Does Anthem Cover Januvia

Explore Anthem's coverage policy for Januvia, including reasons for denials, strategies for approval, costs without insurance, and answers to FAQs.
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Coverage for Januvia with Anthem

 

  • Anthem may cover Januvia, a medication for type 2 diabetes, under certain plans. It's typically covered when deemed medically necessary by a healthcare provider.
  •  

  • Coverage often requires meeting specific criteria including prior authorization. This means your doctor may need to verify the necessity of Januvia.
  •  

  • Patients may need to demonstrate that other less expensive diabetes medications were ineffective before Anthem approves coverage for Januvia.
  •  

  • Your Anthem plan's specific benefits, formulary status, and tier level influence how much you pay out-of-pocket.
  •  

  • Check with Anthem directly or review your health insurance plan documents to confirm coverage details specific to your policy.

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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.

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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 Januvia Coverage with Anthem

 

Check Coverage Basics

 

  • Contact Anthem customer service to confirm if Januvia is included in your specific plan's formulary, which is a list of covered drugs.
  •  

  • Review your benefits package or online account with Anthem to verify coverage details, including co-pays and any coverage limits.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about Januvia as an option for your condition. Ensure that your provider considers it medically necessary for your treatment.
  •  

  • Ask your healthcare provider to write a prescription for Januvia, specifying the dosage and quantity needed.

 

Understand Prior Authorization Requirements

 

  • Determine if Anthem requires prior authorization for Januvia. This means Anthem must approve the medication before you fill the prescription.
  •  

  • Work with your healthcare provider to submit any necessary documentation to Anthem for prior approval if required.

 

Submit a Coverage Request

 

  • Complete any required forms provided by Anthem to request coverage for Januvia. These can typically be found on the Anthem website or via their customer service.
  •  

  • Provide all necessary information, including your healthcare provider's contact details and the prescription for Januvia, along with any medical necessity documentation.

 

Appeals Process

 

  • If your initial request is denied, review the denial letter from Anthem for specific reasons. This letter will also include instructions on how to file an appeal.
  •  

  • Work with your healthcare provider to provide additional documentation or clarification that could support the medical necessity of Januvia for your treatment.
  •  

  • Submit your appeal within the timeframe specified by Anthem, ensuring all requested information is included.

 

Pharmacy Coordination

 

  • Once coverage is approved, coordinate with a pharmacy that is in Anthem's network to fill your prescription for Januvia.
  •  

  • Discuss with your pharmacist about any questions you might have concerning co-pays or drug interactions.

 

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FAQs

Does Anthem Cover Januvia

Explore Anthem's coverage policy for Januvia, including reasons for denials, strategies for approval, costs without insurance, and answers to FAQs.
Curex allergy drops unboxing

Is Januvia Covered by Anthem

 

Coverage for Januvia with Anthem

 

  • Anthem may cover Januvia, a medication for type 2 diabetes, under certain plans. It's typically covered when deemed medically necessary by a healthcare provider.
  •  

  • Coverage often requires meeting specific criteria including prior authorization. This means your doctor may need to verify the necessity of Januvia.
  •  

  • Patients may need to demonstrate that other less expensive diabetes medications were ineffective before Anthem approves coverage for Januvia.
  •  

  • Your Anthem plan's specific benefits, formulary status, and tier level influence how much you pay out-of-pocket.
  •  

  • Check with Anthem directly or review your health insurance plan documents to confirm coverage details specific to your policy.

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Anthem's Approved Criteria for Januvia Coverage

 

Januvia Coverage Criteria by Anthem

 

  • Patient must be diagnosed with type 2 diabetes mellitus.
  •  

  • Januvia is prescribed by a licensed healthcare professional specializing in diabetes management.
  •  

  • Patient must demonstrate inadequate glycemic control on monotherapy with diet and exercise alone.
  •  

  • Consideration for coverage is if the patient has contraindications or intolerance to metformin, or if there is a documented failure to reach glycemic targets despite maximum tolerated dose of metformin.
  •  

  • Januvia may be approved as part of a combination therapy with other antihyperglycemic agents, excluding insulin.
  •  

  • Continued coverage requires periodic evaluation by the prescriber, at least annually, to assess effectiveness and safety.
  •  

  • Documentation of patient's HbA1c levels before initiation of Januvia therapy is required and must show improvement with treatment.
  •  

  • Patient must not have a history of hypersensitivity reaction to any component of Januvia.

 

Why Anthem Might Deny Januvia Coverage

 

Reasons Anthem Might Deny Januvia Coverage

 

  • Januvia is prescribed for an off-label use that is not approved by the FDA or recognized in Anthem’s medical policy guidelines.
  •  

  • The patient has not met the prior authorization requirements, such as providing sufficient medical documentation justifying the need for Januvia specifically.
  •  

  • Januvia is not included in the patient’s specific Anthem plan formulary, possibly due to formulary tier categorizations within the insurance plan benefits.
  •  

  • The patient does not have a diagnosis that aligns with the standard indications for Januvia as outlined in Anthem’s policy, such as being prescribed for use in individuals without type 2 diabetes.
  •  

  • The prescribed dosage or form of Januvia is inconsistent with the established guidelines and recommended doses within Anthem’s coverage criteria.
  •  

  • Medical evidence from the patient is insufficient to demonstrate necessity over alternative covered treatments which may be more cost-effective or align better with plan guidelines.

