Does Affinity Health Plan Cover Lantus

Explore Lantus coverage by Affinity Health Plan, learn why it might be denied, tips to obtain it, costs without insurance, and common queries.
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Lantus Coverage by Affinity Health Plan

 

  • **Prescription Requirements:** Lantus coverage typically requires a prescription from a healthcare provider. Ensure the condition necessitates insulin treatment.
  •  

  • **Formulary Inclusion:** Check if Lantus is listed in Affinity Health Plan's drug formulary, as this impacts coverage and co-payments.
  •  

  • **Prior Authorization:** Coverage may require prior authorization. Verify with your healthcare provider to initiate this process.
  •  

  • **Generic Alternatives:** Consideration for tiered plans or generic insulin alternatives may affect coverage. Review plan details for cost-effective options.
  •  

  • **Network Pharmacies:** Purchase Lantus from pharmacies within the Affinity network to ensure coverage and reduce out-of-pocket expenses.
  •  

  • **Documentation:** Keep thorough documentation, including prior authorizations and medical necessity, to support any claims or appeals.

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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 Lantus Coverage with Affinity Health Plan

 

Verify Your Eligibility for Affinity Health Plan

 

  • Confirm that you meet the eligibility criteria for enrolling in Affinity Health Plan. This might include residency requirements or income qualifications depending on the specific plan type.
  •  

  • If you're not sure about the requirements, contact Affinity Health Plan's customer service or visit their website for detailed eligibility information.

 

Enroll in an Affinity Health Plan

 

  • Visit the Affinity Health Plan website or contact their sales department to begin the enrollment process. You may need to fill out forms online or request a physical application form.
  •  

  • Provide all necessary personal and financial information to assess your plan options and any potential subsidies.

 

Choose the Right Plan Type

 

  • Explore the various plan options available through Affinity Health Plan and select one that best covers prescription medications like Lantus.
  •  

  • Consider plans with comprehensive drug coverage or a strong emphasis on managing chronic conditions like diabetes.

 

Verify Lantus Coverage

 

  • Once enrolled, review the formulary list, which is a list of medications covered by the health plan, to ensure that Lantus is included.
  •  

  • If Lantus is not listed, consider reaching out to Affinity Health Plan’s customer service for clarification on specialty medications coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about prescribing Lantus and make sure they are aware of your insurance plan’s requirements for prior authorizations if necessary.
  •  

  • Your provider might need to submit additional documentation or a letter of medical necessity to support your need for Lantus.

 

Request Prior Authorization (if needed)

 

  • Some insurance plans require prior authorization for certain medications. Work with your healthcare provider to submit any necessary paperwork if Lantus requires prior approval.
  •  

  • Ensure all forms submitted are complete and accurate to avoid processing delays.

 

Monitor Approval Status

 

  • Stay in contact with your healthcare provider and Affinity Health Plan to track the approval status of your Lantus coverage request.
  •  

  • In case of denial, inquire about the appeals process with Affinity Health Plan to contest the decision.

 

Fill Your Prescription

 

  • Once approved, take your Lantus prescription to an in-network pharmacy preferred by Affinity Health Plan for the best rates.
  •  

  • Verify copay amounts and any discounts applicable to Lantus under your plan to manage costs effectively.

 

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FAQs

Does Affinity Health Plan Cover Lantus

Explore Lantus coverage by Affinity Health Plan, learn why it might be denied, tips to obtain it, costs without insurance, and common queries.
Curex allergy drops unboxing

Is Lantus Covered by Affinity Health Plan

 

Lantus Coverage by Affinity Health Plan

 

  • **Prescription Requirements:** Lantus coverage typically requires a prescription from a healthcare provider. Ensure the condition necessitates insulin treatment.
  •  

  • **Formulary Inclusion:** Check if Lantus is listed in Affinity Health Plan's drug formulary, as this impacts coverage and co-payments.
  •  

  • **Prior Authorization:** Coverage may require prior authorization. Verify with your healthcare provider to initiate this process.
  •  

  • **Generic Alternatives:** Consideration for tiered plans or generic insulin alternatives may affect coverage. Review plan details for cost-effective options.
  •  

  • **Network Pharmacies:** Purchase Lantus from pharmacies within the Affinity network to ensure coverage and reduce out-of-pocket expenses.
  •  

  • **Documentation:** Keep thorough documentation, including prior authorizations and medical necessity, to support any claims or appeals.

