Omnipod Dash

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!

Hi! Not sure I understand, but is the 1.25 units supposed to be spread out through the night at a basal rate? Omnipod is not really intended for long acting insulin, but for continuous fast acting insulin throughout the day. Maybe you should give the long acting via a shot and use the pod for rest if the time. Or get a second opinion from another doc??? You could also try a small snack with protein before bed, such as a slice of Apple with peanut butter.

@suzyque I think the OP @breannamcgarvin was talking about the challenge of accurate basal Using a pen versus the pod. Not using long acting in the pod and not using long acting in addition to the pod.

Regarding that @breannamcgarvin, basal requirements change. And also 0.05 units per hour is the lowest the pod can go, but the next increment is 0.1 units per hour. Of course you can program short time durations in case your child needs a little more for a little while but you are at the lowest end. Perhaps a feedback pump such as the Tslim or Medtronic might be worth a look. Cheers good luck.

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In short, my company only approved Medtronic. We spent about 200 hours on the phone fighting to get Omnipod approved, and eventually won. When Dash came out, it was not contested. My advice - keep fighting

My son is on Omni pod. I’ve been trying to get him upgraded to the Dash and am encountering the same issue. Our insurance prescription company won’t cover it. We have been in an appeal status for months!!!