Does Amerigroup Cover Tirzepatide (Mounjaro)

Discover if Amerigroup covers Tirzepatide (Mounjaro). Learn about possible denial reasons, obtaining coverage, costs without insurance, and FAQs.
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Coverage Overview for Tirzepatide (Mounjaro)

 

  • Amerigroup's coverage for Tirzepatide (Mounjaro) can vary based on the specific plan and state.
  •  
  • It's often prescribed for adults with type 2 diabetes when diet and exercise are not enough.
  •  
  • Coverage might be included under certain conditions such as failure with other medications or specific diagnoses.

 

Criteria for Coverage

 

  • Medical necessity must be demonstrated, typically requiring a doctor's prescription that aligns with Amerigroup guidelines.
  •  
  • Prior authorization may be required to confirm that the patient meets the criteria set by Amerigroup.

 

Steps to Access Coverage

 

  • Consult with your healthcare provider to discuss if Tirzepatide is right for your condition.
  •  
  • Contact Amerigroup customer service to confirm specific coverage details for your plan.
  •  
  • Obtain necessary approvals and follow the prescription process as advised by your healthcare provider.

 

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

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

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

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

Kayla Mardaga, NP

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

How to Get Tirzepatide (Mounjaro) Coverage with Amerigroup

 

Check Amerigroup Coverage Policies

 

  • Consult the Amerigroup official website or your policy documents to see if Tirzepatide (Mounjaro) is on their list of covered medications.
  •  

  • Look for any prerequisites or specific conditions that need to be met for coverage, such as prior authorization requirements or step therapy protocols.

 

Consult Your Healthcare Provider

 

  • Speak with your healthcare provider about your interest in Mounjaro and discuss its suitability for your condition.
  •  

  • Ask your doctor to provide a prescription, along with any necessary documentation that might be required for the approval process, like medical history or previous treatment records.

 

Contact Amerigroup Customer Service

 

  • Reach out to Amerigroup’s customer service for guidance on getting coverage for Tirzepatide (Mounjaro). They can provide detailed information on their approval process and documentation requirements.
  •  

  • Request information about network pharmacies and any specific steps you should follow for obtaining the medication.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if needed. This often involves filling out forms and providing detailed medical documentation supporting the necessity of Tirzepatide.
  •  

  • Ensure that all forms and documents are completed accurately and submitted in a timely manner to avoid delays.

 

Appeal a Denial if Necessary

 

  • If your prior authorization request is denied, review the denial letter carefully to understand the reasons for denial and the appeals process.
  •  

  • Gather any additional information or documentation required and submit an appeal with assistance from your healthcare provider or a patient advocate.

 

Utilize Patient Assistance Programs

 

  • If you encounter financial barriers or coverage restrictions, investigate patient assistance programs offered by the drug manufacturer or third-party organizations.
  •  

  • Apply for these programs which may offer financial aid, discounts, or alternative solutions to access Tirzepatide (Mounjaro).

 

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FAQs

Does Amerigroup Cover Tirzepatide (Mounjaro)

Discover if Amerigroup covers Tirzepatide (Mounjaro). Learn about possible denial reasons, obtaining coverage, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Tirzepatide (Mounjaro) Covered by Amerigroup

 

Coverage Overview for Tirzepatide (Mounjaro)

 

  • Amerigroup's coverage for Tirzepatide (Mounjaro) can vary based on the specific plan and state.
  •  
  • It's often prescribed for adults with type 2 diabetes when diet and exercise are not enough.
  •  
  • Coverage might be included under certain conditions such as failure with other medications or specific diagnoses.

 

Criteria for Coverage

 

  • Medical necessity must be demonstrated, typically requiring a doctor's prescription that aligns with Amerigroup guidelines.
  •  
  • Prior authorization may be required to confirm that the patient meets the criteria set by Amerigroup.