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Affinity Health Plan's Approved Criteria for Lantus Coverage

 

Affinity Health Plan's Criteria for Lantus Coverage

 

  • **Medical Necessity:** Lantus is covered for members diagnosed with diabetes mellitus who require insulin to achieve and maintain glycemic control.
  •  

  • **Age Requirement:** Coverage applies to members who are 6 years of age and older, as Lantus is approved for both pediatric and adult use.
  •  

  • **Type of Diabetes:** Lantus is approved for individuals with both Type 1 and Type 2 diabetes who require long-acting insulin.
  •  

  • **Diabetes Management Plan:** Lantus coverage is part of a comprehensive diabetes management plan which includes lifestyle interventions, blood glucose monitoring, and possibly other medications.
  •  

  • **Prescriber Requirements:** The prescribing healthcare provider must be licensed and deemed necessary to prescribe insulin therapy.
  •  

  • **Prior Authorization:** Certain cases may require prior authorization. Clinical documentation substantiating the need for Lantus may be required.
  •  

  • **Step Therapy Protocol:** For some members, using a prescribed oral diabetes medication or alternative insulin regimen before approving Lantus may be needed.
  •  

  • **Current Treatment Response:** Members who have tried and had an inadequate response or intolerance to other insulin formulations may be considered for Lantus.
  •  

  • **Non-Pregnancy Condition:** Lantus is generally covered for non-pregnant members unless specifically deemed necessary during pregnancy according to the treating physician.

 

Why Affinity Health Plan Might Deny Lantus Coverage

 

Reasons for Denial of Lantus Coverage by Affinity Health Plan

 

  • **Non-Formulary Medication:** Lantus may not be included in the formulary list approved by the health plan. Affinity Health Plan might deny coverage if a medication is not on this list.
  •  

  • **Off-Label Use:** When Lantus is prescribed for a condition not approved by the FDA or not generally accepted as a covered use by Affinity Health Plan, coverage can be denied.
  •  

  • **Lack of Prior Authorization:** If the prescribing physician has not obtained prior authorization for Lantus, the medication may not be covered.
  •  

  • **Failure to Meet Medical Necessity Criteria:** Affinity Health Plan may require documentation proving that Lantus is medically necessary. Without providing sufficient evidence, coverage could be denied.
  •  

  • **Availability of Alternates:** If there are other insulin products available that are more cost-effective according to the plan's guidelines, Lantus may not be covered.
  •  

  • **Quantity Limits Exceeded:** There might be limits on how much Lantus can be dispensed during a specific period. Exceeding these limits could lead to a denial of coverage.
  •  

  • **Step Therapy Requirements:** The plan may require trying less expensive medications before approving Lantus. Skipping this protocol can lead to coverage denial.

 

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

  • The price of Lantus (insulin glargine) without insurance can vary based on factors such as the pharmacy, location, and available discounts. Typically, the retail price ranges between $250 and $350 for a 10ml vial at a retail pharmacy.
  •  

  • For the Lantus SoloStar pen, which is a more convenient option for some, the price is generally similar, ranging from $400 to $500 for a pack of five pens.
  •  

  • Prices can fluctuate slightly, so it is advisable to check with local pharmacies or online services for the most current prices and potential savings options.
  •  

  • Consider exploring patient assistance programs offered by the manufacturer or third-party organizations, which might offer Lantus at reduced prices or even for free if you qualify based on income.

 

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 Lantus Coverage with Affinity Health Plan

 

Verify Your Eligibility for Affinity Health Plan

 

  • Confirm that you meet the eligibility criteria for enrolling in Affinity Health Plan. This might include residency requirements or income qualifications depending on the specific plan type.
  •  

  • If you're not sure about the requirements, contact Affinity Health Plan's customer service or visit their website for detailed eligibility information.

