Does Aetna Cover Januvia

Explore why Aetna may deny Januvia coverage, how to secure it, costs without insurance, and answers to FAQs in this comprehensive guide.
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Does Aetna Cover Januvia?

 

  • Yes, Aetna generally covers Januvia, a medication used to manage blood sugar levels in individuals with type 2 diabetes, depending on the specific health plan.
  •  

  • Coverage may vary between different Aetna plans, including Medicare Advantage and employer-provided insurance.
  •  

  • Prescription drug plans often categorize Januvia under tier levels, affecting copayment costs. Higher tiers mean higher out-of-pocket costs.
  •  

  • To ensure coverage, prescription of Januvia must be medically necessary, following Aetna's guidelines for diabetes management.
  •  

  • Aetna may require prior authorization, meaning your healthcare provider needs to confirm that Januvia is the most suitable treatment for your condition.
  •  

  • Patients might need to try lower-cost alternatives (step therapy) before Aetna covers Januvia.
  •  

  • Always check your specific plan details or contact Aetna for the most accurate information about your coverage for Januvia.

 

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Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

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Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Januvia Coverage with Aetna

 

Review Your Current Prescription Coverage

 

  • Check your Aetna insurance policy documents for specifics on prescription medication coverage.
  •  

  • Determine whether Januvia is included in the formulary, Aetna's list of covered drugs.
  •  

  • Contact Aetna customer service for a quick confirmation and details on coverage tiers and any potential restrictions.

 

Consult with Your Healthcare Provider

 

  • Discuss your medical needs with your healthcare provider to ensure Januvia is the best option for your condition.
  •  

  • Request that your doctor provides a prescription and any necessary documentation that identifies why Januvia is important for your treatment.

 

Prior Authorization Requirements

 

  • Find out if Januvia requires prior authorization by checking Aetna's policy online or by calling customer service.
  •  

  • If required, work with your healthcare provider to complete and submit the prior authorization form to Aetna.
  •  

  • Ensure that the form includes detailed medical necessity and supporting documentation.
  •  

  • Follow up to confirm Aetna received the prior authorization request and monitor its progress.

 

Utilize Aetna's Mail Order Pharmacy Services

 

  • Check if using Aetna's mail order pharmacy could provide additional savings or benefits for Januvia.
  •  

  • Enroll in Aetna's mail order program by visiting their website or calling customer service.
  •  

  • Work with your healthcare provider to send prescriptions directly to the mail order pharmacy.

 

Appealing Denied Coverage

 

  • If coverage for Januvia is denied, review the reasons provided by Aetna.
  •  

  • Submit an appeal if you believe the denial was unfounded. Include any additional information or documentation that supports the medical necessity for Januvia.
  •  

  • Engage your healthcare provider in the appeal process for additional credibility and support.
  •  

  • Keep track of timelines and be proactive in following up on your appeal status.

 

Explore Alternative Assistance Options

 

  • Look into pharmaceutical assistance programs offered by the manufacturer of Januvia for additional financial support.
  •  

  • Contact organizations that provide financial aid or help with uncovering prescription costs.

 

Consistently Reassess Coverage

 

  • Regularly review any changes to your Aetna insurance policy that may affect Januvia coverage.
  •  

  • Stay informed about Aetna's formulary updates or changes in tiers that could impact your payments.

 

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FAQs

Does Aetna Cover Januvia

Explore why Aetna may deny Januvia coverage, how to secure it, costs without insurance, and answers to FAQs in this comprehensive guide.
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Is Januvia Covered by Aetna

 

Does Aetna Cover Januvia?