 

Steps to Access Coverage

 

  • Consult with your healthcare provider to discuss if Tirzepatide is right for your condition.
  •  
  • Contact Amerigroup customer service to confirm specific coverage details for your plan.
  •  
  • Obtain necessary approvals and follow the prescription process as advised by your healthcare provider.

 

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Amerigroup's Approved Criteria for Tirzepatide (Mounjaro) Coverage

 

Amerigroup's Coverage Criteria for Tirzepatide (Mounjaro)

 

  • Eligibility is limited to individuals diagnosed with Type 2 Diabetes Mellitus who require additional glycemic management despite following a suitable diet and exercise regimen.
  •  

  • Coverage is typically provided for adults 18 years and older who have demonstrated inadequate control of blood glucose with the use of at least two other antidiabetic agents, which may include Metformin, Sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, or long-acting insulin.
  •  

  • A documented Body Mass Index (BMI) of 30 kg/m² or higher for those with associated comorbidities like hypertension or hyperlipidemia may be used as a supporting factor for coverage eligibility.
  •  

  • The prescribing healthcare provider must present necessary clinical documentation that illustrates the patient’s previous inadequate glycemic control, including recent A1C reports indicating levels above the individualized target set for the patient.
  •  

  • A professional assessment and recommendation that the patient can adhere to the injectable therapy regimen, with considerations for administration training and understanding of potential side effects and action plans.
  •  

  • Regular follow-up appointments should be planned for the management and monitoring of glycemic control, with periodic submissions of A1C levels to reassess ongoing coverage.

 

Why Amerigroup Might Deny Tirzepatide (Mounjaro) Coverage

 

Criteria for Denial of Tirzepatide (Mounjaro) Coverage by Amerigroup

 

  • Tirzepatide is not covered for individuals without a documented diagnosis of Type 2 diabetes.
  •  

  • Amerigroup may deny coverage if the medication is prescribed for weight loss management in individuals who are not diagnosed with Type 2 diabetes.
  •  

  • Coverage may be denied if Tirzepatide is requested as a first-line treatment when other medications or lifestyle changes have not been attempted or documented.
  •  

  • Amerigroup does not cover Tirzepatide if it is used in conjunction with another GLP-1 receptor agonist or similar class medications unless medically justified and documented.
  •  

  • The use of Tirzepatide in pediatric populations is not covered unless explicit indications and approvals are available.
  •  

  • Amerigroup may deny coverage if there is lack of documented failure or intolerance to other preferred diabetes treatments.
  •  

  • Tirzepatide is not covered if prescribed off-label for conditions not approved by the FDA.
  •  

  • Request may be denied if there is insufficient or lack of prior authorization documentation supporting the medical necessity of Tirzepatide.
  •  

  • Amerigroup may deny coverage if proper steps in the step therapy protocol have not been followed or documented according to their policy.
  •  

  • Medication is not covered if the prescriber is not an in-network provider without an appropriate referral.

 

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How Much Does Tirzepatide (Mounjaro) Cost without Insurance?

 

Cost of Tirzepatide (Mounjaro) Without Insurance

 

  • The approximate cost of Tirzepatide, commonly known by its brand name Mounjaro, can vary based on several factors including the pharmacy location and any available discounts.
  •  

  • On average, the price for four doses of Mounjaro, which is typically a one-month supply, is estimated to be between $1,000 and $1,250 without any insurance coverage.
  •  

  • It's essential for patients to check with different pharmacies and consider available savings programs or manufacturer coupons which might offer significant reductions or discounts.
  •  

  • Additionally, some pharmacies might provide membership programs or discount cards that could further lower the costs.

 

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 Tirzepatide (Mounjaro) Coverage with Amerigroup

 

Check Amerigroup Coverage Policies

 

  • Consult the Amerigroup official website or your policy documents to see if Tirzepatide (Mounjaro) is on their list of covered medications.
  •  

  • Look for any prerequisites or specific conditions that need to be met for coverage, such as prior authorization requirements or step therapy protocols.

