Does Blue Cross Blue Shield of Illinois Cover Lantus

Explore Lantus coverage with Blue Cross Blue Shield of Illinois, reasons for denial, costs without insurance, and FAQs in this informative guide.
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Coverage for Lantus

 

  • Blue Cross Blue Shield of Illinois typically covers Lantus, a prescription insulin medication used to manage diabetes, under its pharmacy or medical benefit plans.
  •  

  • Coverage details and conditions may differ based on the specific insurance plan, so it is important to verify with the insurance provider directly or review your plan's benefits documentation.

 

Criteria for Coverage

 

  • To qualify for coverage, a prescription from a licensed healthcare provider is generally required.
  •  

  • Potential pre-authorization might be necessary to confirm the medical necessity of Lantus.
  •  

  • Formulary exceptions or step therapy guidelines could apply, which may require trying alternative medications before coverage approval.

 

Steps to Ensure Coverage

 

  • Contact Blue Cross Blue Shield of Illinois customer service for detailed plan-specific information.
  •  

  • Consult with your healthcare provider to ensure all necessary paperwork and prescriptions are in order.
  •  

  • Check your plan’s drug formulary to confirm if Lantus is listed and understand any associated copayments or coinsurance.

 

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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 Lantus Coverage with Blue Cross Blue Shield of Illinois

 

Contact Blue Cross Blue Shield of Illinois

 

  • Call the customer service number on the back of your insurance card to speak directly with a representative.
  •  

  • Ask for information about prescription drug benefits and coverage for insulin medications like Lantus.
  •  

  • Ensure you understand what your current plan covers regarding diabetes medications.

 

Review your Insurance Plan

 

  • Log in to your Blue Cross Blue Shield of Illinois member account online.
  •  

  • Navigate to the section detailing your prescription drug benefits.
  •  

  • Look through the formulary or drug list to see if Lantus is listed under your plan.
  •  

  • Check for any requirements like prior authorization, step therapy, or quantity limits for Lantus.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of using Lantus for your diabetes treatment.
  •  

  • Request that your healthcare provider note this necessity in your medical records and provide documentation if needed for insurance purposes.
  •  

  • Ensure that your doctor is available to provide additional information if Blue Cross Blue Shield of Illinois requires it for approval.

 

Submit a Prior Authorization if Required

 

  • Obtain the necessary prior authorization forms from the Blue Cross Blue Shield of Illinois website or through your doctor’s office.
  •  

  • Complete the required sections of the form, or coordinate your healthcare provider to complete it.
  •  

  • Submit the form to Blue Cross Blue Shield of Illinois via fax or mail as instructed on the form.

 

Follow Up with Blue Cross Blue Shield of Illinois

 

  • Contact Blue Cross Blue Shield of Illinois to confirm receipt of any submitted prior authorization requests.
  •  

  • Track the progress of your request through your online member account or by calling customer service.
  •  

  • Be prepared to provide any additional information or documentation they may require to process your request.

 

Appeal if Coverage is Denied

 

  • If your request for Lantus coverage is denied, review the denial letter for reasons and understand your right to appeal.
  •  

  • Contact Blue Cross Blue Shield of Illinois to initiate an appeal process.
  •  

  • Prepare and submit any additional documentation or supporting letters from your healthcare provider to strengthen your appeal.

 

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Lantus

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

Is Lantus Covered by Blue Cross Blue Shield of Illinois

 

Coverage for Lantus

 

  • Blue Cross Blue Shield of Illinois typically covers Lantus, a prescription insulin medication used to manage diabetes, under its pharmacy or medical benefit plans.
  •  

  • Coverage details and conditions may differ based on the specific insurance plan, so it is important to verify with the insurance provider directly or review your plan's benefits documentation.

 

Criteria for Coverage

 

  • To qualify for coverage, a prescription from a licensed healthcare provider is generally required.
  •  

  • Potential pre-authorization might be necessary to confirm the medical necessity of Lantus.
  •  

  • Formulary exceptions or step therapy guidelines could apply, which may require trying alternative medications before coverage approval.

 

Steps to Ensure Coverage

 

  • Contact Blue Cross Blue Shield of Illinois customer service for detailed plan-specific information.
  •  

  • Consult with your healthcare provider to ensure all necessary paperwork and prescriptions are in order.
  •  

  • Check your plan’s drug formulary to confirm if Lantus is listed and understand any associated copayments or coinsurance.

