Does Anthem Cover Vyvanse

Explore Anthem's Vyvanse coverage process, potential denials, access tips, costs without insurance, and FAQs to manage prescription expenses effectively.
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Does Anthem Cover Vyvanse

 

  • Anthem may cover Vyvanse, a medication for ADHD and binge eating disorder, under certain plans. Review your specific policy to confirm coverage.
  •  

  • Coverage often requires prior authorization from a healthcare provider. Obtain necessary documents detailing the medical necessity for Vyvanse.
  •  

  • The patient's diagnosis and prior treatment history might affect coverage eligibility. Anthem may require evidence of previous non-stimulant or generic stimulant trials.
  •  

  • Dosage and prescription duration must align with FDA-approved uses and Anthem's pharmacy guidelines. Check your plan for specific limitations.
  •  

  • Out-of-pocket costs will depend on your plan's copay, deductible, and medication tier placement. Use Anthem's online tools or seek assistance to understand coverage specifics and potential costs.

 

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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 Vyvanse Coverage with Anthem

 

Verify Vyvanse Coverage

 

  • Log into your Anthem insurance account through their official website or mobile app.
  •  

  • Look for the "Prescription Coverage" or "Drug Formulary" section to confirm if Vyvanse is listed as a covered medication.
  •  

  • If unable to find it, contact Anthem customer support for personalized assistance regarding your plan's formulary.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Vyvanse.
  •  

  • Ensure your healthcare provider is aware of your insurance coverage, as they may need to complete prior authorization forms.

 

Get a Prescription

 

  • Ask your healthcare provider to prescribe Vyvanse based on your medical evaluation.
  •  

  • Ensure the prescription includes necessary details like the dosage and daily quantity, tailored to your health needs.

 

Check for Prior Authorization Requirements

 

  • Contact Anthem or your pharmacy to confirm if Vyvanse requires prior authorization.
  •  

  • If prior authorization is needed, your healthcare provider should submit the necessary forms to Anthem. This process involves providing medical justification for the medication.

 

Submit Any Necessary Documentation

 

  • Follow up with your healthcare provider to ensure all required documentation is submitted to Anthem.
  •  

  • Upload or mail any additional documents Anthem might request, such as medical records or reports.

 

Track Authorization Status

 

  • Monitor the status of your prior authorization request by logging into your Anthem account or calling their customer service.
  •  

  • Inquire about the average processing time, so you have an idea of when you can expect a decision.

 

Get Your Prescription Filled

 

  • Once authorization is granted, take your prescription to a pharmacy that accepts Anthem insurance. Verify that Vyvanse is in stock.
  •  

  • Consult the pharmacy about any copayments, as these can vary based on your specific Anthem plan and prescription tier.

 

Appeal if Necessary

 

  • If your request for Vyvanse coverage is denied, consult with your healthcare provider about submitting an appeal to Anthem.
  •  

  • Work closely with Anthem's customer service and your healthcare provider to provide additional documentation and a detailed explanation for reconsideration.

 

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FAQs

Does Anthem Cover Vyvanse

Explore Anthem's Vyvanse coverage process, potential denials, access tips, costs without insurance, and FAQs to manage prescription expenses effectively.
Curex allergy drops unboxing

Is Vyvanse Covered by Anthem

 

Does Anthem Cover Vyvanse

 

  • Anthem may cover Vyvanse, a medication for ADHD and binge eating disorder, under certain plans. Review your specific policy to confirm coverage.
  •  

  • Coverage often requires prior authorization from a healthcare provider. Obtain necessary documents detailing the medical necessity for Vyvanse.
  •  

  • The patient's diagnosis and prior treatment history might affect coverage eligibility. Anthem may require evidence of previous non-stimulant or generic stimulant trials.
  •  

  • Dosage and prescription duration must align with FDA-approved uses and Anthem's pharmacy guidelines. Check your plan for specific limitations.
  •  

  • Out-of-pocket costs will depend on your plan's copay, deductible, and medication tier placement. Use Anthem's online tools or seek assistance to understand coverage specifics and potential costs.

 

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Anthem's Approved Criteria for Vyvanse Coverage

 

Coverage Criteria for Vyvanse under Anthem Insurance

 

  • The patient has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and requires pharmacological intervention as part of their treatment plan.
  •  

  • The prescribing healthcare provider must be a licensed physician specializing in mental health or a related field that includes prescribing medications for ADHD.
  •  

  • Vyvanse prescription is being requested after a trial of alternative ADHD medications has been documented as unsuccessful, intolerable, or contraindicated due to patient-specific health conditions.
  •  

  • The patient's comprehensive medical record should reflect previous treatment outcomes and the rationale for selecting Vyvanse as an appropriate next step in pharmacotherapy.
  •  

  • For continuation of Vyvanse coverage, the patient must demonstrate a positive response to the medication, necessitating documentation of improvement in ADHD symptoms as per evaluation by the healthcare provider.
  •  

  • Vyvanse is covered for the treatment of Binge Eating Disorder (BED) in adults who have been evaluated by a healthcare provider, confirming its necessity for managing the disorder's symptoms.
  •  

  • The initial prescription must be for a dosage within the FDA-approved guidelines, and any requests for dosage adjustment must be medically justified and documented by the prescribing healthcare provider.
  •  

  • Patients under 18 years of age require additional documentation from a pediatric or adolescent specialist, supporting Vyvanse usage as part of a comprehensive ADHD treatment plan.
  •  

 

Why Anthem Might Deny Vyvanse Coverage

 

Reasons Why Anthem Might Deny Vyvanse Coverage

 

  • Vyvanse is not considered medically necessary according to Anthem's guidelines for the patient's condition.
  •  

  • The prescribing doctor has not provided sufficient medical documentation to justify the use of Vyvanse.
  •  

  • The patient has not met the required step therapy protocols, which may necessitate trying and failing other medications before Vyvanse is approved.
  •  

  • The dosage prescribed exceeds the FDA-approved or plan-approved guidelines.
  •  

  • Vyvanse is being prescribed for an off-label use that Anthem does not cover.
  •  

  • The patient has not adhered to previous treatment plans, leading to a denial based on non-compliance.
  •  

  • The patient’s insurance plan explicitly excludes coverage for ADHD medications like Vyvanse.
  •  

  • The drug is not included in the formulary plan provided under the current policy.

