Replacement Insulin Pump or replacement Personal Diabetes Manager (PDM) for Omnipod systems may be considered medically necessary for following indications:
- Insulin infusion pumps that are out of warranty, are malfunctioning and cannot be repaired.
- Replacement of an external insulin pump may be medically necessary for individuals who require the closed loop insulin pump system.
Replacement Pump or replacement PDM for Omnipod systems would be considered not medically necessary for a functioning insulin pump with an insulin pump with wireless communication to a glucose monitor or with a functioning PDM for Omnipod systems.
Omnipod® and Omnipod Dash™, programmable disposable external insulin delivery system may be considered medically necessary in children and adults with type 1 or type 2 diabetes.
Members who received the Omnipod Auero’s PDM and supplies between the dates April 1, 2019 and March 31, 2020 and were unable to obtain the DASH Omnipod system through the pharmacy in that timeframe may be eligible for benefits.
Replacing or upgrading an insulin pump or PDM due to individual convenience or newer technology when the current insulin pump or PDM remains functional would be considered not medically necessary.