Does Affinity Health Plan Cover Trulicity

Discover if Affinity Health Plan covers Trulicity, reasons for denial, coverage tips, costs without insurance, and find answers to common Trulicity questions.
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Does Affinity Health Plan Cover Trulicity?

 

  • Trulicity may be covered by Affinity Health Plan under their prescription drug benefits, but specific coverage can vary based on the plan.
  •  

  • Typically, coverage for Trulicity requires it to be deemed medically necessary, usually for managing type 2 diabetes.
  •  

  • To get Trulicity covered, you might need prior authorization, where your healthcare provider provides evidence of need.
  •  

  • Formulary listing affects coverage; check if Trulicity is included in Affinity's formulary or if alternatives are preferred.
  •  

  • Plan members typically pay a co-pay or co-insurance as per their prescription benefits.
  •  

  • Always verify with Affinity Health Plan directly for the most accurate and personalized information regarding coverage.

 

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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.

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 Trulicity Coverage with Affinity Health Plan

 

Start with Affinity Health Plan Membership

 

  • Ensure you have an active Affinity Health Plan membership. Visit their official website or contact customer service to confirm your membership status.
  • If you're not a member yet, you can apply for membership through the Affinity Health Plan website or seek assistance from a customer service representative.

 

Check Plan Details for Prescription Coverage

 

  • Review the specific details of your Affinity Health Plan to determine the prescription drug coverage options.
  • Look for the formulary or list of covered medications. Ensure that Trulicity is included or if prior authorization is required.

 

Consult with Healthcare Provider

 

  • Discuss your need for Trulicity with your healthcare provider, who can assess your medical condition and confirm if Trulicity is appropriate for you.
  • Request a prescription for Trulicity if it aligns with your treatment plan. Your doctor may need to provide clinical justification for insurance coverage.

 

Contact Affinity Health Plan

 

  • Reach out to Affinity Health Plan’s customer service to understand the process for obtaining coverage for Trulicity.
  • Inquire about any necessary documentation or procedures that need to be completed before coverage can be approved.

 

Submit Necessary Documentation

 

  • Provide any required documentation, such as a prior authorization form or medical necessity letter from your doctor, to Affinity Health Plan.
  • Be proactive in communicating with both your healthcare provider and Affinity Health Plan to ensure all paperwork is handled timely and efficiently.

 

Verify Trulicity Coverage and Authorization

 

  • Once all documentation is submitted, verify with Affinity Health Plan that Trulicity is authorized and covered under your plan.
  • Ask about any copayments, deductibles, or out-of-pocket costs associated with your Trulicity prescription.

 

Fill Your Prescription

 

  • Take your prescription to the pharmacy that partners with Affinity Health Plan or use their mail order service, if available.
  • Ensure that the pharmacy confirms the insurance coverage before filling the prescription to avoid unexpected costs.

 

Monitor and Adjust as Needed

 

  • Keep track of your prescription refills and any policy updates from Affinity Health Plan that could affect your coverage.
  • Stay in touch with your healthcare provider for ongoing management and to address any concerns regarding your Trulicity treatment.

 

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FAQs

Does Affinity Health Plan Cover Trulicity

Discover if Affinity Health Plan covers Trulicity, reasons for denial, coverage tips, costs without insurance, and find answers to common Trulicity questions.
Curex allergy drops unboxing

Is Trulicity Covered by Affinity Health Plan

 

Does Affinity Health Plan Cover Trulicity?

 

  • Trulicity may be covered by Affinity Health Plan under their prescription drug benefits, but specific coverage can vary based on the plan.
  •  

  • Typically, coverage for Trulicity requires it to be deemed medically necessary, usually for managing type 2 diabetes.
  •  

  • To get Trulicity covered, you might need prior authorization, where your healthcare provider provides evidence of need.
  •  

  • Formulary listing affects coverage; check if Trulicity is included in Affinity's formulary or if alternatives are preferred.
  •  

  • Plan members typically pay a co-pay or co-insurance as per their prescription benefits.
  •  

  • Always verify with Affinity Health Plan directly for the most accurate and personalized information regarding coverage.

