Sen. Carri Hicks holds study on Medicaid coverage for Omnipod insulin pumps

OKLAHOMA CITY – The Senate Retirement and Insurance Committee held an interim study Monday requested by Sen. Carri Hicks to examine adding Omnipod insulin pump coverage for state Medicaid patients. Omnipod is a newer type of pump, easier to use, and is credited with better health outcomes. Hicks, D-Oklahoma City, is co-chair of the Legislative Diabetes Caucus, and the mother of a child with Type 1 diabetes. She said her son’s health and quality of life have improved with the Omnipod device, which is covered by their family’s insurance. But Oklahomans on Medicaid do not currently have that option, even though 45 other states cover this product for Medicaid patients.

“Oklahoma continues to be the only one in our regional pool who is not adding some form of coverage for the Omnipod. That means folks here have fewer choices to manage their health conditions,” Hicks said. “But it’s important to point out patients who use this newer technology are seeing better health outcomes. That means fewer doctors’ visits, fewer hospitalizations, and fewer complications, like amputations and blindness. Prevention is better than paying for those complications at the back end. This is a benefit Oklahoma should cover.”

Amber Clour has lived with Type 1 diabetes for 40 years. She is the founder of the Diabetes Daily Grind website and host of the Real Life Diabetes podcast. When she was on Medicaid, she was unable to get coverage for Omnipod, but after she was able to return to private insurance, she began using the device. Clour told the committee she’s gone from being in a healthy glucose range 37% of the time to being in that range 88% of the time. The Omnipod, paired with a continuous glucose monitor attached to her arm, automatically reads her numbers and provides dosages as needed, meaning she sleeps more at night and stays healthier. “Every person living with diabetes should have the opportunity to have the health care they need,” Clour said. “I think it is important to point out Omnipod is the only insulin pump therapy not covered by Medicaid in Oklahoma.”

Ryan Bucalo, Director of National Accounts-Medicaid, for Insulet, which makes Omnipod, presented data to the committee showing that Omnipod system users experienced a 70% decrease in costly hospitalizations and emergency department visits, actually reducing the cost for health plans.

“We also heard from another advocate and mom of two children with diabetes who talked about how a visit to grandparents ended up in a medical emergency because the grandparents had difficulty with the older types of insulin pumps – something that isn’t an issue with Omnipod,” Hicks said.

A spokesperson for the Oklahoma Health Care Authority (OHCA) said they would need a dedicated funding stream in order to cover the device. While a higher upfront cost is cited as the reason, Hicks countered that the cost is actually negligible due to improved outcomes. Negotiations on coverage begin Oct. 1.

“Key stakeholders were in the room for this hearing, and I’m hopeful as the negotiations move forward, we can get coverage without legislative action,” Hicks said. “If not, we will be looking forward to filing legislation, elevating the conversation around this innovative health technology to make sure Oklahomans can access this product.”   

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For more information, contact:  Sen. Carri Hicks at 405-521-5543 or Carri.Hicks@oksenate.gov.