Whys doesn’t Medicare cover the OmniPod tubeless insulin pump? I sure wish it was covered.
Medicare has their own formula for calculating what is medically necessary for medical devices, which they classify as “Durable Medical Equipment” also known as DME.
Insulin pumps and blood glucose meters are classified as medically necessary under the Medicare DME coverage. Medication like insulin for an insulin pump, is also considered medically necessary.
The issue with the OmniPod coverage under the Medicare classification, is how the OmniPod device delivers the medically necessary part, which is the case is the insulin.
Medicare covers other insulin pumps that use infusion sets because the insulin pump itself is classified as a device which is necessary in delivering the insulin. By definition insulin pumps that require tubing to deliver the insulin is medically necessary and is covered under Medicare benefits.
Medicare does not cover the OmniPod system because they view the OmniPod system as being two separate items; the tubeless insulin pods and the Personal Diabetes Manager (PDM). Although the insulin is considered medically necessary, the tubeless insulin pods that delivers the insulin is disposable, which disqualifies it as being medically necessary.
The Personal Diabetes Manager (PDM) is also disqualified as a medically necessary device because it does not deliver the insulin which medicare classifies as not being medically necessary.
I believe everyone should have a choice on how to best manage their diabetes. This includes the medical devices they choose for better diabetes mangement and outcomes.
Medicare covers insulin pumps because it offers tighter control and benefits people living with diabetes. This includes both Type 1’s and Type 2’s. From a fiscal perspective, healthcare cost can be expected to go down. Especially, for people who experience hypos and find themselves in the ER. Most people who have fluctuating blood sugars and who are hypoglycemia unaware do benefit form using an insulin pump. Other long terms insurance cost savings for Medicare come from impeding or preventing complications by using an insulin pump.
I found a petition online requesting Medicare to approve the OmniPod insulin pump. You can add your name to the petition for coverage and pass it on to your social network.
Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professionals therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.
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Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview now Diabetes Health magazine.
Nadia holds 11 nominations for her work as a diabetes advocate.
Her passion for working in the diabetes community stemmed from her personal loss. She has used her experience as a caretaker to forge a career in helping others.