 

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Affinity Health Plan's Approved Criteria for Trulicity Coverage

 

Eligibility Criteria for Trulicity Coverage

 

  • The patient must have a documented diagnosis of Type 2 Diabetes Mellitus.
  •  

  • The patient should be 18 years of age or older.
  •  

  • The prescription must be issued by a licensed healthcare provider specializing in endocrinology, diabetology, or internal medicine.

 

Medication Requirements

 

  • Trulicity must be prescribed as part of a comprehensive diabetes management plan, including diet and exercise.
  •  

  • The patient should have inadequate glycemic control with their current therapeutic regimen.

 

Step Therapy

 

  • The patient must have previously tried and failed, or have contraindications or intolerance to, metformin unless otherwise contraindicated.

 

Additional Clinical Information

 

  • The prescribing physician must provide documentation showing a detailed history of the patient’s glucose levels and the requirement for additional therapy.
  •  

  • A clinical rationale is needed if Trulicity is to be used as an adjunct therapy to insulin.

 

Renewal Criteria

 

  • The patient’s latest HbA1c results should indicate an improvement in glycemic control since the initiation of Trulicity therapy.
  •  

  • The patient should not have experienced significant adverse effects from Trulicity that would warrant discontinuation.

 

Why Affinity Health Plan Might Deny Trulicity Coverage

 

Situations Where Affinity Health Plan Might Deny Trulicity Coverage

 

  • **Non-Medical Necessity:** Coverage might be denied if the prescribed use of Trulicity is not deemed medically necessary according to Affinity Health Plan's criteria and guidelines.
  •  

  • **Off-Label Use:** If Trulicity is prescribed for a condition or in a manner not approved by the FDA, Affinity Health Plan may refuse coverage.
  •  

  • **Lack of Prior Authorization:** If prior authorization is required and not obtained before filling the prescription, coverage may be denied.
  •  

  • **Excluded from Plan Benefits:** If Trulicity is listed as an excluded medication under the specific health plan benefits, it may not be covered.
  •  

  • **Non-Compliance with Step Therapy:** Coverage can be denied if step therapy protocols require trials of other medications first and the patient does not comply with these steps before using Trulicity.
  •  

  • **Failure to Meet Criteria Amid Dosage Restrictions:** If the prescribed dosage exceeds plan coverage limits without justifiable medical reason or additional authorizations, payment for the medication might be denied.
  •  

  • **Non-Formulary Medication:** If Trulicity is not on the formulary list for the specific health plan, this could result in a denial of coverage.
  •  

  • **Eligibility Criteria Not Met:** If the patient does not meet required eligibility criteria based on age, diagnosis, or other health plan-specific factors, the plan might deny coverage.

 

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

How Much Does Trulicity Cost without Insurance?

 

Trulicity Cost Overview

 

  • Trulicity is a brand-name medication commonly used to treat type 2 diabetes. It's administered through a weekly injection.

 

Approximate Cost Without Insurance

 

  • The price of Trulicity can vary depending on the pharmacy or location, but the average cost for one pen of 1.5 mg/0.5 mL solution might run approximately $886 to $1,100.
  • Each box typically contains four pens, which is a month's supply, resulting in the total cost being roughly $3,544 to $4,400.

 

Factors Influencing Pricing

 

  • Pharmacy: Prices may differ from one pharmacy to another, so it’s beneficial to compare costs.
  • Location: Costs may vary based on geographic location due to regional pricing strategies and pharmacy benefits.
  • Discount Programs: Some pharmacies may offer savings programs or coupons that could lower the price.

 

Additional Cost-Saving Tips

 

  • Check for manufacturer discounts or patient assistance programs, which may offer significant savings or even free medication for qualified individuals.
  • Consider discussing alternative medications with your healthcare provider to find a more affordable option suitable for your needs.
  • Utilize pharmacy discount cards or look up savings programs online that specifically cater to diabetes medications.

 

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 Trulicity Coverage with Affinity Health Plan

 

Start with Affinity Health Plan Membership

 

  • Ensure you have an active Affinity Health Plan membership. Visit their official website or contact customer service to confirm your membership status.
  • If you're not a member yet, you can apply for membership through the Affinity Health Plan website or seek assistance from a customer service representative.

