Does Blue Cross Blue Shield of Alabama Cover Trelegy

Explore Trelegy coverage with Blue Cross Blue Shield Alabama. Learn denial reasons, costs without insurance, and FAQs for a smoother insurance experience.
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Coverage for Trelegy by Blue Cross Blue Shield of Alabama

 

  • Blue Cross Blue Shield of Alabama may cover Trelegy if prescribed for conditions like COPD or certain types of asthma. Coverage often requires prior authorization to confirm medical necessity.
  •  

  • Eligibility may depend on criteria such as age, documented medical history, and evidence of needing a combination inhaler.
  •  

  • Patients must provide detailed medical records and sometimes might need to try alternative treatments before approval.
  •  

  • Prescription must be from an in-network provider to maximize benefits and reduce out-of-pocket payments.
  •  

  • It's crucial to consult the specific plan details or contact BCBS Alabama directly to understand the precise coverage and requirements for Trelegy under your specific 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.

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 Trelegy Coverage with Blue Cross Blue Shield of Alabama

 

Initiate Contact with Blue Cross Blue Shield of Alabama

 

  • Call the customer service number provided on your insurance card to speak with a representative. Make sure you have your member ID and personal details readily available.
  •  

  • Log into your Blue Cross Blue Shield of Alabama member account online to explore coverage options and contact support. Use their messaging service for a written record of your inquiries.

 

Verify Drug Coverage

 

  • Check if Trelegy is listed on your current formulary document. You can typically find this document on your member account portal, or request a copy from customer service.
  •  

  • Ask the customer service representative if Trelegy is covered under your specific plan. Coverage can vary even within the same insurance provider.

 

Understand Prior Authorization Requirements

 

  • Determine if a prior authorization is necessary for Trelegy. This can often be a requirement for newer or more expensive medications.
  •  

  • Consult with your healthcare provider to ensure they're aware of any prior authorization needed. They may need to submit clinical documentation to support the necessity of Trelegy for your condition.

 

Explore Tier and Copayment Implications

 

  • Ask about the tier level assigned to Trelegy in your plan's drug formulary, as this affects your out-of-pocket costs. Higher-tier medications typically incur higher copayments.
  •  

  • Assess your annual deductible and out-of-pocket maximums to better understand your total costs for the year.

 

Consider Generic or Alternative Options

 

  • Discuss with your healthcare provider whether a generic version of Trelegy or an alternative medication might be available and effective. This could reduce your expenses significantly.
  •  

  • Contact Blue Cross Blue Shield of Alabama to confirm coverage for any suggested alternatives.

 

Submit Claims Correctly

 

  • Ensure all claims for Trelegy are supported with the necessary paperwork, including any prior authorization approvals.
  •  

  • Review your Explanation of Benefits (EOB) for accuracy after each claim submission.

 

Follow Up Regularly

 

  • If initial queries don't resolve your concerns or yield the necessary coverage, persistently follow up until you receive a satisfactory answer or resolution.
  •  

  • Keep detailed records of all communications, including dates, names of representatives, and discussion summaries, to reference in future correspondences.

 

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FAQs

Does Blue Cross Blue Shield of Alabama Cover Trelegy

Explore Trelegy coverage with Blue Cross Blue Shield Alabama. Learn denial reasons, costs without insurance, and FAQs for a smoother insurance experience.
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Is Trelegy Covered by Blue Cross Blue Shield of Alabama

 

Coverage for Trelegy by Blue Cross Blue Shield of Alabama

 

  • Blue Cross Blue Shield of Alabama may cover Trelegy if prescribed for conditions like COPD or certain types of asthma. Coverage often requires prior authorization to confirm medical necessity.
  •  

  • Eligibility may depend on criteria such as age, documented medical history, and evidence of needing a combination inhaler.
  •  

  • Patients must provide detailed medical records and sometimes might need to try alternative treatments before approval.
  •  

  • Prescription must be from an in-network provider to maximize benefits and reduce out-of-pocket payments.
  •  

  • It's crucial to consult the specific plan details or contact BCBS Alabama directly to understand the precise coverage and requirements for Trelegy under your specific policy.

 

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Blue Cross Blue Shield of Alabama's Approved Criteria for Trelegy Coverage

 

Eligibility Criteria for Trelegy Coverage

 

  • Patient must have a confirmed diagnosis of chronic obstructive pulmonary disease (COPD) which includes chronic bronchitis and/or emphysema.
  •  

  • Treatment is for the management of chronic COPD symptoms, including reducing exacerbations.

 

Additional Considerations

 

  • Patients should have a documented history of airflow obstruction, verified through spirometry testing, demonstrating an FEV1/FVC ratio of less than 70% post-bronchodilator.
  •  

  • Proof of inadequate response or contraindication to alternative COPD treatments, such as bronchodilators or corticosteroids, may be required.

 

Prescribing Requirements

 

  • Prescription must be initiated by, or in consultation with, a pulmonologist or respiratory specialist to ensure appropriate use within COPD management protocols.
  •  

  • Continued coverage may require periodic review and adjustment of therapy based on clinical response and tolerability.

