Military family members who are Type 1 diabetics can now get Tricare coverage for the Omnipod 5 insulin pump, Defense Health Agency officials announced.
Beneficiaries must have pre-authorization from their primary care manager for the Omnipod 5, including the initial kit. The device is covered under the Tricare pharmacy benefit as of Feb. 15. The Omnipod 5 is available only through Tricare retail pharmacies, not through Tricare Pharmacy Home Delivery or military pharmacies at this time, officials said.
“It’s great news,” said Eileen Huck, senior deputy director of government relations for the National Military Family Association. “It’s frustrating it took so long,” she said, adding that she’s heard from military families who are grateful that they have been able to use this benefit since Feb. 15.
The device’s controller continually adjusts and administers insulin as required through pods that are worn as a patch on the body. This newest version of the Omnipod communicates directly with the continuous glucose monitor.
The Food and Drug Administration approved the Omnipod 5 in January 2022. The Department of Defense Pharmacy and Therapeutics Committee reviewed the Omnipod 5 at its November meeting and added it to the uniform formulary available at all Tricare retail pharmacies.
If a family is using a nonnetwork pharmacy, they’ll be charged full price for the device up front, and must file a claim with Tricare for reimbursement.
One Navy wife told Military Times her family saw a dramatic improvement in their ability to manage their 7-year-old daughter’s diabetes while using the Omnipod 5, which they had been paying for out of pocket.
The family paid $635 for the starter kit., They received pre-authorization for the pod refills in May 2022, but were later told by Tricare that the pod refills were no longer covered, despite the prior authorization.
Rather than revert to their previous system, which didn’t include the technology for the controller to communicate with the glucose monitor, they paid out of pocket, racking up about $2,500 in costs by the end of September. They were paying $280 for five refill pods in September, and the pods need to be changed every 48 hours.
According to the Tricare Formulary search tool, non-active duty beneficiaries pay $38 for 15 refill pods per 30 days.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.