 

  • Yes, Aetna generally covers Januvia, a medication used to manage blood sugar levels in individuals with type 2 diabetes, depending on the specific health plan.
  •  

  • Coverage may vary between different Aetna plans, including Medicare Advantage and employer-provided insurance.
  •  

  • Prescription drug plans often categorize Januvia under tier levels, affecting copayment costs. Higher tiers mean higher out-of-pocket costs.
  •  

  • To ensure coverage, prescription of Januvia must be medically necessary, following Aetna's guidelines for diabetes management.
  •  

  • Aetna may require prior authorization, meaning your healthcare provider needs to confirm that Januvia is the most suitable treatment for your condition.
  •  

  • Patients might need to try lower-cost alternatives (step therapy) before Aetna covers Januvia.
  •  

  • Always check your specific plan details or contact Aetna for the most accurate information about your coverage for Januvia.

 

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Aetna's Approved Criteria for Januvia Coverage

 

Januvia Coverage Criteria by Aetna

 

  • **Diagnosis of Type 2 Diabetes:** The individual must have a confirmed diagnosis of type 2 diabetes mellitus.
  •  

  • **Treatment Plan:** Januvia is approved for use when it is part of a comprehensive diabetes treatment plan, which may include diet and exercise, as well as other medications.
  •  

  • **Age Requirements:** Coverage is available for adults. The patient is typically required to be 18 years or older for coverage approval.
  •  

  • **Alternative Medications:** The patient may need to demonstrate an inadequate response, intolerance, or contraindication to alternative diabetes medications such as metformin or sulfonylureas before Januvia is covered.
  •  

  • **Dosage Specifications:** The specific dosage of Januvia must align with recommended guidelines. Coverage may specify the approved daily doses to ensure appropriate use.
  •  

  • **Comorbid Conditions:** In some cases, the presence of other medical conditions, such as renal impairment, may influence coverage decisions and dosage requirements.
  •  

  • **Provider Approval:** The treatment plan, including the prescription of Januvia, must be approved by a managing healthcare provider who is coordinating the patient's diabetes care.

 

Why Aetna Might Deny Januvia Coverage

 

Aetna Denial Criteria for Januvia Coverage

 

  • **Off-Label Use:** Aetna might deny coverage for Januvia if it is prescribed for conditions that are not approved by the FDA or are not listed as covered under the specific health plan agreement.
  •  

  • **Prior Authorization Requirements:** If the patient has not fulfilled Aetna's prior authorization requirements, such as failing to provide necessary medical documents supporting the need for Januvia, coverage may be denied.
  •  

  • **Not Meeting Medical Necessity:** Aetna could deny coverage if Januvia does not meet the defined medical necessity criteria as specified in their policy guidelines. This may include insufficient evidence that other first-line treatments were ineffective.
  •  

  • **Quantity Limits:** If the prescribed dosage exceeds the quantity limits set by Aetna, the coverage may be denied unless an exception is approved.
  •  

  • **Duplicate Therapy:** Aetna may not cover Januvia if it is being prescribed alongside other medications that provide the same therapeutic effects, resulting in duplicate therapy.
  •  

  • **Non-Participation in Step Therapy:** If a patient has not followed Aetna's step therapy protocols, which requires trying and documenting the failure of less expensive alternatives before using Januvia, coverage can be rejected.
  •  

 

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How Much Does Januvia Cost without Insurance?

 

Cost of Januvia Without Insurance

 

  • The cost of Januvia (sitagliptin) without insurance can vary based on the pharmacy and location but is typically around $500 to $600 for a 30-day supply of 100 mg tablets.
  •  

  • Prices may differ based on various factors, including pharmacy location, any discount programs available, or changes in the drug market.
  •  

  • It's advisable to check different pharmacies or consider discount programs and prescription savings cards, which can sometimes offer reductions on the retail price.
  •  

  • For individuals paying out of pocket, some online tools or pharmacy networks provide price comparison services to find the best possible rate for Januvia.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Januvia Coverage with Aetna

 

Review Your Current Prescription Coverage

 

  • Check your Aetna insurance policy documents for specifics on prescription medication coverage.
  •  

  • Determine whether Januvia is included in the formulary, Aetna's list of covered drugs.
  •  

  • Contact Aetna customer service for a quick confirmation and details on coverage tiers and any potential restrictions.

