Omnipod GO — CareFirst (Caremark)

Initial criteria

• Request is for Omnipod GO AND ALL of the following:
• Patient does NOT require bolus or mealtime insulin.
• Patient has completed a comprehensive diabetes education program.
• Patient meets ONE of the following:
• Patient has documented frequency of glucose self-testing at least once daily.
• Patient has been using a continuous glucose monitor (CGM).
• Patient has a hypersensitivity to an ingredient in ALL available basal insulin (e.g., long-acting insulin, intermediate-acting insulin).

Approval duration

12 months