 

Check Plan Details for Prescription Coverage

 

  • Review the specific details of your Affinity Health Plan to determine the prescription drug coverage options.
  • Look for the formulary or list of covered medications. Ensure that Trulicity is included or if prior authorization is required.

 

Consult with Healthcare Provider

 

  • Discuss your need for Trulicity with your healthcare provider, who can assess your medical condition and confirm if Trulicity is appropriate for you.
  • Request a prescription for Trulicity if it aligns with your treatment plan. Your doctor may need to provide clinical justification for insurance coverage.

 

Contact Affinity Health Plan

 

  • Reach out to Affinity Health Plan’s customer service to understand the process for obtaining coverage for Trulicity.
  • Inquire about any necessary documentation or procedures that need to be completed before coverage can be approved.

 

Submit Necessary Documentation

 

  • Provide any required documentation, such as a prior authorization form or medical necessity letter from your doctor, to Affinity Health Plan.
  • Be proactive in communicating with both your healthcare provider and Affinity Health Plan to ensure all paperwork is handled timely and efficiently.

 

Verify Trulicity Coverage and Authorization

 

  • Once all documentation is submitted, verify with Affinity Health Plan that Trulicity is authorized and covered under your plan.
  • Ask about any copayments, deductibles, or out-of-pocket costs associated with your Trulicity prescription.

 

Fill Your Prescription

 

  • Take your prescription to the pharmacy that partners with Affinity Health Plan or use their mail order service, if available.
  • Ensure that the pharmacy confirms the insurance coverage before filling the prescription to avoid unexpected costs.

 

Monitor and Adjust as Needed

 

  • Keep track of your prescription refills and any policy updates from Affinity Health Plan that could affect your coverage.
  • Stay in touch with your healthcare provider for ongoing management and to address any concerns regarding your Trulicity treatment.

 

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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.

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Trulicity FAQ

What are the common side effects of Trulicity?

 

Common Side Effects of Trulicity

 

  • Nausea: Initially, many patients experience nausea, which often lessens over time as the body adjusts.
  •  

  • Vomiting: Some individuals may experience vomiting, particularly in the first few doses.
  •  

  • Diarrhea: Digestive disturbances such as diarrhea are commonly reported.
  •  

  • Abdominal Pain: Discomfort in the abdomen can occur, often subsiding with continued use.
  •  

  • Decreased Appetite: Patients often report a reduction in appetite.
  •  

  • Fatigue: Some individuals may feel unusually tired after starting treatment.
  •  

  • Reduced Blood Sugar: Blood sugar levels may become low, especially when used in conjunction with other diabetes medications.

 

How much weight can you lose on Trulicity?

 

Weight Loss with Trulicity

 

  • Trulicity (dulaglutide) is primarily prescribed for managing type 2 diabetes, but many patients also experience weight loss as an additional benefit.
  •  

  • Clinical trials indicate an average weight loss of around 2-6 pounds, but results differ based on individual factors such as diet, exercise, and adherence to the medication.
  •  

  • Some users report greater weight loss; however, it's important to accompany Trulicity with lifestyle changes for optimal results.
  •  

  • Consult with a healthcare provider to tailor a plan that maximizes benefits based on your health needs.

 

How does Trulicity work for type 2 diabetes?

 

How Trulicity Works

 

  • Trulicity is a GLP-1 receptor agonist, helping to regulate blood sugar levels.
  •  

  • It stimulates insulin release in response to high blood glucose.
  •  

  • It slows gastric emptying, which helps reduce post-meal glucose spikes.
  •  

  • Trulicity suppresses glucagon secretion, lowering glucose production by the liver.

 

Benefits

 

  • Easy-to-use once-weekly injection, improving adherence.
  •  

  • Not associated with causing weight gain; may even promote modest weight loss.
  •  

  • May reduce risk of cardiovascular events in patients with heart disease.

 

Considerations

 

  • May cause gastrointestinal side effects, often resolving over time.
  •  

  • Inform your doctor if you have a history of pancreatitis or gallbladder disease.
  •  

  • Monitor for signs of low blood sugar, especially if using other diabetes medications.

 

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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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