Summary: You’ll often pay much less getting your Omnipod Dash pods and G6 CGM sensors from the pharmacy.
Details: Just had a good news experience on some diabetic supplies, and wanted to share it with you.
Up until now, we’ve been getting my daughter’s Omnipod Dash pods directly from Insulet. We first had to pay our deductible ($4,000), and then our insurance covered 20% after that. The pods are over $250 per month. We thought we’d always meet the deductible every year, and considered that the cost of diabetes.
I just switched jobs. My insurance carrier is the same - UHC PPO. Still has a $4K deductible. Same website, etc. Appears identical. However, my new plan has better pharmacy benefits. For some reason, we pay $10 per prescription, even before meeting the deductible. So we pay $10 for insulin vials, pens, pen needles, even G6 sensors, etc (previously, we paid 100% for G6 sensors from CVS before deductible, but strangely, 0% after meeting deductible). But I was not aware we could get Omnipods from CVS. I had Insulet quotes us the price with new insurance, and it was the same — meet the deductible first, then we pay a cost-sharing amount.
After a little research, I learned you can now get pods from the pharmacy (CVS, etc). I had my daughter’s doctor send in a script for Omnipods to CVS, and CVS is filling it — for $10/month! It was so easy and simple.
Another benefit of using pharmacy: CVS instantly quotes you a price, and you pay it at the register, and you’re done. No waiting nervously for the invoice to arrive, hoping insurance paid the right amount. CVS’s system communicates instantly with my insurance company, giving me full price transparency, and instant knowledge as to whether an item is covered or not.
We now get literally all of my daughter’s diabetic supplies from CVS, and are paying $10 per prescription, no matter the item. This is unique to our insurance plan, but I was lucky to find out the DME vs. pharmacy cost difference. Had we just continued to get pods directly from the maker, basically as a DME (Durable Medical Equipment) provider, we’d be on the hook for over $3,000 per year. Always try to get supplies from the pharmacy!