 

Enroll in an Affinity Health Plan

 

  • Visit the Affinity Health Plan website or contact their sales department to begin the enrollment process. You may need to fill out forms online or request a physical application form.
  •  

  • Provide all necessary personal and financial information to assess your plan options and any potential subsidies.

 

Choose the Right Plan Type

 

  • Explore the various plan options available through Affinity Health Plan and select one that best covers prescription medications like Lantus.
  •  

  • Consider plans with comprehensive drug coverage or a strong emphasis on managing chronic conditions like diabetes.

 

Verify Lantus Coverage

 

  • Once enrolled, review the formulary list, which is a list of medications covered by the health plan, to ensure that Lantus is included.
  •  

  • If Lantus is not listed, consider reaching out to Affinity Health Plan’s customer service for clarification on specialty medications coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about prescribing Lantus and make sure they are aware of your insurance plan’s requirements for prior authorizations if necessary.
  •  

  • Your provider might need to submit additional documentation or a letter of medical necessity to support your need for Lantus.

 

Request Prior Authorization (if needed)

 

  • Some insurance plans require prior authorization for certain medications. Work with your healthcare provider to submit any necessary paperwork if Lantus requires prior approval.
  •  

  • Ensure all forms submitted are complete and accurate to avoid processing delays.

 

Monitor Approval Status

 

  • Stay in contact with your healthcare provider and Affinity Health Plan to track the approval status of your Lantus coverage request.
  •  

  • In case of denial, inquire about the appeals process with Affinity Health Plan to contest the decision.

 

Fill Your Prescription

 

  • Once approved, take your Lantus prescription to an in-network pharmacy preferred by Affinity Health Plan for the best rates.
  •  

  • Verify copay amounts and any discounts applicable to Lantus under your plan to manage costs effectively.

 

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Lantus FAQ

What is Lantus used for?

 

What is Lantus Used For?

 

  • Lantus is primarily used to manage blood sugar levels in individuals with type 1 and type 2 diabetes.
  •  

  • It is a long-acting insulin, providing a steady release of insulin over a 24-hour period with no pronounced peak, mimicking natural insulin secretion.
  •  

  • It's taken once daily, often at the same time each day, helping to maintain consistent blood glucose control.
  •  

  • Beneficial for patients requiring basal insulin to prevent hyperglycemia between meals and overnight.
  •  

  • Alongside diet and exercise, Lantus is vital for comprehensive diabetes management.

 

How does Lantus work in the body?

 

How Lantus Works

 

  • Lantus is a long-acting insulin, also known as insulin glargine. It provides a stable and continuous release of insulin to control blood sugar levels.
  •  

  • The formulation of Lantus enables it to dissolve slowly upon injection, creating a slow and steady insulin level that lasts up to 24 hours.
  •  

  • This minimizes the risk of blood sugar peaks and troughs, providing more consistent blood glucose management.
  •  

  • Lantus mimics the basal level of insulin production in the pancreas, thus helping to maintain glucose balance between meals and overnight.
  •  

  • It binds to insulin receptors, facilitating glucose uptake into muscle and fat tissues, while inhibiting hepatic glucose production.

 

What are the side effects of Lantus?

 

Common Side Effects

 

  • Injection site reactions such as redness, swelling, or itching can occur.
  • Hypoglycemia, or low blood sugar, is a frequent side effect.
  • Weight gain may happen due to improved glucose utilization.

 

Less Common Side Effects

 

  • Allergic reactions like rash or itching may occur but are rare.
  • Systemic reactions such as swelling of hands/feet can occur.
  • Visual changes might be experienced during initial treatment.

 

Serious Side Effects

 

  • Severe hypoglycemia requiring intervention.
  • Signs of allergic reactions like difficulty breathing, require immediate attention.
  • Hypokalemia may develop, leading to muscle weakness or cramps.

 

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

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.

Got questions? We have answers.

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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