 

Consult with Your Healthcare Provider

 

  • Discuss your medical needs with your healthcare provider to ensure Januvia is the best option for your condition.
  •  

  • Request that your doctor provides a prescription and any necessary documentation that identifies why Januvia is important for your treatment.

 

Prior Authorization Requirements

 

  • Find out if Januvia requires prior authorization by checking Aetna's policy online or by calling customer service.
  •  

  • If required, work with your healthcare provider to complete and submit the prior authorization form to Aetna.
  •  

  • Ensure that the form includes detailed medical necessity and supporting documentation.
  •  

  • Follow up to confirm Aetna received the prior authorization request and monitor its progress.

 

Utilize Aetna's Mail Order Pharmacy Services

 

  • Check if using Aetna's mail order pharmacy could provide additional savings or benefits for Januvia.
  •  

  • Enroll in Aetna's mail order program by visiting their website or calling customer service.
  •  

  • Work with your healthcare provider to send prescriptions directly to the mail order pharmacy.

 

Appealing Denied Coverage

 

  • If coverage for Januvia is denied, review the reasons provided by Aetna.
  •  

  • Submit an appeal if you believe the denial was unfounded. Include any additional information or documentation that supports the medical necessity for Januvia.
  •  

  • Engage your healthcare provider in the appeal process for additional credibility and support.
  •  

  • Keep track of timelines and be proactive in following up on your appeal status.

 

Explore Alternative Assistance Options

 

  • Look into pharmaceutical assistance programs offered by the manufacturer of Januvia for additional financial support.
  •  

  • Contact organizations that provide financial aid or help with uncovering prescription costs.

 

Consistently Reassess Coverage

 

  • Regularly review any changes to your Aetna insurance policy that may affect Januvia coverage.
  •  

  • Stay informed about Aetna's formulary updates or changes in tiers that could impact your payments.

 

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Januvia FAQ

What are the common side effects of Januvia?

 

Common Side Effects of Januvia

 

  • **Headache**: Often reported and can range from mild to moderate.
  •  

  • **Upper respiratory tract infections**: Can include symptoms like nasal congestion, sore throat, and runny nose.
  •  

  • **Sore throat**: May occur alongside other symptoms such as cough.
  •  

  • **Diarrhea**: Typically mild but can be uncomfortable.
  •  

  • **Nausea**: Some patients experience this, usually transient.
  •  

  • **Abdominal pain**: Not very common but can occur.
  •  

  • **Joint pain**: Although less common, can be experienced by some individuals.

How does Januvia work to control blood sugar?

 

How Januvia Works

 

  • Januvia (sitagliptin) is a DPP-4 inhibitor that enhances the body's own ability to control blood sugar levels by increasing incretin levels, hormones that help regulate insulin production.
  •  

  • Incretins like GLP-1 function by promoting insulin secretion from the pancreas when blood sugar levels are high, and they reduce glucose production in the liver.

 

Benefits

 

  • Prevents rapid glucose level increases after meals while maintaining normal insulin activity during fasting states.
  •  

  • Has a low risk of causing hypoglycemia, a common concern with some other diabetes medications.

 

Considerations

 

  • Commonly prescribed for patients with type 2 diabetes as part of a comprehensive health plan, including diet and exercise.
  •  

  • Adjustments may be necessary for those with renal impairment.

 

Can Januvia be taken with other diabetes medications?

 

Can Januvia Be Combined with Other Diabetes Medications?

 

  • Januvia, a DPP-4 inhibitor, is commonly used with other oral diabetes medications like metformin, sulfonylureas, or thiazolidinediones to improve blood sugar control.
  •  

  • When combined, careful monitoring is essential to avoid hypoglycemia, especially when Januvia is used with insulin or sulfonylureas which can lower blood sugar too much.
  •  

  • Consult your healthcare provider before combining januvia with any other medication to tailor treatment to your specific needs and health status.
  •  

  • There generally aren’t major drug-drug interaction concerns with Januvia, but liver and kidney function should be regularly assessed as they might affect treatment.

 

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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

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Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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