Does Blue Cross Blue Shield of Arizona Cover Trelegy

Explore Trelegy coverage with Blue Cross Blue Shield of Arizona, reasons for denial, costs without insurance, and answers to common questions.
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Coverage for Trelegy

 

  • Blue Cross Blue Shield of Arizona may cover Trelegy for the treatment of COPD and Asthma, depending on the specific plan and medical necessity criteria.
  •  

  • Pre-authorization is typically required. Your healthcare provider must demonstrate that Trelegy is medically necessary for your condition.

 

Criteria for Getting Trelegy Covered

 

  • A doctor’s prescription stating the necessity of Trelegy is required.
  •  

  • Patients may need a prior trial of alternative therapies before Trelegy is approved.
  •  

  • Coverage may also depend on whether Trelegy is included in the plan’s formulary.

 

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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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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 Arizona

 

Check Your Current Insurance Plan

 

  • Review your existing Blue Cross Blue Shield of Arizona plan documents. They usually contain detailed information about your prescription drug coverage.
  • Verify if Trelegy is included in your plan’s formulary, which is a list of medications that are covered.
  • Contact customer service for any questions or clarifications about Trelegy coverage within your current plan.

 

Consult With Your Doctor

 

  • Discuss with your healthcare provider to confirm that Trelegy is the appropriate medication for your condition.
  • Ask your doctor to provide a prescription and potentially a medically backed letter of necessity if required for insurance purposes.

 

Contact Blue Cross Blue Shield of Arizona

 

  • Call the customer service number found on the back of your insurance card to inquire about Trelegy coverage.
  • Ask about any specific requirements or steps needed to ensure the medication is covered, such as prior authorization.
  • Inquire about any cost-sharing responsibilities, such as copays or deductibles, associated with filling a Trelegy prescription.

 

Complete Any Required Paperwork

 

  • Fill out any necessary forms that Blue Cross Blue Shield of Arizona requires for coverage approval.
  • Ensure that both you and your healthcare provider complete and submit these documents promptly.

 

Seek Prior Authorization if Needed

 

  • If prior authorization is required, work with your healthcare provider to submit the necessary documentation to Blue Cross Blue Shield of Arizona.
  • Keep track of this process and follow up with your insurer to ensure the authorization is approved.

 

Choose a Pharmacy

 

  • Select an in-network pharmacy to fill your Trelegy prescription to ensure coverage under your plan.
  • Verify with the pharmacy that they will handle any insurance processing required for Trelegy.

 

Submit Claims If Necessary

 

  • Some medications require you to pay upfront and submit a claim for reimbursement. Be sure to ask about this when filling Trelegy.
  • Keep all receipts and complete any insurance claim forms if you need to submit a reimbursement claim.

 

Follow-up and Adjustments

 

  • After starting Trelegy, monitor how it affects your health and keep your healthcare provider informed of any concerns.
  • Be open to reviewing your current plan's drug coverage annually during open enrollment to ensure Trelegy remains covered.

 

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FAQs

Does Blue Cross Blue Shield of Arizona Cover Trelegy

Explore Trelegy coverage with Blue Cross Blue Shield of Arizona, reasons for denial, costs without insurance, and answers to common questions.
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Is Trelegy Covered by Blue Cross Blue Shield of Arizona

 

Coverage for Trelegy

 

  • Blue Cross Blue Shield of Arizona may cover Trelegy for the treatment of COPD and Asthma, depending on the specific plan and medical necessity criteria.
  •  

  • Pre-authorization is typically required. Your healthcare provider must demonstrate that Trelegy is medically necessary for your condition.

 

Criteria for Getting Trelegy Covered

 

  • A doctor’s prescription stating the necessity of Trelegy is required.
  •  

  • Patients may need a prior trial of alternative therapies before Trelegy is approved.
  •  

  • Coverage may also depend on whether Trelegy is included in the plan’s formulary.

 

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

 

Eligibility Criteria for Trelegy Coverage

 

  • Member must be diagnosed with Chronic Obstructive Pulmonary Disease (COPD) or Asthma, with supporting documentation provided by a healthcare provider.

 

Requirements for COPD

 

  • Documentation of a history of exacerbations or significant symptoms of COPD, despite regular treatment with long-acting bronchodilators.

 

Requirements for Asthma

 

  • Patient must demonstrate non-response to a combination of inhaled corticosteroids and long-acting beta-agonists or experience continued symptoms despite optimal treatment regimens.

