; maybe @mohe0001 might comment?
The “new” O5 isn’t a new product as such, not like the O4 (Dash) pods vs the O5 (pods with integrated AIDS). Dash and O5 are not mechanically different but they have different algos; different approaches, so they are certainly different products. The June upgrade to the O5 does not change the approach and is not, so far as I can see, optional; all O5 pods will be the new version once the change has run through the distribution network. It should still be an O5 pod, regardless of BG target.
Most likely your insurance simply changed the coverage; the “formulary”. Possibly you are on Medicare and you hit your birthday; speaking as a Medicare user of the O4 (Dash) pods my birthday is always a day on which I go out and have a stiff drink.
You do have options, though they may not manifest until December. It all depends on the type of insurance… Employer, resign and post bad reviews on FaceBook. ACA, get a new plan. Medicare, shop round, several times a year. Outside the US, write letters (not effective in the US), talk to your MP/government official and explain why an AIDS really does help T2s as much, mostly likely more, as T1s.
There are many possibilities but, alas, fewer solutions. There’s always a solution.
That is quoted from the email that Insulet sent a few months ago. They seem to say the “new upgraded” pods will be routinely included in a refill as an equivalent replacement for the old pods that you were routinely getting from your pharmacy and were covered.
Maybe your pharmacy entered something wrongly into their computer? You should ask them to double check the coverage, things don’t sound right. If they can’t solve it, maybe try a different pharmacy (Gentry mail order is very good and will give you reliable answers about coverage, 844-443-6879 )
Omnipod 5 G6 Pods (Gen 5) NDC/NRC: 08508-3000-21 | 5 Pods per box | 2 boxes | 1 Year Monthly refills | Change Pod every 72 or 48 hrs ** |
I.e. a one month supply (2 or 3 boxes, depending on how long the pod lasts).
It would be typical if either the insurance formulary has not been updated and the prescription has or vice versa…
The easy way to find out is to check the formulary online or by calling the insurer customer support, but when I was with moda they did not have Omnipod on their online formulary at all apparently because it isn’t a drug. moda customer support on the 'phone, however, were knowledgeable and professional so even though the web site was useless (it still is) the 'phone guys were great.
That’s called “non-medical switching.”
The law depends on where you live and what your policy type is.
FEDERAL LAW
If you are on a large employer plan, federal law makes the rules.
AI says this about current federal law: “There is currently no specific federal law addressing non-medical switching, which is when insurers require patients to switch medications for non-health-related reasons. However, various states have introduced legislation to protect patients from this practice.”
Bummer. I guess federal law is still on the TO DO list. A ban on Non Medical Switching has been introduced, but hasn’t passed.
Federal law over private healthcare policies is one of the last things to change. They fight like hell over that.
My policy is managed under state law. It’s a privatley held, commercial insurance plan. MN state law is as follows:
“Minnesota has implemented a law that prohibits insurers from changing drug formularies for medications a patient is currently using during the contract year, which helps protect patients from non-medical switching. This law aims to ensure continuity in prescription drug coverage and prevent negative health outcomes associated with forced medication changes.” Mid-Year Formulary Changes | Minnesota Medical Association
I don’t know what type of plan @Deb080451, there wasn’t enough information for me to even guess. @Deb080451 do you have private insurance, Medicare Part D or Medicare Advantage (Part C) with perscription drug coverage (“MA-PD”)?
For private the “map” on this page may help:
To use that map after clicking on a state you have to use the “<Back” button to return to the map, the one on the right side at the same line as the state name (have I ever talked about GUIs?) @mohe0001 the MN law isn’t there. That might be because aimedalliance has a problem with its scope or maybe aimed is just an AI like their name suggests (they do claim to be a 501(c)(3)).
For Medicare (both Part D and MA-PD) I don’t think you are correct. The Google AI does seem to suggest that mid-year swaps are possible when I ask, “Does Medicare permit non-medical switching?” however the Justice In Aging link, from 2016, that is quoted implies the opposite (by not saying it is allowed):
At this point I’m guessing we are talking private insurance, not Medicare because if it were a prescription code error the pharmacist would surely have realized and the most likely report would be that the medication was “not covered”. That said anything is possible.
@Deb080451: Did the insurance company suggest alternate treatment such as a different pump or MDI? Normally I would expect an endo to immediately file for an exception if the current therapy (including the pump) is effective.
