Does Anthem Cover Lantus

Explore Anthem's Lantus coverage, reasons for denial, ways to secure approval, costs without insurance, and FAQs in one comprehensive guide.
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Does Anthem Cover Lantus?

 

  • Anthem typically covers Lantus as part of its prescription drug benefits; however, this can vary based on the specific plan and state regulations.
  •  

  • To confirm coverage, it's essential to check the individual policy or consult the Anthem formulary or drug list.

 

Criteria for Coverage

 

  • Prescription: Coverage generally requires a prescription from a healthcare provider, confirming the medical necessity for Lantus.
  •  

  • Step Therapy: Some plans may require trying other diabetes medications before approving Lantus.
  •  

  • Prior Authorization: Anthem might need prior authorization, meaning your healthcare provider must justify why Lantus is necessary for you.

 

Steps to Obtain Coverage

 

  • Consult with your healthcare provider to discuss the need for Lantus, ensuring they provide necessary documentation and medical justification.
  •  

  • Review your Anthem plan details, including the formulary list, to understand any specific requirements like step therapy or prior authorization.
  •  

  • Contact Anthem customer service for assistance and to verify coverage specific to your plan.

 

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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 Lantus Coverage with Anthem

 

Contact Anthem Customer Service

 

  • Before taking any steps, contact Anthem's customer service to confirm if Lantus is included in your coverage plan. Have your policy number ready for reference.
  •  

  • Request detailed information on drug coverage, co-pays, and any necessary requirements for Lantus. Take notes during this conversation for future reference.

 

Verify Prescription Drug Formulary

 

  • Check Anthem's prescription drug formulary on their official website or through your Anthem member portal to ensure Lantus is listed as a covered medication.
  •  

  • If you can't find Lantus in the formulary list online, ask a customer service representative or your doctor to verify its coverage status. Formularies can differ by state and plan.

 

Consult Your Healthcare Provider

 

  • Discuss your need for Lantus with your healthcare provider and ensure they provide a prescription that aligns with Anthem's coverage policies.
  •  

  • Ask your provider for assistance with potential prior authorization documentation, if needed, to ensure coverage.

 

Prior Authorization Process

 

  • If prior authorization is needed by Anthem, work with your healthcare provider to gather required documents for the submission.
  •  

  • Submit the prior authorization form through Anthem's designated process, either online, via fax, or as directed by your provider.
  •  

  • Follow up with both Anthem and your healthcare provider to ensure the submission was successful and is being processed.

 

Explore Financial Assistance Options

 

  • If there are high out-of-pocket costs, inquire about financial assistance programs through Lantus's manufacturer or nonprofit organizations that may help reduce costs.
  •  

  • Contact your provider or pharmacy for potential alternative cost-saving strategies if Lantus is only partially covered or not covered at all.
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FAQs

Does Anthem Cover Lantus

Explore Anthem's Lantus coverage, reasons for denial, ways to secure approval, costs without insurance, and FAQs in one comprehensive guide.
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Is Lantus Covered by Anthem

 

Does Anthem Cover Lantus?

 

  • Anthem typically covers Lantus as part of its prescription drug benefits; however, this can vary based on the specific plan and state regulations.
  •  

  • To confirm coverage, it's essential to check the individual policy or consult the Anthem formulary or drug list.

 

Criteria for Coverage

 

  • Prescription: Coverage generally requires a prescription from a healthcare provider, confirming the medical necessity for Lantus.
  •  

  • Step Therapy: Some plans may require trying other diabetes medications before approving Lantus.
  •  

  • Prior Authorization: Anthem might need prior authorization, meaning your healthcare provider must justify why Lantus is necessary for you.

 

Steps to Obtain Coverage

 

  • Consult with your healthcare provider to discuss the need for Lantus, ensuring they provide necessary documentation and medical justification.
  •  

  • Review your Anthem plan details, including the formulary list, to understand any specific requirements like step therapy or prior authorization.
  •  

  • Contact Anthem customer service for assistance and to verify coverage specific to your plan.

 

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Anthem's Approved Criteria for Lantus Coverage

 

Eligibility for Lantus Coverage

 

  • The patient has a diagnosis of diabetes mellitus, which includes both type 1 and type 2 diabetes.
  •  

  • Lantus is prescribed as part of a comprehensive diabetes treatment plan which could include diet, exercise, and other antidiabetic agents.
  •  

  • The individual requires a long-acting insulin for the management of their blood glucose levels.
  •  

  • The patient has demonstrated inadequate glycemic control with oral antidiabetic agents alone.
  •  

 

Prior Authorization Requirements

 

  • A healthcare provider must submit documentation supporting the diagnosis of diabetes mellitus.
  •  

  • Detailed medical records should illustrate previous treatments and their outcomes, highlighting the necessity of adding Lantus to the treatment regimen.
  •  

  • The physician must provide a rationale for the preferred use of Lantus over other long-acting insulins if the patient has previously been on different insulin therapies.
  •  

 

Age Limitation

 

  • Lantus coverage is generally approved for patients 6 years of age and older.
  •  

  • Specific cases involving patients under 6 years may require additional medical justification and documentation provided by the healthcare professional.
  •  

 

Prescription Limitations

 

  • Coverage for Lantus is subject to quantity limits based on recommended dosing and the medical requirements of the patient.
  •  

  • Patients may be required to adhere to a step therapy protocol, which involves trying and failing preferred step therapy alternatives prior to receiving coverage for Lantus.
  •  

 

Re-Evaluation and Continuation of Coverage

 

  • Potential periodic re-evaluation of the patient’s response to therapy, focusing on improved glycemic control and overall health outcomes.
  •  

