$49$0.99

Does Affinity Health Plan Cover Prolia

Discover if Affinity Health Plan covers Prolia, reasons for denials, coverage tips, costs without insurance, and get answers to common Prolia questions.

Treat your allergies with Curex

as seen on

“Curex is changing the landscape of allergies in 2024”

Coverage for Prolia under Affinity Health Plan

Prolia is covered by Affinity Health Plan for patients who meet specific medical criteria. Coverage is generally intended for individuals with osteoporosis at high risk for fracture.

Patients typically need to have documented evidence of insufficient response or intolerance to other osteoporosis treatments before qualifying for Prolia coverage.

The prescribing physician may need to provide medical records or documentation showing the necessity of the treatment due to high-risk factors such as post-menopausal bone density loss or previous osteoporotic fractures.

Pre-authorization is often required; patients should consult their healthcare provider and Affinity Health Plan for specific requirements and processes to ensure that necessary authorizations are in place prior to receiving treatment.

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49 $9.99

Review your allergy test results with a Curex allergist.

Start Now

Clinical Support

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 Prolia Coverage with Affinity Health Plan

Verify Prolia Coverage with Affinity Health Plan

Contact Affinity Health Plan directly to confirm that Prolia is covered under your specific health plan. You can usually find a customer service number on your insurance card or the Affinity Health Plan website.

Consult the formulary provided by Affinity Health Plan. This is a list of covered medications and may be available online or through your healthcare provider.

Speak with Your Healthcare Provider

Discuss your need for Prolia with your healthcare provider. Ensure they understand that this is a medication you need to have covered by your insurance plan.

Your healthcare provider can help find alternative medications or treatment plans in case Prolia is not covered.

Obtain a Prescription

Request a prescription for Prolia from your healthcare provider, specifying that it needs coverage from Affinity Health Plan.

If your provider is familiar with the insurance approval process, ask for any additional steps or documentation that may expedite coverage approval.

Submit a Prior Authorization Request

Work with your healthcare provider’s office to submit a prior authorization request if necessary. This is often required for medications like Prolia.

Ensure the prior authorization includes relevant medical justifications and supporting documentation regarding the necessity of Prolia for your treatment.

Visit the Affinity Health Plan Portal

Log in to your Affinity Health Plan member portal for any enrollment forms or documentation that might be necessary for medication coverage.

If available, check status updates on your prior authorization or prescription coverage process through the portal.

Contact Customer Support

If you encounter issues or delays, contact Affinity Health Plan’s customer support for assistance and to clarify any misunderstandings about coverage policies or necessary actions on your end.

Record all interaction details such as the representative's name, time of call, and any reference numbers provided.

Appeal if Necessary

If your request for Prolia coverage is denied, you may have the option to appeal the decision through Affinity Health Plan’s appeals process.

Consult with your healthcare provider about additional documentation that can support your appeals case.

Submit all necessary appeal paperwork before any specified deadlines to ensure your appeal is considered.

Happy Customers

We love helping people!

Allie, Nevada

"I have two cats I can finally cuddle!"
‍

Cat and dog allergies

Zachary, Texas

“I can breathe through my nose for the first time in like 20 years!"

Dust and mold allergies

Erika, New York

“I've noticed less sneezing and shortness of breath.”

Tree and grass allergies

Richard, Texas

I love the convenience!
‍

Tree and cat allergies

We Treat Allergies

Food Allergies

Weed Pollens

Cat Allergies

Dog Allergies

Dust Mites

Molds

Tree Pollens

curex user showing allergy treatment kit

a male patient showing allergy drops vial

50,000+ users have overcome their allergies

Am I eligible?

At-home Immunotherapy

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option

Treatment prescribed
by clinician

Clinicaly made allergen extracts are customized for your allergies

Your immune system gets desensitized to allergens, giving you long-term relief.

FAQs

Does Affinity Health Plan Cover Prolia

Discover if Affinity Health Plan covers Prolia, reasons for denials, coverage tips, costs without insurance, and get answers to common Prolia questions.

Achieve Your Goals Faster with Curex

Is Prolia Covered by Affinity Health Plan

Coverage for Prolia under Affinity Health Plan

Prolia is covered by Affinity Health Plan for patients who meet specific medical criteria. Coverage is generally intended for individuals with osteoporosis at high risk for fracture.

