Omnipod® HCP:
Medicare Coverage and
Access FAQ’s

How can I/my patients find a Medicare Part D plan that covers Omnipod?

How much will my patients pay for Omnipod under Medicare Part D?

What paperwork requirements do I need to submit for my patients to get Omnipod through Medicare Part D?

What is the formulary exception/Coverage Determination process?

What is the dedicated phone line to triage patients to for Medicare support?

If you’d like more information about Medicare, please visit: 
Medicare.gov or call 1-800-MEDICARE

Ready to prescribe?

* Source: IQVIA OPCL. Majority is defined over 70%. Based on paid claims for Omnipod 5 G6 Pods and Omnipod DASH pods. Includes Medicare paid claims January 2023 through December 2023.

1. Centers for Medicare & Medicaid Services. CMS Releases 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonstration. Published July 29, 2024. Accessed Oct 5, 2024.
https://www.cms.gov/newsroom/fact-sheets/cmsreleases-2025-medicare-part-d-bid-information-and-announces-premium-stabilization-demonstration

2. Q1Medicare. The 2025 Medicare Part D Outlook. Published 2024. Accessed October 7, 2024.
https://q1medicare.com/PartD-The-2025-Medicare-Part-D-Outlook.php?utm_source=partd&utm_campaign=NavLink&utm_medium=LeftNav

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