 

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

 

Lantus Coverage Criteria

 

  • Lantus is approved for coverage when used for the treatment of Type 1 or Type 2 diabetes mellitus in patients who require a long-acting insulin for the control of hyperglycemia.
  •  

  • Verification of diagnosis: Documentation from a healthcare provider confirming a diagnosis of diabetes.
  •  

  • Age requirement: Patients must typically be over the age of 18, unless prescribed by a pediatric endocrinologist.
  •  

  • Clinical necessity: Providers should submit evidence showing the clinical necessity for using Lantus as opposed to other forms of insulin.
  •  

  • Previous treatment history: There should be documented evidence of previous attempts to control glucose levels with other basal insulins or a combination of diabetes medications.
  •  

  • Prescribing provider: Lantus must be prescribed by an endocrinologist, diabetologist, or any healthcare provider specializing in diabetes care.
  •  

  • Dosage and administration: Detailed information about the patient's previous and current insulin regimens to ensure proper dosage and transition to Lantus.

 

Required Documentation

 

  • Comprehensive patient medical history that includes previous diabetes treatments, current treatment plan, and any relevant lab results demonstrating ongoing need for insulin therapy.
  •  

  • A letter of medical necessity from the prescribing healthcare provider.
  •  

  • Detailed documentation of any adverse reactions or contraindications to other forms of insulin, if applicable.

 

Additional Considerations

 

  • A review of the patient's overall diabetic management plan, including lifestyle modifications and auxiliary medications.
  •  

  • Coordination with a diabetes educator or care manager may be required to optimize the patient’s therapeutic regimen and ensure compliance with the treatment plan.
  •  

  • Potential need for step therapy, where patients may be required to try other insulin products prior to Lantus unless contraindicated or proved ineffective.

 

Why Blue Cross Blue Shield of Illinois Might Deny Lantus Coverage

 

Non-Formulary Status

 

  • Lantus may not be covered under certain insurance plans if it is not included in the formulary list of approved medications.

 

Prior Authorization Requirements

 

  • Coverage may be denied if necessary prior authorization was not obtained before prescribing Lantus.

 

Step Therapy

 

  • Denial can occur if step therapy criteria is not met, requiring trial and failure of alternative medications before coverage of Lantus.

 

Non-Medical Necessity

 

  • Requests can be denied due to insufficient evidence proving that Lantus is medically necessary for the patient's treatment plan.

 

Exclusion for Cosmetic or Non-Therapeutic Use

 

  • Lantus will not be covered if it is prescribed for non-therapeutic, cosmetic, or other purposes that do not qualify as necessary medical treatment.

 

Dosage and Quantity Limits

 

  • Coverage can be denied if prescribed dosages exceed established limits without proper justification or approval.

 

Off-Label Use

 

  • Lantus is not covered when prescribed for a use not approved by the FDA and not recognized in standard medical treatment guidelines.

 

Out-of-Network Providers

 

  • Using an out-of-network provider might lead to denial of Lantus coverage unless exceptions are made.

 

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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 of Illinois

 

Contact Blue Cross Blue Shield of Illinois

 

  • Call the customer service number on the back of your insurance card to speak directly with a representative.
  •  

  • Ask for information about prescription drug benefits and coverage for insulin medications like Lantus.
  •  

  • Ensure you understand what your current plan covers regarding diabetes medications.

 

Review your Insurance Plan

 

  • Log in to your Blue Cross Blue Shield of Illinois member account online.
  •  

  • Navigate to the section detailing your prescription drug benefits.
  •  

  • Look through the formulary or drug list to see if Lantus is listed under your plan.
  •  

  • Check for any requirements like prior authorization, step therapy, or quantity limits for Lantus.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of using Lantus for your diabetes treatment.
  •  

  • Request that your healthcare provider note this necessity in your medical records and provide documentation if needed for insurance purposes.
  •  

  • Ensure that your doctor is available to provide additional information if Blue Cross Blue Shield of Illinois requires it for approval.

 

Submit a Prior Authorization if Required

 

  • Obtain the necessary prior authorization forms from the Blue Cross Blue Shield of Illinois website or through your doctor’s office.
  •  

  • Complete the required sections of the form, or coordinate your healthcare provider to complete it.
  •  

  • Submit the form to Blue Cross Blue Shield of Illinois via fax or mail as instructed on the form.

 

Follow Up with Blue Cross Blue Shield of Illinois

 

  • Contact Blue Cross Blue Shield of Illinois to confirm receipt of any submitted prior authorization requests.
  •  

  • Track the progress of your request through your online member account or by calling customer service.
  •  

  • Be prepared to provide any additional information or documentation they may require to process your request.

 

Appeal if Coverage is Denied

 

  • If your request for Lantus coverage is denied, review the denial letter for reasons and understand your right to appeal.
  •  

  • Contact Blue Cross Blue Shield of Illinois to initiate an appeal process.
  •  

  • Prepare and submit any additional documentation or supporting letters from your healthcare provider to strengthen your appeal.

 

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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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