Does Affinity Health Plan Cover Trelegy

Explore Trelegy coverage by Affinity Health Plan, tips for approval, cost without insurance, and FAQs in our comprehensive guide.
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Does Affinity Health Plan Cover Trelegy?

 

  • Affinity Health Plan generally covers Trelegy, a medication prescribed for COPD and asthma, under its prescription drug coverage. Coverage depends on the specific plan and formulary, so it's crucial to verify with Affinity Health or through your plan documents.
  •  

  • To have Trelegy covered, the patient often needs to have a documented diagnosis of COPD or asthma, and the prescribing doctor must provide justification for using Trelegy over other treatments.
  •  

  • Prior authorization may be required. This means your healthcare provider must submit a request to the insurance provider explaining why Trelegy is medically necessary before coverage is approved.
  •  

  • Patients might need to try and fail other medications before qualifying for Trelegy coverage, as per step therapy protocols.
  •  

  • Out-of-pocket costs can vary depending on the plan's tier for the medication and whether the patient has reached their deductible or out-of-pocket maximum.

 

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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 Trelegy Coverage with Affinity Health Plan

 

Initiate Contact with Affinity Health Plan

 

  • Reach out to Affinity Health Plan's customer service via phone, email, or online chat to inquire about including Trelegy within your coverage. Gather information about specific plans that accommodate this prescription.
  •  

  • Visit the official Affinity Health Plan website to locate relevant contact details and customer service options available for queries related to medication coverage.

 

Understand Prescription Coverage Policies

 

  • Review your current plan documentation to understand your prescription benefits. This will help determine if Trelegy is listed or what steps are needed to include it.
  •  

  • Learn about tiered prescription formularies, as some medications may have different co-pays or pre-authorization requirements stopping Trelegy's immediate coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of Trelegy for your condition. They may need to provide medical documentation supporting the requirement of this medication.
  •  

  • Your healthcare provider could assist in providing necessary paperwork or direct communication with Affinity to expedite coverage requests.

 

Submit a Coverage Request

 

  • Prepare and submit any required documentation, such as a request form, medical records, or a letter of necessity, to Affinity Health Plan to review for Trelegy coverage.
  •  

  • Ensure all paperwork is accurately filled out and contains all essential details regarding your health condition and the necessity of Trelegy.

 

Follow Up with Affinity Health Plan

 

  • Contact Affinity Health Plan after submission to check the status of your request. This will keep the communication line open and allow you to address any immediate concerns.
  •  

  • Inquire about the potential need for any additional documentation or steps required to finalize the coverage of Trelegy.

 

Consider Appeals Process

 

  • If initially denied, review Affinity Health Plan's appeals process to challenge the decision. Compile any additional supportive information from your healthcare provider if necessary.
  •  

  • Communicate with a plan representative to guide you through the appeal filing process and ask for any advice or additional steps to enhance the likelihood of approval.

 

Stay Informed and Persistent

 

  • Keep track of all interactions and documents sent and received while liaising with Affinity Health Plan to streamline any future discussions or appeals.
  •  

  • Maintain ongoing communication to ensure your request for Trelegy coverage is addressed promptly and efficiently.

 

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FAQs

Does Affinity Health Plan Cover Trelegy

Explore Trelegy coverage by Affinity Health Plan, tips for approval, cost without insurance, and FAQs in our comprehensive guide.
Curex allergy drops unboxing

Is Trelegy Covered by Affinity Health Plan

 

Does Affinity Health Plan Cover Trelegy?

 

  • Affinity Health Plan generally covers Trelegy, a medication prescribed for COPD and asthma, under its prescription drug coverage. Coverage depends on the specific plan and formulary, so it's crucial to verify with Affinity Health or through your plan documents.
  •  

  • To have Trelegy covered, the patient often needs to have a documented diagnosis of COPD or asthma, and the prescribing doctor must provide justification for using Trelegy over other treatments.
  •  

  • Prior authorization may be required. This means your healthcare provider must submit a request to the insurance provider explaining why Trelegy is medically necessary before coverage is approved.
  •  

  • Patients might need to try and fail other medications before qualifying for Trelegy coverage, as per step therapy protocols.
  •  

  • Out-of-pocket costs can vary depending on the plan's tier for the medication and whether the patient has reached their deductible or out-of-pocket maximum.

 

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Affinity Health Plan's Approved Criteria for Trelegy Coverage

 

Criteria for Trelegy Coverage

 

  • Member must be 18 years of age or older for coverage consideration.
  •  

  • Documentation must include a confirmed diagnosis of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema, or asthma that is not adequately controlled with standard treatments.
  •  

  • The patient must demonstrate inadequate response to long-term use of a combination of an inhaled corticosteroid and a long-acting beta2-agonist (LABA) or a long-acting muscarinic receptor antagonist (LAMA).
  •  

  • There must be evidence that the patient has been adherent to their current respiratory treatment plan, and the treatment outcome is still inadequate.
  •  

  • A healthcare provider must provide a rationale for why Trelegy is preferred over other treatment options, indicating potential benefits related to the patient's specific condition or history.
  •  

  • Documentation should confirm there are no allergies to the components of Trelegy and that the patient is not at an increased risk of adverse reactions based on medical history and concurrent therapies.
  •  

  • Approval might require a trial period, with renewal subject to the patient demonstrating clinical improvement, not experiencing unacceptable side effects, and evidence of continued need as determined by a healthcare provider.

 

Why Affinity Health Plan Might Deny Trelegy Coverage

 

Non-Medically Necessary Use

 

  • Trelegy may be denied coverage if it is determined that the medication is not medically necessary for the member's condition.

 

Off-Label Use

 

  • Affinity Health Plan might not cover Trelegy if it is prescribed for a condition not approved by the FDA. Coverage is typically limited to approved indications.