 

Prescribing Physician Criteria

 

  • Trelegy must be prescribed by a pulmonologist, allergist, or another specialist with experience in managing COPD or asthma.

 

Prior Medication Requirements

 

  • Patients should have tried and not adequately responded to or tolerated previous treatment options including, but not limited to, inhaled corticosteroids and long-acting beta agonists or long-acting antimuscarinic agents.

 

Age Criteria

 

  • Trelegy is covered for adult patients aged 18 years and older.

 

Monitoring and Assessment

 

  • Ongoing assessment by the prescribing physician to evaluate the effectiveness of Trelegy and adjust treatment as necessary.

 

Continuation of Therapy

 

  • Continued coverage of Trelegy requires documentation of clinical benefit, evidenced by a reduction in exacerbations, improved lung function, or a decrease in rescue inhaler usage.

 

Why Blue Cross Blue Shield of Arizona Might Deny Trelegy Coverage

 

Reasons for Denial of Trelegy Coverage

 

  • The patient does not meet the specific medical criteria required for Trelegy coverage as per Blue Cross Blue Shield of Arizona's policy, which may include a lack of documented evidence of diagnosis for Chronic Obstructive Pulmonary Disease (COPD) or asthma.
  •  

  • Treatment with Trelegy is not deemed medically necessary. This determination can be based on clinical guidelines or lack of evidence supporting the need for a triple therapy regimen in the member's treatment plan.
  •  

  • Trelegy is prescribed for off-label use that is not supported by Blue Cross Blue Shield of Arizona policy. Off-label usage may include indications that are not approved by the FDA or not listed in the formulary guidelines.
  •  

  • The patient has not completed or adhered to previous therapies or treatment plans as required by Blue Cross Blue Shield of Arizona's step therapy protocols, which could necessitate trial and failure of other medications prior to being prescribed Trelegy.
  •  

  • Trelegy is requested for a condition not covered under the plan, as certain medical conditions and treatments may be excluded from the policy coverage.
  •  

  • This medication is received from a non-participating pharmacy or provider without obtaining necessary approvals or exceptions required by Blue Cross Blue Shield of Arizona.
  •  

 

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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 Arizona

 

Check Your Current Insurance Plan

 

  • Review your existing Blue Cross Blue Shield of Arizona plan documents. They usually contain detailed information about your prescription drug coverage.
  • Verify if Trelegy is included in your plan’s formulary, which is a list of medications that are covered.
  • Contact customer service for any questions or clarifications about Trelegy coverage within your current plan.

 

Consult With Your Doctor

 

  • Discuss with your healthcare provider to confirm that Trelegy is the appropriate medication for your condition.
  • Ask your doctor to provide a prescription and potentially a medically backed letter of necessity if required for insurance purposes.

 

Contact Blue Cross Blue Shield of Arizona

 

  • Call the customer service number found on the back of your insurance card to inquire about Trelegy coverage.
  • Ask about any specific requirements or steps needed to ensure the medication is covered, such as prior authorization.
  • Inquire about any cost-sharing responsibilities, such as copays or deductibles, associated with filling a Trelegy prescription.

 

Complete Any Required Paperwork

 

  • Fill out any necessary forms that Blue Cross Blue Shield of Arizona requires for coverage approval.
  • Ensure that both you and your healthcare provider complete and submit these documents promptly.

 

Seek Prior Authorization if Needed

 

  • If prior authorization is required, work with your healthcare provider to submit the necessary documentation to Blue Cross Blue Shield of Arizona.
  • Keep track of this process and follow up with your insurer to ensure the authorization is approved.

 

Choose a Pharmacy

 

  • Select an in-network pharmacy to fill your Trelegy prescription to ensure coverage under your plan.
  • Verify with the pharmacy that they will handle any insurance processing required for Trelegy.

 

Submit Claims If Necessary

 

  • Some medications require you to pay upfront and submit a claim for reimbursement. Be sure to ask about this when filling Trelegy.
  • Keep all receipts and complete any insurance claim forms if you need to submit a reimbursement claim.

 

Follow-up and Adjustments

 

  • After starting Trelegy, monitor how it affects your health and keep your healthcare provider informed of any concerns.
  • Be open to reviewing your current plan's drug coverage annually during open enrollment to ensure Trelegy remains covered.

 

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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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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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