Family members of military personnel who have Type 1 diabetes can now obtain 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 starter kit. The device is covered by the Tricare pharmacy benefit from February 15th. The Omnipod 5 is only available at Tricare retail pharmacies, not 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 that it took so long,” she said, adding that she has heard from military families who are grateful to be able to use this benefit since Feb. 15.
The device’s controller continuously adjusts and delivers insulin as needed through capsules that are worn as a patch on the body. This latest 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 household is using an out-of-network pharmacy, they will be charged the full price of the device in advance and must file a claim with Tricare for reimbursement.
A Navy wife told the Military Times that 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 paid for out of pocket.
The family paid $635 for the starter kit. They received a pre-authorization for the capsule refills in May 2022, but were later informed by Tricare that the capsule refills were no longer covered despite the prior authorization.
Instead of going back to their previous system, which didn’t include the technology for the controller to communicate with the glucose monitor, they paid out of pocket, accumulating 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 research tool, non-active beneficiaries pay $38 for 15 refill capsules every 30 days.
Karen has covered military families, quality of life, and consumer issues for the Military Times for more than 30 years and co-authored a chapter on media coverage of military families in the book “A Battle Plan to Support Military Families.” She previously worked for newspapers in Guam, Norfolk, Jacksonville, Florida, and Athens, Georgia.