In order to get the twiist pump on Medicare, first I asked my endo to complete the Formulary Exception form for my Part D Medicare insurance (Healthspring, formerly Cigna). That’s about a five page form. I filled in the parts that I could to help the process along and the endo did her parts. The endo’s office faxed the form to Express Scripts and I received a phone call 5 hours later saying it was approved! I called Sequel to order the pump and schedule the training. They told me to expect a call from a local sales rep, the pump will ship from Byram, Sequel will contact my endo to complete the order with Byram.
Since I’ve been using Omnipods on this Part D plan I will hit the Out of Pocket annual max ($2100 for 2026 calendar year?) with either Omnipod or twiist, so it looks like a zero net cost change of pumps. And not locked in I hope and able to go back to Omnipod if twiist doesn’t work out and/or if Insulet ever gets around to upgrading the pods and software (as announced in Dec. ‘25).
I have been using Dexcom CGMs for years but will need to switch because twiist pump only communicates with Eversense 365 and Libre 3 plus (15 day). My endo gave me two samples of the Libre 3 plus so I started wearing one earlier this week to test it against Dexcom G7 and fingersticks. After these two sample sensors I’ll decide between the two CGMs and get started on the twiist. (I’ve read all the bad reviews of Libre but decided to see for myself if it will be OK. If not, I’ll go to the Eversense 365 but no idea when I can schedule a sensor insertion. The nearest MD certified to insert is a 3 hour drive from me.)
As far as I can tell, both Eversense 365 and Libre 3 plus CGMs will be 100% covered as DME by Part B Medicare and my supplemental insurance.
I’m really looking forward to using the twiist, especially an actual infusion set (vs. the little doinker angled cannula on the pods) and a much better Loop software setup than the frustrating Omnipod 5. Have never used a tubed pump but hoping it’s an easy transition. Wish me luck!