 

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How Much Does Januvia Cost without Insurance?

 

Cost of Januvia Without Insurance

 

  • The cost of Januvia (sitagliptin) without insurance can vary based on the pharmacy and location but is typically around $500 to $600 for a 30-day supply of 100 mg tablets.
  •  

  • Prices may differ based on various factors, including pharmacy location, any discount programs available, or changes in the drug market.
  •  

  • It's advisable to check different pharmacies or consider discount programs and prescription savings cards, which can sometimes offer reductions on the retail price.
  •  

  • For individuals paying out of pocket, some online tools or pharmacy networks provide price comparison services to find the best possible rate for Januvia.

 

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 Januvia Coverage with Anthem

 

Check Coverage Basics

 

  • Contact Anthem customer service to confirm if Januvia is included in your specific plan's formulary, which is a list of covered drugs.
  •  

  • Review your benefits package or online account with Anthem to verify coverage details, including co-pays and any coverage limits.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about Januvia as an option for your condition. Ensure that your provider considers it medically necessary for your treatment.
  •  

  • Ask your healthcare provider to write a prescription for Januvia, specifying the dosage and quantity needed.

 

Understand Prior Authorization Requirements

 

  • Determine if Anthem requires prior authorization for Januvia. This means Anthem must approve the medication before you fill the prescription.
  •  

  • Work with your healthcare provider to submit any necessary documentation to Anthem for prior approval if required.

 

Submit a Coverage Request

 

  • Complete any required forms provided by Anthem to request coverage for Januvia. These can typically be found on the Anthem website or via their customer service.
  •  

  • Provide all necessary information, including your healthcare provider's contact details and the prescription for Januvia, along with any medical necessity documentation.

 

Appeals Process

 

  • If your initial request is denied, review the denial letter from Anthem for specific reasons. This letter will also include instructions on how to file an appeal.
  •  

  • Work with your healthcare provider to provide additional documentation or clarification that could support the medical necessity of Januvia for your treatment.
  •  

  • Submit your appeal within the timeframe specified by Anthem, ensuring all requested information is included.

 

Pharmacy Coordination

 

  • Once coverage is approved, coordinate with a pharmacy that is in Anthem's network to fill your prescription for Januvia.
  •  

  • Discuss with your pharmacist about any questions you might have concerning co-pays or drug interactions.

 

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Januvia FAQ

What are the common side effects of Januvia?

 

Common Side Effects of Januvia

 

  • **Headache**: Often reported and can range from mild to moderate.
  •  

  • **Upper respiratory tract infections**: Can include symptoms like nasal congestion, sore throat, and runny nose.
  •  

  • **Sore throat**: May occur alongside other symptoms such as cough.
  •  

  • **Diarrhea**: Typically mild but can be uncomfortable.
  •  

  • **Nausea**: Some patients experience this, usually transient.
  •  

  • **Abdominal pain**: Not very common but can occur.
  •  

  • **Joint pain**: Although less common, can be experienced by some individuals.

How does Januvia work to control blood sugar?

 

How Januvia Works

 

  • Januvia (sitagliptin) is a DPP-4 inhibitor that enhances the body's own ability to control blood sugar levels by increasing incretin levels, hormones that help regulate insulin production.
  •  

  • Incretins like GLP-1 function by promoting insulin secretion from the pancreas when blood sugar levels are high, and they reduce glucose production in the liver.

 

Benefits

 

  • Prevents rapid glucose level increases after meals while maintaining normal insulin activity during fasting states.
  •  

  • Has a low risk of causing hypoglycemia, a common concern with some other diabetes medications.

 

Considerations

 

  • Commonly prescribed for patients with type 2 diabetes as part of a comprehensive health plan, including diet and exercise.
  •  

  • Adjustments may be necessary for those with renal impairment.

 

Can Januvia be taken with other diabetes medications?

 

Can Januvia Be Combined with Other Diabetes Medications?

 

  • Januvia, a DPP-4 inhibitor, is commonly used with other oral diabetes medications like metformin, sulfonylureas, or thiazolidinediones to improve blood sugar control.
  •  

  • When combined, careful monitoring is essential to avoid hypoglycemia, especially when Januvia is used with insulin or sulfonylureas which can lower blood sugar too much.
  •  

  • Consult your healthcare provider before combining januvia with any other medication to tailor treatment to your specific needs and health status.
  •  

  • There generally aren’t major drug-drug interaction concerns with Januvia, but liver and kidney function should be regularly assessed as they might affect treatment.

 

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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.

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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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