 

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How Much Does Vyvanse Cost without Insurance?

 

Understanding the Cost of Vyvanse Without Insurance

 

  • Purchase prices for Vyvanse can vary depending on factors such as the dosage and the location of purchase. Typically, a 30-day supply of Vyvanse can price approximately between $350 and $500.
  •  

  • Costs might differ by pharmacy, with some options offering discounts or savings programs for those paying out-of-pocket.
  •  

  • It’s advisable to explore pharmacy discount cards or manufacturer copay assistance programs, as they can sometimes reduce the retail price.
  •  

  • Online pharmacy services may also present more competitive pricing, but always ensure they are reputable and that prescriptions are valid and properly filled.

 

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 Vyvanse Coverage with Anthem

 

Verify Vyvanse Coverage

 

  • Log into your Anthem insurance account through their official website or mobile app.
  •  

  • Look for the "Prescription Coverage" or "Drug Formulary" section to confirm if Vyvanse is listed as a covered medication.
  •  

  • If unable to find it, contact Anthem customer support for personalized assistance regarding your plan's formulary.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Vyvanse.
  •  

  • Ensure your healthcare provider is aware of your insurance coverage, as they may need to complete prior authorization forms.

 

Get a Prescription

 

  • Ask your healthcare provider to prescribe Vyvanse based on your medical evaluation.
  •  

  • Ensure the prescription includes necessary details like the dosage and daily quantity, tailored to your health needs.

 

Check for Prior Authorization Requirements

 

  • Contact Anthem or your pharmacy to confirm if Vyvanse requires prior authorization.
  •  

  • If prior authorization is needed, your healthcare provider should submit the necessary forms to Anthem. This process involves providing medical justification for the medication.

 

Submit Any Necessary Documentation

 

  • Follow up with your healthcare provider to ensure all required documentation is submitted to Anthem.
  •  

  • Upload or mail any additional documents Anthem might request, such as medical records or reports.

 

Track Authorization Status

 

  • Monitor the status of your prior authorization request by logging into your Anthem account or calling their customer service.
  •  

  • Inquire about the average processing time, so you have an idea of when you can expect a decision.

 

Get Your Prescription Filled

 

  • Once authorization is granted, take your prescription to a pharmacy that accepts Anthem insurance. Verify that Vyvanse is in stock.
  •  

  • Consult the pharmacy about any copayments, as these can vary based on your specific Anthem plan and prescription tier.

 

Appeal if Necessary

 

  • If your request for Vyvanse coverage is denied, consult with your healthcare provider about submitting an appeal to Anthem.
  •  

  • Work closely with Anthem's customer service and your healthcare provider to provide additional documentation and a detailed explanation for reconsideration.

 

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Vyvanse FAQ

What are the side effects of Vyvanse?

 

Common Side Effects

 

  • Loss of appetite
  • Insomnia
  • Dry mouth
  • Anxiety
  • Weight loss
  • Increased heart rate

 

Less Common Side Effects

 

  • Dizziness
  • Diarrhea
  • Rash
  • Blurred vision
  • Irritability

 

Serious Side Effects

 

  • Chest pain
  • Shortness of breath
  • Hallucinations
  • Severe anxiety or panic attacks
  • Swelling of extremities
  • Uncontrolled movements or vocal outbursts

 

Recommendations

 

  • Consult with a healthcare provider if side effects persist or worsen.
  • Monitor heart rate and blood pressure regularly.
  • Inform your doctor of any other medications being taken.

 

How long does Vyvanse stay in your system?

 

How Vyvanse Functions

 

  • Vyvanse is a prodrug, meaning it's inactive until metabolized in the body, which affects its duration.

 

Duration in the System

 

  • Vyvanse typically lasts 10-12 hours for therapeutic effects due to its extended-release formulation.
  • The half-life is around 10-13 hours, meaning it takes this time for half of the drug to be eliminated.

 

Detection Window

 

  • Blood: Detectable for up to 8 hours after ingestion.
  • Urine: Can be detected for up to 3 days, depending on metabolism and dosage.
  • Hair: May remain detectable for up to a month or longer.

 

Factors Influencing Duration

 

  • Metabolic rate, age, organ function, and dosage can alter the duration.
  • Chronic use may lead to accumulation, slightly extending the detectable period.

 

Is Vyvanse the same as Adderall?

 

Difference Between Vyvanse and Adderall

 

  • Composition: Vyvanse contains lisdexamfetamine, a prodrug requiring conversion in the body, while Adderall contains mixed amphetamine salts.
  •  

  • Onset: Vyvanse typically takes longer to start acting due to its prodrug nature, whereas Adderall provides quicker results.
  •  

  • Duration: Vyvanse lasts about 10-14 hours, while Adderall's duration varies based on the formulation: instant-release lasts 4-6 hours, extended-release lasts up to 12 hours.
  •  

  • Use: Both treat ADHD, but Vyvanse is also approved for binge eating disorder.
  •  

  • Abuse Potential: Vyvanse's requirement for metabolic activation reduces its immediate abuse risk compared to Adderall.

 

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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.

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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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