For the purpose of clarity, the term “copay” shall encompass any out-of-pocket expense for one (1) month’s supply of Pods, including any deductible, copays and other out-of-pocket expenses that the participant would have to disburse to procure said supply of Pods.If the benefits check result in a copay greater than two hundred dollars ($200), Insulet, or its authorized partners, shall arrange for the shipment of one (1) Omnipod DASH Intro Kit, in accordance with Section 4, below.If the benefits check results in a monthly copay equal to or below two hundred dollars ($200), then Insulet, or its pharmacy partner, shall issue a one-time only copay card to the participant, for a value equal to the out-of-pocket expenses the participant would have to pay for an Omnipod DASH 30-day initial shipment, in accordance with Section 3, below.Once Insulet, or its pharmacy partner, has received the request, including a valid prescription for the Omnipod DASH Intro Kit and Omnipod DASH Pods, the participant’s benefits will be checked by Insulet or its pharmacy partner.A participant shall sign the 30-day Omnipod DASH Free Trial Acknowledgement through the appropriate platform provided by Insulet’s pharmacy partner.Eligible participants have two (2) options, based on the following: With this program, Participants may be eligible to receive a 30-day supply of Omnipod DASH products at no cost for them. Please contact Insulet Customer Support at 1-80 for details. This offer is only valid in the United States, Puerto Rico, and the U.S. Participants on certain commercial insurance plans may not be eligible. This offer is not valid for participants whose Omnipod DASH prescription is paid for in whole or in part by Medicare, Medicaid, or any other federal or state programs, or where prohibited by law. The Program is open only to new Pod Therapy patients coming from multiple daily injections or tubed pumps only who have not previously used Omnipod® 5, Omnipod DASH or Omnipod Insulin Management System. Eligibility criteria: Subject to program limitations and terms and conditions, the Omnipod DASH 30-day Free Trial Program (the “Program”) is open to patients who have a valid Omnipod DASH prescription and who have commercial or private insurance, including plans available through state and federal healthcare exchanges.
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