Does anyone have experience getting their prescription insurance company to approve the Omnipod Dash for their child? (Through an appeal process if it’s not currently an “approved prescription” covered under their prescription plan?
Since the Dash only came out recently (April 2019 to my understanding) I’m told that it’s not included in many prescription insurance company’s covered list as of right now, but that they typically update their formularies every January/February. We are gathering all of our documents to submit for an appeal, since our 7 year old son is on what the endo calls a “baby dose” of long acting insulin (only 1.25 units a night) and the Dash is the only tubeless option that can be programmed this low. Unfortunately at 1.0 units of Basaglar a night his glucose levels increase about 50 through the night, and at 1.25 units of Basaglar our Dexcom alerts go off for dropping below 90 from 2-3 times a night, so we are exhausted from having to give him 3-4 oz milk 2-3 times a night to keep him in the 90-160 range and avoid him going hypo.
Our medical plan covers the original Omnipod, but unfortunately it won’t work for us since the basal rate can’t be programmed to our low needs.
If anyone else has had this challenge with their insurance company, and was able to convince them it was medically necessary and covered it as a result of filing an appeal, I’d really appreciate any tips!