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Does Blue Cross Blue Shield of Illinois Cover Jardiance

Discover if BCBS Illinois covers Jardiance, learn why coverage may be denied, and find out options and costs. Explore important FAQs on Jardiance insurance coverage.

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Coverage for Jardiance

Blue Cross Blue Shield of Illinois may cover Jardiance for specific conditions like Type 2 diabetes management.

Coverage usually applies if the medication is considered medically necessary by the healthcare provider.

Basic Rules & Criteria

Patients generally need a prescription from their healthcare provider to qualify for coverage.

Prior authorization might be required, meaning the healthcare provider must demonstrate the medical necessity of Jardiance to the insurance company.

Coverage may also depend on whether Jardiance is listed in the plan's formulary. Checking the plan's formulary can provide clarity.

Co-pays or deductibles may apply, affecting the total out-of-pocket cost for the medication.

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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.

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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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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.

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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 Jardiance Coverage with Blue Cross Blue Shield of Illinois

Verify Your Plan Benefits

Log in to your Blue Cross Blue Shield of Illinois member portal to review your current plan benefits. Look for information on prescription drug coverage.

Check if Jardiance is listed under covered medications. This can often be found within the formulary or drug list section of your plan details.

Consult with Your Healthcare Provider

Discuss with your healthcare provider about the necessity of Jardiance and obtain a prescription if deemed appropriate.

Ensure that your provider includes any necessary medical information to support your need for Jardiance if coverage requires authorization.

Contact Blue Cross Blue Shield of Illinois

Call the customer service number found on your Blue Cross Blue Shield of Illinois membership ID card for assistance regarding prescription coverage inquiries.

Ask specifically if Jardiance requires pre-authorization or if there's any special criteria you must meet for it to be covered.

Submit a Pre-Authorization Request

If Jardiance requires pre-authorization, work with your healthcare provider to gather and submit the necessary documentation to Blue Cross Blue Shield of Illinois.

Ensure all forms are filled out completely and accurately to avoid delays in the review process.

Follow Up on the Request

Monitor your member portal or contact customer service to confirm the status of your pre-authorization request.

If approved, verify that the pharmacy has received the coverage confirmation before filling the prescription.

Appeal a Denial

If your request for Jardiance coverage is denied, review the details of the denial letter for specific reasons and possible errors.

Work with your healthcare provider to submit an appeal along with any additional supporting documentation required to justify medical necessity.

Consider Assistance Programs

If coverage is denied and appeals are unsuccessful, investigate patient assistance programs offered by the manufacturer of Jardiance or other organizations to help reduce out-of-pocket costs.

Ensure that any assistance does not conflict with your insurance plan's terms and conditions.

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Jardiance

Discover if BCBS Illinois covers Jardiance, learn why coverage may be denied, and find out options and costs. Explore important FAQs on Jardiance insurance coverage.

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Is Jardiance Covered by Blue Cross Blue Shield of Illinois

Coverage for Jardiance

Blue Cross Blue Shield of Illinois may cover Jardiance for specific conditions like Type 2 diabetes management.

Coverage usually applies if the medication is considered medically necessary by the healthcare provider.

Basic Rules & Criteria

Patients generally need a prescription from their healthcare provider to qualify for coverage.

Prior authorization might be required, meaning the healthcare provider must demonstrate the medical necessity of Jardiance to the insurance company.

Coverage may also depend on whether Jardiance is listed in the plan's formulary. Checking the plan's formulary can provide clarity.

Co-pays or deductibles may apply, affecting the total out-of-pocket cost for the medication.

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Blue Cross Blue Shield of Illinois's Approved Criteria for Jardiance Coverage

Criteria for Jardiance Coverage by Blue Cross Blue Shield of Illinois

**FDA Approval**: Jardiance (empagliflozin) must be prescribed for uses that have been approved by the U.S. Food and Drug Administration (FDA), including but not limited to managing blood sugar levels in individuals with type 2 diabetes.

**Age Requirement**: Coverage is generally provided for adults aged 18 and older as specified by the medication guidelines.

**Diagnosis of Type 2 Diabetes**: The patient must be diagnosed with type 2 diabetes mellitus and require medication to help improve glycemic control.

**Use in Heart Failure and Kidney Disease**: Jardiance may be covered as part of treatment plans for reducing the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease, and for slowing the progression of chronic kidney disease.

**Physician Prescription**: A prescription from a licensed healthcare provider is mandatory. The prescription should detail the necessity of Jardiance for the individual's treatment.

**Previous Medication Trials**: Insurance coverage may require documentation that the patient has attempted treatment with other antidiabetic medications and that Jardiance is required as part of a comprehensive treatment plan.

**Plan-Specific Guidelines**: Patients must adhere to any additional guidelines or requirements specific to their health plan under Blue Cross Blue Shield of Illinois.

**Pharmacy Benefit Manager Approval**: Coverage might need authorization from the pharmacy benefit manager, which may involve demonstrating medical necessity through clinical evidence and safety data.

**Chronic Disease Management Programs**: In some cases, patients enrolled in chronic disease management programs may have additional access rights to Jardiance due to coordinated health care efforts.

Why Blue Cross Blue Shield of Illinois Might Deny Jardiance Coverage

Reasons for Denial of Jardiance Coverage by Blue Cross Blue Shield of Illinois

Jardiance is prescribed for off-label use. Coverage may be denied if Jardiance is prescribed for a condition not approved by the FDA for this medication.

Lack of documentation proving medical necessity. If the provider does not submit sufficient evidence that Jardiance is medically necessary for the patient, coverage might be denied.