  • Continued approval might require submission of updated medical records or test results that reflect the medical necessity and efficacy of the ongoing treatment with Lantus.
  •  

 

Why Anthem Might Deny Lantus Coverage

 

Situations Where Anthem Might Deny Lantus Coverage

 

  • **Non-medically Necessary**: Anthem may deny coverage for Lantus if it is determined that the prescription is not medically necessary according to their clinical guidelines.
  •  

  • **Availability of Generics**: If a generic or lower-cost alternative to Lantus is available and deemed appropriate for the patient's condition, Anthem might deny coverage for Lantus to favor the cost-effective option.
  •  

  • **Policy Exclusions**: Anthem policies may include specific drug exclusion lists, and Lantus can be excluded from coverage based on these internal policies.
  •  

  • **Improper Documentation**: If there is insufficient or improper documentation provided by the healthcare provider to justify the use of Lantus, coverage may be denied.
  •  

  • **Prior Authorization Not Obtained**: Failure to obtain prior authorization from Anthem before filling the prescription for Lantus can result in a denial of coverage.
  •  

  • **Off-label Use**: Lantus prescribed for uses not approved by regulatory agencies might not be covered by Anthem, especially if there's insufficient evidence supporting the off-label use.
  •  

  • **Prior Treatment Requirements**: Anthem may require that other therapies have been tried and shown to be ineffective before Lantus is covered. If these step therapy requirements are not met, coverage might be denied.

 

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

  • The price of Lantus (insulin glargine) without insurance can vary based on factors such as the pharmacy, location, and available discounts. Typically, the retail price ranges between $250 and $350 for a 10ml vial at a retail pharmacy.
  •  

  • For the Lantus SoloStar pen, which is a more convenient option for some, the price is generally similar, ranging from $400 to $500 for a pack of five pens.
  •  

  • Prices can fluctuate slightly, so it is advisable to check with local pharmacies or online services for the most current prices and potential savings options.
  •  

  • Consider exploring patient assistance programs offered by the manufacturer or third-party organizations, which might offer Lantus at reduced prices or even for free if you qualify based on income.

 

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 Lantus Coverage with Anthem

 

Contact Anthem Customer Service

 

  • Before taking any steps, contact Anthem's customer service to confirm if Lantus is included in your coverage plan. Have your policy number ready for reference.
  •  

  • Request detailed information on drug coverage, co-pays, and any necessary requirements for Lantus. Take notes during this conversation for future reference.

 

Verify Prescription Drug Formulary

 

  • Check Anthem's prescription drug formulary on their official website or through your Anthem member portal to ensure Lantus is listed as a covered medication.
  •  

  • If you can't find Lantus in the formulary list online, ask a customer service representative or your doctor to verify its coverage status. Formularies can differ by state and plan.

 

Consult Your Healthcare Provider

 

  • Discuss your need for Lantus with your healthcare provider and ensure they provide a prescription that aligns with Anthem's coverage policies.
  •  

  • Ask your provider for assistance with potential prior authorization documentation, if needed, to ensure coverage.

 

Prior Authorization Process

 

  • If prior authorization is needed by Anthem, work with your healthcare provider to gather required documents for the submission.
  •  

  • Submit the prior authorization form through Anthem's designated process, either online, via fax, or as directed by your provider.
  •  

  • Follow up with both Anthem and your healthcare provider to ensure the submission was successful and is being processed.

 

Explore Financial Assistance Options

 

  • If there are high out-of-pocket costs, inquire about financial assistance programs through Lantus's manufacturer or nonprofit organizations that may help reduce costs.
  •  

  • Contact your provider or pharmacy for potential alternative cost-saving strategies if Lantus is only partially covered or not covered at all.

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Lantus FAQ

What is Lantus used for?

 

What is Lantus Used For?

 

  • Lantus is primarily used to manage blood sugar levels in individuals with type 1 and type 2 diabetes.
  •  

  • It is a long-acting insulin, providing a steady release of insulin over a 24-hour period with no pronounced peak, mimicking natural insulin secretion.
  •  

  • It's taken once daily, often at the same time each day, helping to maintain consistent blood glucose control.
  •  

  • Beneficial for patients requiring basal insulin to prevent hyperglycemia between meals and overnight.
  •  

  • Alongside diet and exercise, Lantus is vital for comprehensive diabetes management.

 

How does Lantus work in the body?

 

How Lantus Works

 

  • Lantus is a long-acting insulin, also known as insulin glargine. It provides a stable and continuous release of insulin to control blood sugar levels.
  •  

  • The formulation of Lantus enables it to dissolve slowly upon injection, creating a slow and steady insulin level that lasts up to 24 hours.
  •  

  • This minimizes the risk of blood sugar peaks and troughs, providing more consistent blood glucose management.
  •  

  • Lantus mimics the basal level of insulin production in the pancreas, thus helping to maintain glucose balance between meals and overnight.
  •  

  • It binds to insulin receptors, facilitating glucose uptake into muscle and fat tissues, while inhibiting hepatic glucose production.

 

What are the side effects of Lantus?

 

Common Side Effects

 

  • Injection site reactions such as redness, swelling, or itching can occur.
  • Hypoglycemia, or low blood sugar, is a frequent side effect.
  • Weight gain may happen due to improved glucose utilization.

 

Less Common Side Effects

 

  • Allergic reactions like rash or itching may occur but are rare.
  • Systemic reactions such as swelling of hands/feet can occur.
  • Visual changes might be experienced during initial treatment.

 

Serious Side Effects

 

  • Severe hypoglycemia requiring intervention.
  • Signs of allergic reactions like difficulty breathing, require immediate attention.
  • Hypokalemia may develop, leading to muscle weakness or cramps.

 

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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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