Page 21 - MarinerMagazine_23Spring

TRICARE

Omnipod 5 Insulin Delivery Device

Talking Points

Background
The Omnipod 5 insulin delivery device, including the ini-
tial kit, is now covered under the TRICARE Pharmacy
Program with pre-authorization for Type 1 diabetics. The
Omnipod 5 must be filled through a retail pharmacy only
and isn’t available via military pharmacy or home delivery.

Beneficiaries who choose to pick up the device at a retail
pharmacy will be charged at the brand-name formulary
copayment for each component. If they choose to use a
non-network pharmacy for their device, they will have to
pay the full price of the device up front and file a claim
for reimbursement. Reimbursement may be subject to a n Beneficiaries can use the Omnipod 5 with or with-
deductible or applicable cost-shares. out a continuous glucose monitor (CGM). However,
if they want to take advantage of automated insulin
Talking Points: delivery, they can sync the Omnipod 5 with a com-
n Beginning Feb. 15, 2023, the TRICARE Pharmacy patible CGM.
Program covers the Omnipod 5 insulin delivery n The TRICARE pharmacy benefit covers three
device with prior authorization. CGMs: the Dexcom G6 and the Freestyle Libre
versions 2 and 3.
n The Omnipod 5 is available through the TRICARE
retail pharmacy network. It isn’t available through n Beneficiaries should contact their pharmacy to con-
TRICARE Pharmacy Home Delivery or at military firm availability of the Omnipod 5. They can also use
pharmacies. the Formulary Search Tool at www.esrx.com/tform.
n Network pharmacies will charge the brand-name
formulary copayment. For more information on n Beneficiaries enrolled in the US Family Health Plan
pharmacy copayments, visit www.tricare.mil/ (USFHP) must use USFHP pharmacy providers
pharmacy. and aren’t eligible for the TRICARE Pharmacy
n If beneficiaries choose a non-network phar- Program. To learn more, visit www.usfhp.com or call
macy to pick up their device, they’ll have to pay 1-800-748-7347.
the full price of the device and file a claim for
reimbursement. Reimbursements are subject to n The Omnipod 5 System is a tubeless, automated
deductible and applicable cost-shares. insulin delivery system.
n According to the Omnipod 5’s marketing
n Beneficiaries must have pre-authorization approval website, it requires no multiple daily injections,
to get the Omnipod 5. They should talk to their limited fingersticks, and is fully controlled by a
primary care manager about how to get pre-authori- compatible personal smartphone.
zation, or visit www.tricare.mil (https://tricare.mil/ n Omnipod 5 is the first tubeless insulin deliv-
CoveredServices/Pharmacy/ManageScripts/Refills/ ery device that fully integrates with a CGMS
PreAuth) for more information. approved by the Food and Drug Administration.

The Naval Enlisted Reserve Association 21

5/18/23 3:15 PM
Mariner Spring 2023 Volume 66 Issue 051823.indd 21
Mariner Spring 2023 Volume 66 Issue 051823.indd 21 5/18/23 3:15 PM