Welcome charity2301!
Check with your insurance company whether they cover the pod as a pharmacy benefit. So far as I can tell all the US insurers are swapping to the pharmacy benefit, not just for the Dash pods but also for the previous, UST400 pods. (A couple of months ago I received two five packs of UST400 pods from Walgreens and only realized when I pulled the backing off the package of a pod and saw the canula cover had reverted from blue to clear!)
Now the pharmacy benefit may pay higher or lower than the DME benefit; you find that out from your plan details. Remember it is open enrollment period the time when you consider changing your insurance policy; do this every year.
When I choose my plan I only consider plans that pay 0% of anything, because only those plans allow me to pay my medical cost from pre-tax income. Doing this reduces my costs by the tax I would otherwise pay on $6000. As a result I don’t care much about DME vs prescription but I do hate Edgepark and Walgreens is OK; for example they admitted the wrong-pod mistake instantly and it only took three phone calls after that to get the replacement Dash pods.
Your plan controls what you do next. Even if you are on an employer plan you need to look at the potential benefit of swapping to an ACA plan but bear in mind that employer plans seem to have been in a constant flux and may change substantially this year.
I assume you are below the out-of-pocket maximum[1] (OOPMax) though, because your plan is paying something. So you must have some kind of plan which is at least ‘silver’; the deductible[2] and the OOPMax are not the same as they are in the bronze plan that I buy.
Consequently you do need to consider all the numbers. This is the standard insurance thing; you need to calculate the total for your covered medical expenses over the year and see where this puts you in the range between the plan deductible and the plan OOPMax.
I the actual cost of a one month supply of pods is somewhere between $300 and $350[3]. The price Walgreens tells me it charges moda for a one month supply of Dash pods is $617.99. The price I was paying Edgepark earlier this year for one month of UST400 (not Dash) pods was $531.15; Edgepark billed $1312.66, but $531.15 is the “negotiated” price that I paid, moda paid nothing.
So for me the DME and pharmacy benefit costs are the same; Dash pods cost more than UST400 because they include the cost of the PDM, about $1000 per year. It doesn’t matter how I get my supply.
It’s not directly relevant to the question you asked, but notice that the price I pay is about twice the Insulet cost. This seems to be true for everything I get through moda; the insurance company doubles the price so that I pay the full cost plus a top-up for the insurance premium. My OOPMax is $6000 so I actually pay an extra $3000 to moda over the year. If you get a “silver” plan you pay the extra up front, so silver and higher plans typically don’t make any sense; you pay the same, or more, if you hit the OOPMax and you pay a lot more if you don’t.
[1] Out-of-pocket maximum, or OOPMax; the total amount you pay in a year before the insurance triggers and pays everything for the remainder of the year. OOPMax is basically the amount you are responsible for; it is the same as the deductible on car insurance except that you only pay the OOPMax once a year.
[2] Deductible; not the same as the deductible on car insurance. When you have paid this amount the insurance company starts reducing the price you pay. The OOPMax still controls the total you pay, the deductible means that you reach OOPMax slower so at the end of the year you may find you have met the deductible but the OOPMax. If you meet both you need a plan with a lower deductible; it will cost less, if you don’t you need to do the math.
[3] The actual cost is what the manufacturer would retail price the product at if sold directly; it’s the same as the price paid in other countries either by the government or the consumer. It’s a while since I bought pods directly from Insulet so the number I gave is pretty much a guess. Perhaps someone who is currently supplied directly could fill in the prices? See this link to a diatribe article from 2013 and search for “price”.