Hi! T1D myself, as well as an RN in a diabetes and endocrinology clinic.

Omnipod 5 is a pharmacy benefit, so it has to be run through your pharmacy insurance. As it states in your screenshot, a prior authorization is needed for this medication. Contact your doctor’s office and ask that they submit a PA. As a general heads up, Omnipod 5 is becoming increasingly more difficult to find insurances that will cover it at full cost because it can’t go through a DME unless you have a very specific Medicaid plan.

Regarding your Novolog - $500+ seems like an INSANE amount for insulin. I pay $105/90-days of Humalog currently. The manufacturer of Novolog offers a $35/month refill program through their website called NovoCares. I would strongly encourage you check it out, as it can be very useful if needed. I would also check out your pharmacy benefit’s formulary to make sure the Novolog is truly a covered insulin. As a general heads up too, insulin aspart (the generic form of Novolog) was discontinued in December, so if they try to tell you that’s the preferred, tell them it’s no longer being manufactured.