Patients typically need to have documented evidence of insufficient response or intolerance to other osteoporosis treatments before qualifying for Prolia coverage.

The prescribing physician may need to provide medical records or documentation showing the necessity of the treatment due to high-risk factors such as post-menopausal bone density loss or previous osteoporotic fractures.

Pre-authorization is often required; patients should consult their healthcare provider and Affinity Health Plan for specific requirements and processes to ensure that necessary authorizations are in place prior to receiving treatment.

A weight management program tailored to you

Start with Curex

Affinity Health Plan's Approved Criteria for Prolia Coverage

Eligibility Criteria for Prolia Coverage

Patient must be diagnosed with osteoporosis, confirmed through bone density testing.

Gender-Specific Requirements

Postmenopausal women with an increased risk of fracture based on medical history or current bone density readings.

Men with an increased risk for fracture due to primary or hypogonadal osteoporosis.

Treatment History Considerations

Patients who have experienced failure, contraindication, or intolerance to other osteoporosis treatments such as bisphosphonates.

Fracture Risk Assessment

Individuals with a history of osteoporotic fracture, or who are at high risk of fracture based on clinical evaluation.

Patients diagnosed with multiple risk factors for fracture, such as low bone mass and history of falls.

Age-Related Criteria

Typically, individuals aged 50 years and older with evidence of clinical necessity for treatment.

Bone Health Monitoring

Regular follow-up with documented monitoring of bone health is essential to continue coverage, ensuring the treatment's effectiveness and safety.

Professional Prescription

Prolia must be prescribed by a specialist in endocrinology, rheumatology, or a similar field to ensure appropriate use and monitoring.

Health Plan Documentation

Approval for coverage may require submission of the patient's medical history, including previous treatment options attempted and current bone density reports.

Why Affinity Health Plan Might Deny Prolia Coverage

Situations Where Prolia May Be Denied Coverage by Affinity Health Plan

Affinity Health Plan might deny Prolia coverage if it does not meet the FDA-approved indications for use. This includes any off-label use that is not supported by authoritative medical guidelines.

Prolia coverage could be denied if the patient does not meet specific clinical criteria set by Affinity, such as failing to demonstrate osteoporosis and a high risk of fracture through validated assessment tools.

If the patient has not tried and failed, or cannot tolerate, other medications that are typically prescribed for osteoporosis before attempting Prolia, coverage may be denied by Affinity Health Plan.

Affinity might not cover Prolia if the required pre-authorization process is not completed or if the documentation submitted does not meet their coverage criteria.

Prolia may be denied if a patient has a current or past infection or other contraindications that are listed in the plan’s policy documentation and clinical guidelines.

In cases where Prolia is prescribed for a condition not recognized by the plan's medical policy, Affinity Health Plan might enforce a denial of coverage.

Prolia coverage might be refused if the prescribed dosage or frequency does not align with approved guidelines or cost-effectiveness assessments stipulated by Affinity Health Plan.

Together with our partners we have changed the lives of over 300,000 patients.

Join Curex

How Much Does Prolia Cost without Insurance?

Prolia Cost Without Insurance

Prolia (denosumab) is a prescription medication primarily used to treat osteoporosis in postmenopausal women and men at high risk of fractures. Without insurance, the cost of Prolia can be significant.

The approximate cost for a single 60mg/ml injection of Prolia is around $1,500 to $2,000. This price may vary based on location, pharmacy pricing, and additional dispensing fees.

It's important to note that prices can fluctuate and might be subject to discounts or coupons offered by pharmacies or through the manufacturer's patient assistance programs.

Patients without insurance coverage for Prolia might also consider reaching out to Amgen, the manufacturer, for potential cost-assistance programs or savings options that may be available.

Pharmacies, including major chains and independent stores, may offer price matching or competitive pricing, so it's advisable to compare prices across different providers.

Clinical Support

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

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

Kayla Mardaga, NP

How to Get Prolia Coverage with Affinity Health Plan

Verify Prolia Coverage with Affinity Health Plan

Contact Affinity Health Plan directly to confirm that Prolia is covered under your specific health plan. You can usually find a customer service number on your insurance card or the Affinity Health Plan website.