Why Blue Cross Blue Shield of Alabama Might Deny Trelegy Coverage

 

Exclusions for Trelegy Coverage

 

  • The patient does not meet the established medical necessity criteria as specified by Blue Cross Blue Shield of Alabama's policy for Trelegy.
  •  

  • The request for Trelegy is for a condition or indication not approved by the FDA or not supported by appropriate clinical evidence according to the insurer's guidelines.
  •  

  • The use of Trelegy falls under an experimental or investigational category, as deemed by the policy, which means there is insufficient proof of its efficacy for the patient's particular condition.
  •  

  • The prescribed dosage of Trelegy exceeds the recommended limits established by Blue Cross Blue Shield, or if it's higher than what the policy allows for coverage.
  •  

  • The patient is already undergoing an alternative therapy, and their condition does not warrant the specific need for Trelegy as per the insurance guidelines.
  •  

  • The physician's prescription lacks the requisite documentation, such as prior authorization, or necessary records to support the use of Trelegy in treating the patient's condition.
  •  

  • The patient is seeking Trelegy coverage for cosmetic or non-essential health reasons, which are categorized as exclusions by the insurance plan.

 

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How Much Does Trelegy Cost without Insurance?

 

Approximate Cost of Trelegy Without Insurance

 

  • The cost of Trelegy Ellipta, without insurance, can vary significantly based on several factors like the pharmacy, geographical location, or available discounts. On average, patients can expect to pay between $550 to $650 for a 30-day supply.
  •  

  • Prices may also fluctuate depending on ongoing promotions or pharmacy memberships that can provide additional savings.
  •  

  • It’s advisable for patients to use discount cards, check for manufacturer coupons, or explore patient assistance programs to lower the out-of-pocket expense.
  •  

  • Shopping around, comparing prices at different pharmacies, or using online price comparison tools can also result in significant cost savings for Trelegy.

 

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 Trelegy Coverage with Blue Cross Blue Shield of Alabama

 

Initiate Contact with Blue Cross Blue Shield of Alabama

 

  • Call the customer service number provided on your insurance card to speak with a representative. Make sure you have your member ID and personal details readily available.
  •  

  • Log into your Blue Cross Blue Shield of Alabama member account online to explore coverage options and contact support. Use their messaging service for a written record of your inquiries.

 

Verify Drug Coverage

 

  • Check if Trelegy is listed on your current formulary document. You can typically find this document on your member account portal, or request a copy from customer service.
  •  

  • Ask the customer service representative if Trelegy is covered under your specific plan. Coverage can vary even within the same insurance provider.

 

Understand Prior Authorization Requirements

 

  • Determine if a prior authorization is necessary for Trelegy. This can often be a requirement for newer or more expensive medications.
  •  

  • Consult with your healthcare provider to ensure they're aware of any prior authorization needed. They may need to submit clinical documentation to support the necessity of Trelegy for your condition.

 

Explore Tier and Copayment Implications

 

  • Ask about the tier level assigned to Trelegy in your plan's drug formulary, as this affects your out-of-pocket costs. Higher-tier medications typically incur higher copayments.
  •  

  • Assess your annual deductible and out-of-pocket maximums to better understand your total costs for the year.

 

Consider Generic or Alternative Options

 

  • Discuss with your healthcare provider whether a generic version of Trelegy or an alternative medication might be available and effective. This could reduce your expenses significantly.
  •  

  • Contact Blue Cross Blue Shield of Alabama to confirm coverage for any suggested alternatives.

 

Submit Claims Correctly

 

  • Ensure all claims for Trelegy are supported with the necessary paperwork, including any prior authorization approvals.
  •  

  • Review your Explanation of Benefits (EOB) for accuracy after each claim submission.

 

Follow Up Regularly

 

  • If initial queries don't resolve your concerns or yield the necessary coverage, persistently follow up until you receive a satisfactory answer or resolution.
  •  

  • Keep detailed records of all communications, including dates, names of representatives, and discussion summaries, to reference in future correspondences.

 

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Trelegy FAQ

1. What are the side effects of Trelegy?

 

Common Side Effects of Trelegy

 

  • Headaches
  • Back pain
  • Hoarseness
  • Oral thrush

 

Serious Side Effects

 

  • Increased heart rate
  • Chest pain
  • High blood pressure
  • Pneumonia in COPD patients

 

Less Common Side Effects

 

  • Diarrhea
  • Cough
  • Sore throat
  • Gastrointestinal discomfort

 

Precautions

 

  • Monitor for worsening symptoms.
  • Consult a doctor for persistent side effects.

 

2. How does Trelegy compare to Breo?

 

Comparison of Trelegy and Breo

 

  • Trelegy combines three active ingredients: fluticasone furoate (a corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Breo contains only two: fluticasone furoate and vilanterol.
  •  

  • This combination in Trelegy allows for better control of symptoms for COPD patients requiring more comprehensive therapy, whereas Breo is more suitable for those requiring less intensive treatment.
  •  

  • Both medications are administered once daily via inhalation, but Trelegy’s triple therapy provides a broader mechanism of action.
  •  

  • Side effects are generally similar, though patients transitioning from Breo to Trelegy may experience different responses due to the added component.

 

3. Is Trelegy a steroid?

 

Is Trelegy a Steroid?

 

  • Components: Trelegy contains three active ingredients: fluticasone furoate, umeclidinium, and vilanterol. Fluticasone furoate is a corticosteroid.
  •  

  • Steroid Role: The corticosteroid in Trelegy helps reduce inflammation in the airways, which is crucial for treating conditions like COPD and asthma.
  •  

  • Multi-Action: In addition to the steroid, umeclidinium (an anticholinergic) and vilanterol (a long-acting beta-agonist) work to relax and open the airways.
  •  

  • Usage: Trelegy is inhaled, delivering these components directly to the lungs for targeted action, minimizing systemic steroid exposure.

 

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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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