Switch from Omnipod to Tandem Control-IQ?

Hello! I’m new to this forum and would appreciate your thoughts: I start Medicare this February, and find that setting up Part D for Omnipod is trickier than expected. How I wish Omnipod were with the tubed pumps on Part B. Many Part D carriers don’t do Omnipod DASH which I was hoping to switch to this spring, for a closed loop Omni-Dexcom G6. I’ve never used a tubed pump, but may want to try the Tandem Control-IQ because 1) it might be more straight-forward on Part B; 2) I’m developing some scar tissue from using Omni for 5 years (and infusion sets could access depths with better insulin absorption) and 3) Control-IQ is the only closed loop device that Medicare approves. Thanks for any words of encouragement for my tube-fears, for the Tandem/Dexcom G6 closed loop system, and recommendations for DME suppliers (I’ve had bad experiences with both Byram and Edgepark).
Thanks,
Nikki

Hi @NkkSF and welcome to the forum. I’ve only used tuved pumps - stains with Minimed (now Medtronic) and switching to Tandem’s TSLIM several years ago. I started using ControlIQ this fall - just a few months ago.
Don’t be scared of a tubed pump. I do admit that I occasionally shah on a doorknob if I don’t tuck myself in. Thankfully for me doing so had not pulled out my infusion set. Personally I like the tubing - without it you have to use a PDM (remote control). There are lots of users on the forum who live it and have no problems with it, but I’m scared to death I might lose mine and be up a creek without a paddle. We all have our preferences and our fears, and that’s a motivator for me but may not be for you (or certainly the many who use it. So that’s a “me” thing.
I do find the different cannula depths helpful. BTW, while Tandem had its own infusion sets which I believe are proprietary, there are various types and Angie’s of insertion devices. There’s a steel(?) needle, which I’ve never used, and ones that insert at 90 or 30 degree angles. You week probably start your selection with the depth that works better for you (if you go on the system you’ll have a rep who can help you decide), then the other options. You might see if your rep or trainer has samples you can try so you can check out ease of insertion and comfort before getting a 30 or 90 day supply.
I’ve used Edgepark for ages and only jag one problem. I think they’ve worked with every insurance plan I’ve ever had (and there have been several). What issue did you have? The one I had in my case was rather serious - someone processed something incorrectly and my doctor said Edgepark needed me to start over at Ground 0 as if I were a brand new pump user and document medical necessity, etc. I didn’t realize that was still done, and this happened in 2019!
Long story short, my doctor’s office was instrumental in getting me back. It was a huge pain and I can’t imagine how it could have happened, but once in 20+ years I decided I could live with, and everything has gone smoothly ever since. If you don’t mind my asking, what issue did you have? I’ve learned that when there is one with a provider, it’s best to let the professionals navigate it. Not a lawyer, but my doctor knows what is needed and may be the one who must provide it. I step back, give my doctor any info or records they may need, and let them do the work.
CIQ is great, but like any system it responds to what you put into it. You and your doctor will need to determine the background settings for your pump - basal rates, carb ratio, insulin duration, etc. Those are things you will need with or without CIQ, and it will involve some trial and error. Some of your settings will probably vary at different times of the day. That’s perfectly normal. And from time to time you may need to tweak them a bit as your body’s needs change. That’s normal too. Perhaps it’s because I’m old school and took injections for 30+ years before going to a pump, but personally I think it’s good to know how to use your pump manually before letting CIQ take over. You can still use your Dexcom with your pump, but you would make any adjustments on your own rather than letting CIQ adjust for highs and lows. I just find it’s good to know the basics as well as the advanced.
As I said before, CIQ relies on having good settings in place but you need to provide good carb counts when you enter your foods, and be vigilant about entering them. CIQ is not an artificial pancreas. I’ve forgotten to bolus for a meal and poor CIQ was trying to adjust but I just kept going up. Likewise if I overestimate my carbs. Although the system is slowing or stopping insulin delivery, I have had situations where it could not keep up and I dropped very low. Again that was because I overestimated my carbs somehow.
That’s to give you an overall picture, and I fear I might have intimidated you. So let me switch gears and say I find using a pump is great. Some people do fine on shots but a pump is what I needed. CIQ is a great tool and hopefully you will love it and appreciate it. There is some adjustment involved and there will be some tweaking as you establish your settings, so don’t get frustrated - it’s part of the process. You’ll work closely with your doctor or nurse educator (there’s a new term now BTW but I still use this one) as you learn to adjust, and at some point you will learn when and how to make them yourself. Eventually you’ll be throwing around terms like “basal rate,” “bolus,” “infusion set” and others, like a pro.

