Apr 25, 2023
Effective March 1, 2023, WHA began covering the Omnipod DASH and the Omnipod 5 insulin management delivery systems for insulin-dependent diabetes with prior authorization through the pharmacy benefit.
The manufacturer of Omnipod Insulin Management System adjusted their payment options by only allowing this DME (durable medical equipment) product to pay under the pharmacy benefit. WHA believes in access for their members, and as such they have made operational adjustments to allow payment under the pharmacy benefit. This is unique in that insulin pumps and management delivery systems are typically covered under DME, and this is the only one WHA covers under their pharmacy benefit.
Diabetes educators or endocrinologists considering the use of this Omnipod insulin pump for a WHA member are required to submit a prior authorization (PA) request to the WHA pharmacy department. The new policy applies only to WHA members with coverage under a commercial benefit plan (not applicable to WHA Medicare enrollees).
Contact your Amwins Connect Regional Sales Manager for more information.