 

Consult Your Healthcare Provider

 

  • Speak with your healthcare provider about your interest in Mounjaro and discuss its suitability for your condition.
  •  

  • Ask your doctor to provide a prescription, along with any necessary documentation that might be required for the approval process, like medical history or previous treatment records.

 

Contact Amerigroup Customer Service

 

  • Reach out to Amerigroup’s customer service for guidance on getting coverage for Tirzepatide (Mounjaro). They can provide detailed information on their approval process and documentation requirements.
  •  

  • Request information about network pharmacies and any specific steps you should follow for obtaining the medication.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if needed. This often involves filling out forms and providing detailed medical documentation supporting the necessity of Tirzepatide.
  •  

  • Ensure that all forms and documents are completed accurately and submitted in a timely manner to avoid delays.

 

Appeal a Denial if Necessary

 

  • If your prior authorization request is denied, review the denial letter carefully to understand the reasons for denial and the appeals process.
  •  

  • Gather any additional information or documentation required and submit an appeal with assistance from your healthcare provider or a patient advocate.

 

Utilize Patient Assistance Programs

 

  • If you encounter financial barriers or coverage restrictions, investigate patient assistance programs offered by the drug manufacturer or third-party organizations.
  •  

  • Apply for these programs which may offer financial aid, discounts, or alternative solutions to access Tirzepatide (Mounjaro).

 

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.

Tirzepatide (Mounjaro) FAQ

What are common side effects of Tirzepatide (Mounjaro)?

 

Common Side Effects of Tirzepatide (Mounjaro)

 

  • Nausea: Frequently reported, especially when starting treatment or increasing the dose.
  •  

  • Diarrhea: Some patients experience loose stools during treatment.
  •  

  • Decreased Appetite: Commonly occurs and can aid in weight management.
  •  

  • Vomiting: May happen occasionally, often alongside nausea.
  •  

  • Constipation: Some individuals might experience slower bowel movements.
  •  

  • Abdominal Pain: Discomfort or pain may occur during therapy.
  •  

  • Fatigue: A feeling of tiredness or exhaustion might present itself in some users.
  •  

  • In rare cases, hypoglycemia occurs, especially if combined with insulin or sulfonylureas.

 

How does Tirzepatide (Mounjaro) help with weight loss?

 

How Tirzepatide Aids Weight Loss

 

  • Dual Agonist Action: Tirzepatide acts on both GLP-1 and GIP receptors. These hormones help regulate appetite and glucose, influencing energy balance and metabolism.
  •  

  • Appetite Suppression: By mimicking these hormones, it reduces hunger, promoting lower calorie intake.
  •  

  • Increased Satiety: Delays gastric emptying, enhancing fullness and reducing meal frequency.
  •  

  • Improved Blood Sugar Control: Helps stabilize blood glucose levels, reducing insulin spikes that can stimulate hunger.
  •  

  • Enhanced Energy Expenditure: Modulates metabolic pathways to increase calorie burning, aiding fat loss.

 

Is Tirzepatide (Mounjaro) the same as Ozempic or Wegovy?

 

Comparing Tirzepatide with Ozempic and Wegovy

 

  • Composition: Tirzepatide (Mounjaro), Ozempic, and Wegovy are different medications. Tirzepatide is a dual GIP and GLP-1 receptor agonist, whereas Ozempic and Wegovy contain semaglutide, a GLP-1 receptor agonist.
  •  

  • Indications: Both Ozempic and Mounjaro target type 2 diabetes, but Wegovy is approved mainly for chronic weight management.
  •  

  • Mechanism: All induce insulin secretion and appetite suppression, yet Mounjaro's dual action may offer distinct benefits in glucose control and weight loss.
  •  

  • Dosage and Administration: Dosage forms and protocols vary; always follow medical guidance specific to the prescribed drug.
  •  

  • Considerations: Always consult your healthcare provider to determine the best option based on personal health needs and conditions.

 

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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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