I think it’s by supplemental plan preventing me from Medicare coverage. If I had the Plan D it would be covered with Medicare with a co-pay (not sure the cost). I have Plan G which is has excellent coverage for everything else except infusion pumps. Thanks CatLady for the suggestion. I guess I’ll have to wait till Oct to see if there’s a better Plan I can switch to.
Omnipod did send me a financial form and I’ll have to see what that brings. I’ll let you all know as it happens.
3 Likes
Got the prior auth approved for Dash pods via pharmacy this week. The pharmacy quoted me a $243 co-pay (20%) for TWO boxes of Dash pods (10 pods total, 30 day supply). Earlier this year I had been paying a 20% co pay amount of $221 for FOUR boxes (40 pods total, 90 day supply) of Eros pods ordered direct from Insulet. Checked with Edgepark and they quoted $248 co-pay for four boxes of pods, not bad.
Provided that Edgepark comes through and can competently process my order. I am sticking with the old Eros pods via DME until next year. Dash pods via pharmacy are exorbitantly expensive for me with this insurance plan. Fingers crossed.
1 Like
I just started using Edgepark. They are charging me $325 for 3 months of Eros pods. It took a very long time to get my first order (a couple of months) but I am hoping it will be prompt going forward.
1 Like
I am in first order purgatory with Edgepark. Getting the runaround (2 weeks ago they told me they have everything they need to process the order, today they said they faxed a request for clinical notes to my Dr. on July 2). Edgepark also tells me I will have zero co pay which does not make sense to me, seems like I will be hit with a sizeable co pay when the order ships.
As luck would have it I got a new prior auth approved by insurer: 15 Dash pods for 30 days, pharmacy co pay is $152 for the 15 pods. That is roughly 150% of the co pay I used to pay when ordering direct from Insulet…which I can no longer do thanks to the network change. I am giving up on the Eros pods via Edgepark/DME and go with the Dash.
3 Likes
Ouch. We are currently dealing in Dexcom hell since they stopped selling directly. Now we are dealing with Byram that hasn’t managed to ship in three weeks now, but can’t quite tell us why not.
3 Likes
Same for me, it took about a month to get my first 3-month order. I was charged $325 co-pay. Less than what Insulet charged but still not insignificant!
I submitted a prescription order for the Eros pods to Express Scripts via pharmacy benefits, shipped directly to my home. It took about a week or so to get everything setup and I just received my first 3-month supply today, co-pay is only $20! I have yet to confirm they are indeed the EROS pods, but my pod expires today so I will confirm.
SO, don’t give up on EROS, try Express Scripts!!! I HAVE to use EROS for Loop, so would not switch in any case to DASH!
@Chris I also use Express Scripts for Dexcom. So far pretty good. I think sensors are $100 co-pay.
2 Likes
Now my head is spinning…with my insurance Eros pods are only covered as DME and Dash pods are only covered as pharmacy benefit. Anyway, I am figuring Dash pods as pharmacy benefit will be easier to get next year when I start Medicare so am OK with going that route. Especially if Omnipod Horizon uses the Dash pods, will make for a seamless transition.
1 Like
I think you can get the Eros pods via pharmacy benefits, and it is much cheaper, at least for me.
Others have told me they also get Eros from ExpressScripts via pharmacy benefits. You’ll have to have your Dr write a prescription for them which ExpressScripts will request on your behalf if you provide your Dr phone number. Mine was processed same day.
I thought I had received my pods today, but on opening the box, they were Dex sensors. I should be receiving the pods soon, so I’ll update you again.
1 Like
Chris. I also have been going through it between Omnipod not mailing it directly. And on top of that I’ve gone on Medicare which I can not find a DME company that provides Omnipod Dash.
2 Likes
I agree. May I ask, what is the Eros pods? Do they work with the Dash?
I did find out the my Medicare will cover the Omnipod pods, but haven’t found a DME company that deals with it?
1 Like
The Eros pods are the original Omnipod, they work with the old style push button PDM controller. They also work with Loop software that some people add to their iPhones. The Dash pods are the newer version that needs a new Dash PDM controller, looks like a stripped down Samsung phone. They will not work with the old push button PDM.
The way it worked out for me, I gave up on getting Eros pods from a DME supplier and obtained Dash pods from pharmacy. Insulet sent a free Dash PDM controller after I picked up my first order of Dash pods at the pharmacy. So as soon as I use up my remaining Eros pods I will start up the Dash pods.
2 Likes
Thanks for the info.
1 Like
moda covers dash pods as a prescription benefit. Based on many, many calls with them I believe that if the doc writes a prescription they will handle it as a prescription. moda are also the out-and-out winner for T1D coverage in Oregon, at least at the south end of Oregon. Their HSA HDCP plan is to die for, well, maybe that is a bad choice of words, but I know exactly what I will pay; the premium plus the out-of-pocket max.
Open enrollment runs through August 15 in Oregon. I don’t know how that applies to people who already have 2021 coverage.
2 Likes
I want my ACA plan. Hum, let me be clear; I WANT MY ACA PLAN. Modern communication skills… I still have 1,365 days to go, but the curious idea of going bankrupt for my country doesn’t appeal to me.
It really does matter what kind of insurance plans you have. Before Medicare on my insurance I paid $0 for anything DME and my pods were classed as DME and completely free. On Medicare my eros pods are covered only by pharmacy benefits per Medicare and my prior insurance is now a supplemental to medicare and controls my costs. So now I pay $40 for whatever amount I need for a 90 day supply and they come from OptumRx.
2 Likes
I’m in Canada in Alberta. Sensors and transmitters are now available through a pharmacy. The transmitters have also come down a lot in price, only about $65 each at Safeway pharmacy. It’s so strange that some in the USA have trouble finding out where they can purchase the Dexcom sensors and transmitters. Seems to have ben streamlined better here in Canada. So sorry for the trouble you’re having. 
@Shecamp How much does a box of 3 G6 sensors cost you at Safeway?
Are you in Edmonton or Grand Prairie? I’ve never seen any Dexcom products at my Safeway in Calgary 
1 Like
I do have some receipts, posted one a while ago. Think the sensors are $299/pack of 3.
But the transmitters are approximately $65 each.
I’ll try and find the receipt on here that I posted but it was back in June 2022.
1 Like
I am in Edmonton.
1 Like
Edmonton.
1 Like