 

Failure to Meet Step Therapy Requirements

 

  • If the member has not tried and failed on alternative treatments as required by the plan's step therapy protocols before Trelegy, coverage may be denied.

 

Lack of Prior Authorization

 

  • Coverage for Trelegy can be denied if prior authorization procedures were not completed before dispensing the medication.

 

Exclusion of Benefits

 

  • If Trelegy is explicitly listed under any exclusions in the coverage policy, it might not be covered under Affinity Health Plan.

 

Non-Compliance with Plan's Formulary

 

  • Trelegy might be denied if it is not listed on the plan’s formulary and no exception is granted.

 

Duplicate Therapy

 

  • If Trelegy is being prescribed concurrently with other medications that contain similar active ingredients or therapeutic outcomes, coverage might be denied due to duplicate therapy policies.

 

Coverage Limitations and Restrictions

 

  • There could be specific dosage or supply limits that, if exceeded, result in non-coverage of Trelegy.

 

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How Much Does Trelegy Cost without Insurance?

 

Approximate Cost of Trelegy Without Insurance

 

  • The cost of Trelegy Ellipta, without insurance, can vary significantly based on several factors like the pharmacy, geographical location, or available discounts. On average, patients can expect to pay between $550 to $650 for a 30-day supply.
  •  

  • Prices may also fluctuate depending on ongoing promotions or pharmacy memberships that can provide additional savings.
  •  

  • It’s advisable for patients to use discount cards, check for manufacturer coupons, or explore patient assistance programs to lower the out-of-pocket expense.
  •  

  • Shopping around, comparing prices at different pharmacies, or using online price comparison tools can also result in significant cost savings for Trelegy.

 

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 Trelegy Coverage with Affinity Health Plan

 

Initiate Contact with Affinity Health Plan

 

  • Reach out to Affinity Health Plan's customer service via phone, email, or online chat to inquire about including Trelegy within your coverage. Gather information about specific plans that accommodate this prescription.
  •  

  • Visit the official Affinity Health Plan website to locate relevant contact details and customer service options available for queries related to medication coverage.

 

Understand Prescription Coverage Policies

 

  • Review your current plan documentation to understand your prescription benefits. This will help determine if Trelegy is listed or what steps are needed to include it.
  •  

  • Learn about tiered prescription formularies, as some medications may have different co-pays or pre-authorization requirements stopping Trelegy's immediate coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of Trelegy for your condition. They may need to provide medical documentation supporting the requirement of this medication.
  •  

  • Your healthcare provider could assist in providing necessary paperwork or direct communication with Affinity to expedite coverage requests.

 

Submit a Coverage Request

 

  • Prepare and submit any required documentation, such as a request form, medical records, or a letter of necessity, to Affinity Health Plan to review for Trelegy coverage.
  •  

  • Ensure all paperwork is accurately filled out and contains all essential details regarding your health condition and the necessity of Trelegy.

 

Follow Up with Affinity Health Plan

 

  • Contact Affinity Health Plan after submission to check the status of your request. This will keep the communication line open and allow you to address any immediate concerns.
  •  

  • Inquire about the potential need for any additional documentation or steps required to finalize the coverage of Trelegy.

 

Consider Appeals Process

 

  • If initially denied, review Affinity Health Plan's appeals process to challenge the decision. Compile any additional supportive information from your healthcare provider if necessary.
  •  

  • Communicate with a plan representative to guide you through the appeal filing process and ask for any advice or additional steps to enhance the likelihood of approval.

 

Stay Informed and Persistent

 

  • Keep track of all interactions and documents sent and received while liaising with Affinity Health Plan to streamline any future discussions or appeals.
  •  

  • Maintain ongoing communication to ensure your request for Trelegy coverage is addressed promptly and efficiently.

 

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Trelegy FAQ

1. What are the side effects of Trelegy?

 

Common Side Effects of Trelegy

 

  • Headaches
  • Back pain
  • Hoarseness
  • Oral thrush

 

Serious Side Effects

 

  • Increased heart rate
  • Chest pain
  • High blood pressure
  • Pneumonia in COPD patients

 

Less Common Side Effects

 

  • Diarrhea
  • Cough
  • Sore throat
  • Gastrointestinal discomfort

 

Precautions

 

  • Monitor for worsening symptoms.
  • Consult a doctor for persistent side effects.

 

2. How does Trelegy compare to Breo?

 

Comparison of Trelegy and Breo

 

  • Trelegy combines three active ingredients: fluticasone furoate (a corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Breo contains only two: fluticasone furoate and vilanterol.
  •  

  • This combination in Trelegy allows for better control of symptoms for COPD patients requiring more comprehensive therapy, whereas Breo is more suitable for those requiring less intensive treatment.
  •  

  • Both medications are administered once daily via inhalation, but Trelegy’s triple therapy provides a broader mechanism of action.
  •  

  • Side effects are generally similar, though patients transitioning from Breo to Trelegy may experience different responses due to the added component.

 

3. Is Trelegy a steroid?

 

Is Trelegy a Steroid?

 

  • Components: Trelegy contains three active ingredients: fluticasone furoate, umeclidinium, and vilanterol. Fluticasone furoate is a corticosteroid.
  •  

  • Steroid Role: The corticosteroid in Trelegy helps reduce inflammation in the airways, which is crucial for treating conditions like COPD and asthma.
  •  

  • Multi-Action: In addition to the steroid, umeclidinium (an anticholinergic) and vilanterol (a long-acting beta-agonist) work to relax and open the airways.
  •  

  • Usage: Trelegy is inhaled, delivering these components directly to the lungs for targeted action, minimizing systemic steroid exposure.

 

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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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