Prescribing InPen^TM smart* insulin pen

Step 1

Select either a Novo or Lilly InPen, color, and the quantity.

Insulin cartridges and needles should be separately prescribed to the local pharmacy or mail order pharmacy.

• Humalog^® U100 cartridges: NDC 00002751659 
• Novolog^® U100 cartridges: NDC 00169330312 
• Fiasp^® U100 cartridges: NDC 00169320515

Step 2

Submit order through EMR/EHR to the local pharmacy of choice. Alternatively, we offer the following mail order pharmacies:

• Gem Edwards Pharmacy
• Express RX (California only)
• Alto Pharmacy (select cities^‡)

Additional patient support available at www.medtronicdiabetes.com/inpen-training

Additional questions? Call 800-646-4633, option 1 for Medtronic 24-Hour Technical Support.

^‡ Alto Pharmacy available in the following cities: Austin, TX, Dallas-Fort Worth Metro, TX, Denver, CO, Houston, TX, Irvine/Orange County, CA, Las Vegas, NV, Los Angeles, CA, New York Metro, NY, San Diego, CA, San Francisco, CA, San Jose, CA, Seattle, WA

How to change Meal Therapy Mode:

To progress the Meal Therapy Mode in the InPen app from Fixed Dose to Meal Estimation/Carbohydrate Counting or from Meal Estimation to Carbohydrate Counting, you have two options:

Option 1:

EMR confirmation of Meal Therapy Mode to Medtronic MiniMed Pharmacy

1. Search for “MiniMed Distribution Corp” in your EMR’s Pharmacy Finder
2. Send the eRx to MiniMed Distribution Corp and indicate in the SIG (directions) 
   “Unlock Meal Therapy Settings to ____. Patient’s settings confirmed. Use as directed.”

If you have trouble locating Medtronic Pharmacy in your EMR, you can submit the information via fax or phone:

• Fax: 866-874-3150
• Phone: 800-646-4633, option 9

How to search for Medtronic Pharmacy in EHR:

• Select pharmacy type: RETAIL
• Search “MiniMed Distribution Corp”

OR

• Search by NCPDP: 5900990

If you need assistance, contact your EHR’s customer service line. You can also confirm therapy mode changes to Medtronic via phone: 800-646-4633, option 9, option 1.

Please allow 24 business hours to process. Once confirmed, the patient’s app will be automatically updated and will be alerted with an in-app notification when the patient opens their InPen app.

Option 2:

Confirm therapy mode changes to Medtronic via phone: 800-646-4633, option 9, option 1.

Eligibility Requirements for InPen User Access Program:
Open to insured patients and patients with commercial prescription insurance and those who are not enrolled in any government-funded program that pays for prescription devices or treatments. Excluded participants include patients enrolled in any federal, state, or government-funded healthcare program such as Medicare, Medicare Advantage, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), the Department of Defense (DoD) or TRICARE® that provides coverage for InPen, or where prohibited by law. Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. If at any time a patient becomes enrolled under any such federal, state, or government-funded healthcare program, he/she will no longer be able to use this program and must call (800) 646-4633 to stop participation. Restrictions may apply. Offer subject to change or discontinue without notice. This is not health insurance. Offer applies to a maximum of 2 prescribed InPens per Patient per benefit year. Offer good only in the USA at participating pharmacies and cannot be redeemed at government-subsidized clinics.

Important Safety Information: Guardian™ Connect CGM System
The Guardian™ Connect system requires a prescription and is indicated for continuous or periodic monitoring of glucose levels in the interstitial fluid under the skin, in patients (14 to 75 years of age) with diabetes mellitus. The system is intended to complement, not replace, information obtained from standard blood glucose monitoring devices, and is not recommended for people who are unwilling or unable to perform a minimum of two meter blood glucose tests per day, or for people who are unable or unwilling to maintain contact with their healthcare professional. The system requires a functioning mobile electronic device with correct settings. If the mobile device is not set up or used correctly, you may not receive sensor glucose information or alerts. For complete details of the system and its components, including warnings, contraindications, and precautions, please consult the user guide at http://www.medtronicdiabetes.com/support/download-library/user-guides and important safety information.

Important Safety Information: InPen^TM Smart Insulin Pen
The InPen^TM requires a prescription. It is a home-use reusable pen injector for single-patient use by people with diabetes under the supervision of an adult caregiver, or by a patient age 7 and older for the self-injection of a desired dose of insulin. The pen injector is compatible with Lilly Humalog^® U-100 3.0 mL cartridges, Novo Nordisk Novolog^® U-100 3.0 mL cartridges, and Novo Nordisk Fiasp^® U-100 3.0 mL cartridges and single-use detachable and disposable pen needles (not included). The pen injector allows the user to dial the desired dose from 0.5 to 30 units in one-half (1/2) unit increments.

The InPen^TM dose calculator, a component of the InPen^TM app, is indicated for the management of diabetes by people with diabetes under the supervision of an adult caregiver, or by a patient age 7 and older for calculating an insulin dose or carbohydrate intake based on user entered data.

For an insulin dose based on amount of carbohydrates, a healthcare professional must provide patient-specific target blood glucose, insulin-to-carbohydrate ratio, insulin sensitivity parameters, and duration of insulin action to be programmed into the software prior to use as it is required for set up.

For an insulin dose based on fixed/variable meal sizes, a healthcare professional must provide patient-specific fixed doses/meal sizes to be programmed into the software prior to use.

For additional product and important safety considerations, see User Guide and http://bit.ly/InPenSafety.