Consult the formulary provided by Affinity Health Plan. This is a list of covered medications and may be available online or through your healthcare provider.

Speak with Your Healthcare Provider

Discuss your need for Prolia with your healthcare provider. Ensure they understand that this is a medication you need to have covered by your insurance plan.

Your healthcare provider can help find alternative medications or treatment plans in case Prolia is not covered.

Obtain a Prescription

Request a prescription for Prolia from your healthcare provider, specifying that it needs coverage from Affinity Health Plan.

If your provider is familiar with the insurance approval process, ask for any additional steps or documentation that may expedite coverage approval.

Submit a Prior Authorization Request

Work with your healthcare provider’s office to submit a prior authorization request if necessary. This is often required for medications like Prolia.

Ensure the prior authorization includes relevant medical justifications and supporting documentation regarding the necessity of Prolia for your treatment.

Visit the Affinity Health Plan Portal

Log in to your Affinity Health Plan member portal for any enrollment forms or documentation that might be necessary for medication coverage.

If available, check status updates on your prior authorization or prescription coverage process through the portal.

Contact Customer Support

If you encounter issues or delays, contact Affinity Health Plan’s customer support for assistance and to clarify any misunderstandings about coverage policies or necessary actions on your end.

Record all interaction details such as the representative's name, time of call, and any reference numbers provided.

Appeal if Necessary

If your request for Prolia coverage is denied, you may have the option to appeal the decision through Affinity Health Plan’s appeals process.

Consult with your healthcare provider about additional documentation that can support your appeals case.

Submit all necessary appeal paperwork before any specified deadlines to ensure your appeal is considered.

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

‍

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Prolia FAQ

What are the side effects of Prolia?

Common Side Effects of Prolia

Back pain
Muscle pain
Joint pain
Increased cholesterol levels
Bladder infection

Serious Side Effects

Serious allergic reactions: Difficulty breathing and rash
Severe bone/joint/muscle pain
Low blood calcium levels
Jawbone problems (osteonecrosis)
Unusual thigh bone fractures

Important Notes

Always report any unusual symptoms to your healthcare provider.
Maintain regular follow-up appointments to monitor your health.
This is not an exhaustive list; consult your doctor or pharmacist for more information.

How long does Prolia stay in your system?

How Long Does Prolia Stay in Your System

Prolia, or denosumab, is a medication used for osteoporosis treatment. After administration, its active effects last around 6 months, which is why it's typically given bi-annually.

The drug's elimination from the body may take longer due to its biological nature and mechanism. Prolia is a monoclonal antibody and is mainly cleared through the reticuloendothelial system, involving processes like protein degradation.

An important factor is the half-life of Prolia, which averages 25 to 28 days. Complete clearance from the system can vary, potentially extending up to 9 months after the last dose.

Individual factors, such as metabolic rate and kidney function, can affect the duration Prolia remains detectable in the body. Consultation with a healthcare professional is advised to understand its impact on specific health concerns.

Is Prolia the same as Reclast?

Comparison of Prolia and Reclast

Prolia: A brand name for denosumab, Prolia is an injectable biophosphonate used to treat osteoporosis by inhibiting bone resorption. It's administered every 6 months as a subcutaneous injection.

Reclast: Known as zoledronic acid, Reclast is also a biophosphonate but given as an intravenous infusion. It works similarly by decreasing bone loss and is typically administered once a year.

Mechanism: While both drugs target bone resorption, Prolia and Reclast function differently at a cellular level. Prolia inhibits RANK ligand, while Reclast inhibits osteoclast activity.

Side Effects: Both medications may cause nausea, fatigue, and joint pain. However, Prolia can also lead to hypocalcemia, while Reclast may cause flu-like symptoms post-infusion.

Have questions left?

‍

Get a personalized online consultation with a doctor at Curex

Learn More

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”

Becky D.

"If I could give 6 stars, I would. BEST... BEST… BEST… service.”

Ferdian K.

“The Curex staff has been professional, efficient, and really focused on my individual needs.”

Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

Button Text

A weight management program tailored to you

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. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does Affinity Health Plan Cover Prolia

Discover if Affinity Health Plan covers Prolia, reasons for denials, coverage tips, costs without insurance, and get answers to common Prolia questions.

Achieve Your Goals Faster with Curex