Thanks for your comments about CIQ, Dorie. I’ve used the Omnipod pump for 5 years, so my fears are about pump TUBING, which I’ve avoided up until now. Part D coverage/formulary questions are proving hard to resolve. For example, Express scripts doesn’t do a DASH starter kit, just pods. I might decide to try the tubed CIQ after a little more research. Part B seems more straight forward than Part D for a pump/supplies…I’m hoping to talk to a Tandem rep and someone at my endocrinologist’s office very soon.

@NkkSF Welcome Nikki, to the JDRF TypeOneNation Forum! I hope that here you will hear thoughts and tips from other people living with diabetes that might help you with your diabetes management; I’m not a licensed medical provider.

The “PODS” used with the Insulet OmniPod Systems are considered ‘pharmacy’ because they are not durable; Durable Medical Equipment [DME, covered by “Part B” of Medicare need to have a certain life duration of use. When you say that you are going on Medicare, are you beginning just with the Basic [Original] Medicare that covers only hospital, or are you buying a Medicare Advantage Plan that includes the Basic Original, plus prescription medical coverage, physician services, and a few other benefits?

I have had a Medicare Advantage Plan, “AAARP Medicare Advantage Choice” plan since I slipped into my 70s 10 years ago and have found that I’m fully covered for all my Tandem t-Slim x2 supplies and my Dexcom G6 supplies - co-pay $0.00 for three month’s supply. I’ve had excellent service with Byram [the Dexcom representative set up my account] and the online re-ordering goes on without a hitch. Last summer, Byram made refilling even easier - I receive a text from Byram, and all I need to do is enter one [appropriate] word, and my last order is duplicated without fuss.

I find that Control IQ [CIQ] is really outstanding, even beyond my highest hopes. I began using CIQ a year ago during its initial launch and have enjoyed TIR in the 90+% range since last February.

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Thanks for your replies, folks. Today I finally heard back from Omnipod about Part D coverage under Medicare --but after I pretty much decided to switch to Tandem Control IQ (covered with other tubed pumps under Part B). I say “pretty much” because I’m not looking forward to the tubing (but I want a closed loop system).

In case this Medicare Part D information might help others, the rep states: These Part D plans have Tier 3 copay level (lowest we know to be available for Omnipod supplies) and Tier 4 copay level. No auth needed for any of these plans.

UHC/AARP Medicare Advantage (1, 2, 3 Preferred). No auth needed, Tier 3 copay. Call 800-850-6807 to see if you are eligible.

UHC/AARP Medicare Advantage Choice - No auth needed, Tier 3 copay. Call 800-850-6807 to see if you are eligible.

UHC/AARP Preferred Part D plan (PDP) and Medicare Advantage Preferred - No auth needed, Tier 3 copay. Call 800-850-6807 to see if you are eligible.

Cigna Healthsprings Medicare Advantage or Part D, No auth needed, Tier 3 copay. Call 855-391-2556 to see if you are eligible.

Humana Gold, Community and Choice Medicare Advantage , No auth needed, Tier 3 copay. Call 888-347-0092 to see if you are eligible.

Tier 4 Copay level plans:
Envision/Elixir PDP, No Auth needed, Tier 4 copay. Call 866-250-2005 to see if you are eligible.

PS I learned that there’s no starter kit for DASH because Omnipod sends the DASH PDM free of charge. So DASH pods are the only thing listed on formularies.

Since you’ve used pods for so long tubing may be more of an adjustment than for people who have always used other pumps, but it can be done. @Dennis shared some important info on Medicare’s plans so there may be hope. There are people on the firm who have switched from Omnipod to tube pumps and vice versa - you could search those threads, or start your own asking for experiences. Wishing you all the best.

My daughter (12 now, Dx’d at 6) recently switched from Omnipod to Tandem for the same reason: she really needs Control IQ.

Omnipod is saying Horizon/Omnipod 5 (their version of the same technology, also using Dexcom) should be out later this year. Until then, she’s dealing. And it’s fine. I’m sure it will be for you, too. :slightly_smiling_face: