Does Blue Cross Blue Shield Cover Lantus

Explore Lantus coverage with Blue Cross Blue Shield, reasons for denial, tips for approval, costs without insurance, and FAQs in this informative guide.
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Does Blue Cross Blue Shield Cover Lantus?

 

  • Blue Cross Blue Shield typically covers Lantus under its prescription drug plans, but coverage specifics can vary by individual policy and state regulations.
  • Generally, coverage is provided for conditions such as Type 1 and Type 2 diabetes when Lantus is deemed medically necessary by a healthcare provider.
  • Plans may require prior authorization, meaning a healthcare provider must demonstrate Lantus is necessary for effective treatment.
  • Some plans might encourage trying less expensive insulin options before approving Lantus through step therapy protocols.
  • Patients should verify with their specific Blue Cross Blue Shield plan for details regarding copayments, deductibles, and any restrictions that might apply.
  • Using pharmacies within the insurer's network can help maximize benefits and reduce out-of-pocket costs.

 

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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 Blue Cross Blue Shield

 

Verify Your Insurance Plan

 

  • Check your specific Blue Cross Blue Shield (BCBS) plan details by reviewing the policy documents or logging into your member account on their website.
  •  

  • Look for information on prescription drug coverage and locate the formulary list to see if Lantus is included.
  •  

  • If you can't find the information, contact BCBS customer service for clarification on whether Lantus is covered under your plan.

 

Consult With Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Lantus for your medical condition and alternative options if it's not covered.
  •  

  • Ask your healthcare provider to write a prescription for Lantus if it's deemed necessary and you confirm it's covered.
  •  

  • Your healthcare provider can sometimes assist with prior authorization or justification for insurance coverage.

 

Understand Prior Authorization Requirements

 

  • If Lantus requires prior authorization, gather all necessary documentation and medical history needed for submission.
  •  

  • Get a prior authorization request form, often available on the BCBS website or through your healthcare provider.
  •  

  • Coordinate with your healthcare provider to complete and submit the prior authorization form along with the necessary supporting documents.

 

Call BCBS For Assistance

 

  • Contact BCBS member services directly for assistance on how to ensure Lantus is covered.
  •  

  • Request a clear explanation of your prescription benefits and ask for any required forms or instructions for obtaining coverage.
  •  

  • Take notes on the information provided and keep records of all correspondence and reference numbers from the BCBS representatives.

 

Consider Appeals If Denied

 

  • If coverage for Lantus is denied, review the denial letter carefully to understand the reasons for denial.
  •  

  • Prepare and submit an appeal letter with detailed explanation and supporting documents justifying the medical necessity of Lantus.
  •  

  • Your healthcare provider's input can be valuable in strengthening your appeal.

 

Explore Additional Assistance Programs

 

  • If difficulties persist in obtaining Lantus coverage, explore patient assistance programs or discount cards provided by the manufacturer.
  •  

  • Organizations such as NeedyMeds or the Partnership for Prescription Assistance may provide support for individuals struggling with medication costs.
  •  

  • Consider consulting with a pharmacist who might provide additional advice on securing affordable access to Lantus.

 

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Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Blue Cross Blue Shield Cover Lantus

Explore Lantus coverage with Blue Cross Blue Shield, reasons for denial, tips for approval, costs without insurance, and FAQs in this informative guide.
Curex allergy drops unboxing

Is Lantus Covered by Blue Cross Blue Shield

 

Does Blue Cross Blue Shield Cover Lantus?

 

  • Blue Cross Blue Shield typically covers Lantus under its prescription drug plans, but coverage specifics can vary by individual policy and state regulations.
  • Generally, coverage is provided for conditions such as Type 1 and Type 2 diabetes when Lantus is deemed medically necessary by a healthcare provider.
  • Plans may require prior authorization, meaning a healthcare provider must demonstrate Lantus is necessary for effective treatment.
  • Some plans might encourage trying less expensive insulin options before approving Lantus through step therapy protocols.
  • Patients should verify with their specific Blue Cross Blue Shield plan for details regarding copayments, deductibles, and any restrictions that might apply.
  • Using pharmacies within the insurer's network can help maximize benefits and reduce out-of-pocket costs.

 

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Blue Cross Blue Shield's Approved Criteria for Lantus Coverage

 

Lantus Coverage Eligibility Criteria

 

  • Lantus is approved for patients with a diagnosis of diabetes mellitus who require long-acting insulin to control hyperglycemia.
  • Candidates for Lantus therapy must have a documented history of uncontrolled blood glucose levels despite appropriate use of other antidiabetic medications.
  • The prescription for Lantus must come from a licensed healthcare provider specializing in diabetes or endocrinology, or must show evidence of consultation with such a specialist.
  • Documentation must include current HbA1c levels reflecting the need for long-acting insulin therapy.
  • Patients should display a commitment to managing their diabetes, indicated by regular follow-ups and evidence of adherence to diabetes management plans.
  • In cases of pediatric patients, Lantus may be approved if the patient demonstrates inadequate glycemic control with other basal insulin analogs, with documentation supporting the necessity for therapy.
  • Lantus may also be covered for pregnant patients experiencing gestational diabetes who require insulin therapy and have not achieved glycemic control with other medical therapies.

 

Preferred Drug List Considerations

 

  • Lantus is considered a Tier 2 preferred medication by Blue Cross Blue Shield, reflecting its efficacy and necessity in managing long-term diabetes care.
  • Eligibility for coverage determination aligns with Blue Cross Blue Shield’s guidelines on preferred medications and cost-effective treatment modalities.
  • In the case of existing prescriptions for alternative long-acting insulin treatments, switching to Lantus must be deemed medically necessary with supportive evidence from clinical evaluation.

 

Documentation Requirements

 

  • To ensure coverage, healthcare providers must submit detailed medical records, including insulin treatment history, glucose level trends, and any previous medications attempted.
  • All applications for Lantus coverage must include a comprehensive treatment plan outlining proposed dosing schedules and anticipated therapeutic outcomes.
  • Provider notes should reflect the patient's understanding of Lantus use, including potential side effects and self-administration techniques.

 

Continuing Coverage Criteria

 

  • Continuing coverage for Lantus requires evidence of improved glycemic control as demonstrated by follow-up HbA1c measurements and self-monitoring of blood glucose (SMBG) logs.
  • Maintenance of insurance coverage is contingent on regular medical evaluations and updated prescriptions reflecting the ongoing necessity of Lantus therapy.
  • Periodic medication review is required to ensure that Lantus remains the most appropriate therapy, considering advances in treatment options and evolving clinical guidelines.

 

Why Blue Cross Blue Shield Might Deny Lantus Coverage

 

Reasons for Denial of Lantus Coverage

 

  • **Non-Formulary Drug**: Lantus may be classified as a non-formulary drug under certain plans, meaning it is not included in the list of preferred medications that Blue Cross Blue Shield covers. This can happen if they favor alternative insulin products.
  •  

  • **Lack of Prior Authorization**: If prior authorization is required and not obtained before the prescription is filled, Blue Cross Blue Shield may deny coverage. Prior authorization ensures that the medication is medically necessary.
  •  

  • **Failure to Meet Step Therapy Requirements**: Some plans might enforce step therapy protocols, where a patient must first try and fail less expensive medications before Lantus is approved for coverage. If these steps are not followed, coverage might be denied.
  •  

  • **Off-Label Usage**: Lantus coverage may be denied if it is prescribed for a condition other than those approved by the FDA, as this is considered off-label use and may not be covered by insurance plans.
  •  

  • **Policy Exclusions**: Specific health insurance policies might have exclusions that apply to certain medications, including Lantus. Understanding the individual policy details is critical in determining coverage.
  •  

  • **Quantity Limits Exceeded**: Some plans may cover Lantus but impose specific limits on the quantity or dosage. If a prescription exceeds these limits without proper justification or authorization, coverage might be denied.
  •  

  • **Non-Compliance with Renewal Process**: Coverage may also be contingent upon compliance with a regular renewal or reauthorization process to verify continued necessity of the medication, which, if not adhered to, can lead to a denial.

 

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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 Blue Cross Blue Shield

 

Verify Your Insurance Plan

 

  • Check your specific Blue Cross Blue Shield (BCBS) plan details by reviewing the policy documents or logging into your member account on their website.
  •  

  • Look for information on prescription drug coverage and locate the formulary list to see if Lantus is included.
  •  

  • If you can't find the information, contact BCBS customer service for clarification on whether Lantus is covered under your plan.

 

Consult With Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Lantus for your medical condition and alternative options if it's not covered.
  •  

  • Ask your healthcare provider to write a prescription for Lantus if it's deemed necessary and you confirm it's covered.
  •  

  • Your healthcare provider can sometimes assist with prior authorization or justification for insurance coverage.

 

Understand Prior Authorization Requirements

 

  • If Lantus requires prior authorization, gather all necessary documentation and medical history needed for submission.
  •  

  • Get a prior authorization request form, often available on the BCBS website or through your healthcare provider.
  •  

  • Coordinate with your healthcare provider to complete and submit the prior authorization form along with the necessary supporting documents.

 

Call BCBS For Assistance

 

  • Contact BCBS member services directly for assistance on how to ensure Lantus is covered.
  •  

  • Request a clear explanation of your prescription benefits and ask for any required forms or instructions for obtaining coverage.
  •  

  • Take notes on the information provided and keep records of all correspondence and reference numbers from the BCBS representatives.

 

Consider Appeals If Denied

 

  • If coverage for Lantus is denied, review the denial letter carefully to understand the reasons for denial.
  •  

  • Prepare and submit an appeal letter with detailed explanation and supporting documents justifying the medical necessity of Lantus.
  •  

  • Your healthcare provider's input can be valuable in strengthening your appeal.

 

Explore Additional Assistance Programs

 

  • If difficulties persist in obtaining Lantus coverage, explore patient assistance programs or discount cards provided by the manufacturer.
  •  

  • Organizations such as NeedyMeds or the Partnership for Prescription Assistance may provide support for individuals struggling with medication costs.
  •  

  • Consider consulting with a pharmacist who might provide additional advice on securing affordable access to Lantus.

 

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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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