Failure to meet prerequisite steps in the treatment plan. Jardiance coverage may be denied if the patient has not tried or documented the failure of alternative, less expensive medications as prescribed by the insurance company's step therapy program.

Non-compliance with pre-authorization or prior approval requirements. If Jardiance is dispensed without approved pre-authorization from Blue Cross Blue Shield of Illinois, it may not be covered.

Use of non-network pharmacies. Obtaining Jardiance from a pharmacy outside the preferred network could lead to denial of coverage.

Incomplete or incorrect claim submission. Coverage may be denied if there are errors or missing information on the claim submitted for Jardiance.

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How Much Does Jardiance Cost without Insurance?

Estimated Cost of Jardiance Without Insurance

The cost of Jardiance can vary depending on the pharmacy you visit, but as an oral medication used primarily to treat type 2 diabetes, it is often priced at a premium. Without insurance, the average monthly cost is approximately $550 to $650 for a 30-day supply of 10 mg or 25 mg tablets.

Prices can also vary based on location, pharmacy discounts, and available manufacturer coupons, so it's advisable to shop around or look for any available patient assistance programs to potentially lower the out-of-pocket cost.

Ways to Lower the Cost of Jardiance

**Pharmacy Discount Cards:** Utilizing pharmacy discount cards can sometimes provide substantial savings on your prescription, reducing the price by a notable percentage.

**Manufacturer Coupons and Programs:** Eli Lilly, the manufacturer of Jardiance, may offer savings cards or assistance programs to help eligible patients reduce their costs. It's worth checking through their official website or consulting with your healthcare provider.

**Generic Alternatives:** Although there may not be a generic version of Jardiance available currently, consulting with your healthcare provider about other generic medications for your condition may offer a more budget-friendly option.

**Bulk Purchasing Options:** Some pharmacies might offer discounts for purchasing a 90-day supply instead of a 30-day supply, which can lead to savings in the long term.

Clinical Support

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

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

Kayla Mardaga, NP

How to Get Jardiance Coverage with Blue Cross Blue Shield of Illinois

Verify Your Plan Benefits

Log in to your Blue Cross Blue Shield of Illinois member portal to review your current plan benefits. Look for information on prescription drug coverage.

Check if Jardiance is listed under covered medications. This can often be found within the formulary or drug list section of your plan details.

Consult with Your Healthcare Provider

Discuss with your healthcare provider about the necessity of Jardiance and obtain a prescription if deemed appropriate.

Ensure that your provider includes any necessary medical information to support your need for Jardiance if coverage requires authorization.

Contact Blue Cross Blue Shield of Illinois

Call the customer service number found on your Blue Cross Blue Shield of Illinois membership ID card for assistance regarding prescription coverage inquiries.

Ask specifically if Jardiance requires pre-authorization or if there's any special criteria you must meet for it to be covered.

Submit a Pre-Authorization Request

If Jardiance requires pre-authorization, work with your healthcare provider to gather and submit the necessary documentation to Blue Cross Blue Shield of Illinois.

Ensure all forms are filled out completely and accurately to avoid delays in the review process.

Follow Up on the Request

Monitor your member portal or contact customer service to confirm the status of your pre-authorization request.

If approved, verify that the pharmacy has received the coverage confirmation before filling the prescription.

Appeal a Denial

If your request for Jardiance coverage is denied, review the details of the denial letter for specific reasons and possible errors.

Work with your healthcare provider to submit an appeal along with any additional supporting documentation required to justify medical necessity.

Consider Assistance Programs

If coverage is denied and appeals are unsuccessful, investigate patient assistance programs offered by the manufacturer of Jardiance or other organizations to help reduce out-of-pocket costs.

Ensure that any assistance does not conflict with your insurance plan's terms and conditions.

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Jardiance FAQ

What is Jardiance used for?

What is Jardiance Used For?

Jardiance is primarily used to manage type 2 diabetes by helping to lower blood sugar levels in adults.

It works by promoting the excretion of excess glucose through urine, thus reducing the amount of sugar the body absorbs.

In addition to blood sugar management, Jardiance is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.

Patients with heart failure may benefit from Jardiance as it helps in reducing the risk of hospitalization due to heart failure.

What are the side effects of Jardiance?

Common Side Effects of Jardiance

Urinary tract infections: Symptoms may include burning sensation while urinating and frequent urges.
Increased urination: This is due to Jardiance's mechanism of removing excess glucose via urine.

Serious Side Effects

Ketoacidosis: This rare condition might present as difficulty breathing, nausea, or confusion.
Dehydration: Symptoms can be dizziness or light-headedness, especially upon standing.

Allergic Reactions

Rash or hives can occur, requiring immediate medical attention.

Precautions

Consult your healthcare provider before starting if you have kidney issues or are on diuretics.

Can Jardiance cause weight loss?

Can Jardiance Cause Weight Loss?

Yes, Jardiance (empagliflozin) can lead to weight loss. This medication is primarily used to treat type 2 diabetes.

It works by preventing glucose reabsorption in the kidneys, leading to glucose excretion through urine, which may also result in calorie loss.

Clinical trials have shown weight reduction as a common side effect, often averaging 2-3 kg.

This loss can differ among individuals; factors like diet and exercise may influence the extent of weight change.

Always consult with healthcare professionals to understand the benefits and risks associated with your specific health condition.

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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. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does Blue Cross Blue Shield of Illinois Cover Jardiance

Discover if BCBS Illinois covers Jardiance, learn why coverage may be denied, and find out options and costs. Explore important FAQs on Jardiance insurance coverage.

Achieve Your Goals Faster with Curex