Does Blue Cross Blue Shield of Illinois Cover Trelegy

Explore Trelegy coverage by Blue Cross Blue Shield of Illinois, learn coverage tips, costs without insurance, and get answers to common questions.
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Coverage for Trelegy with Blue Cross Blue Shield of Illinois

 

  • Trelegy Ellipta is generally covered under Blue Cross Blue Shield of Illinois' prescription drug plans, though specific coverage may vary based on the individual's plan and formulary.
  •  

  • For Trelegy to be covered, it must be deemed medically necessary. Doctors typically prescribe Trelegy for COPD or asthma treatment when other medications are not sufficient.
  •  

  • Prior authorization might be required. This means the healthcare provider must justify the need for Trelegy to the insurance company.
  •  

  • Patients may be required to try and fail alternative therapies before insurance covers Trelegy, often referred to as "step therapy."
  •  

  • It is essential to confirm coverage specifics by reviewing your policy's drug formulary or contacting Blue Cross Blue Shield of Illinois directly.

 

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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.

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 Illinois

 

Verify Your Plan Coverage

 

  • Contact Blue Cross Blue Shield of Illinois (BCBSIL) customer service to verify if your health plan covers Trelegy. You can find the phone number on your insurance card or visit the BCBSIL website for more information.
  •  

  • Inquire about any specific drug formularies and whether Trelegy is listed as a covered medication. This may vary depending on your specific insurance plan.
  •  

  • Check if there are any pre-authorization or step therapy requirements for Trelegy under your plan, which might affect coverage.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Trelegy for your treatment. They should be able to provide justification for its use if required for insurance purposes.
  •  

  • Your doctor may need to provide medical documentation or complete a prior authorization form to ensure coverage by BCBSIL.
  • Ensure that your doctor’s office has the correct insurance information to send necessary documentation to BCBSIL.

 

Prior Authorization Process

 

  • If required, have your healthcare provider initiate the prior authorization process. This often involves submitting a request to BCBSIL that includes your medical history and reasons for prescribing Trelegy.
  •  

  • Your provider's office should be familiar with the steps involved, but you can confirm with BCBSIL about any specific forms or processes that must be followed.
  •  

  • Stay in regular contact with both your healthcare provider and BCBSIL to ensure that the authorization is progressing and to address any potential issues promptly.

 

Pharmacy Coordination

 

  • Once authorization is obtained, coordinate with your pharmacy to fill your Trelegy prescription. Ensure that they are aware that the authorization has been granted.
  •  

  • Verify that the pharmacy has all necessary information to process the claim through BCBSIL, including your insurance details and any authorization numbers.
  •  

  • Check with the pharmacy if there are any copay or coinsurance costs associated with your prescription and explore any available discount programs or plans.

 

Appeal Denials if Necessary

 

  • If coverage is denied, request a written explanation of the decision from BCBSIL. Understanding the reasons can help guide your next steps.
  •  

  • Work with your healthcare provider to gather any additional documentation needed to appeal the decision. This might include additional medical records or letters of medical necessity.
  •  

  • Submit a formal appeal to BCBSIL, following their specific appeals process, and continue to engage with their representatives regularly to track the status of your appeal.

 

Explore Financial Assistance Programs

 

  • If you continue to face challenges with coverage or costs, explore manufacturer assistance programs or other financial aid resources that may help reduce your out-of-pocket expenses for Trelegy.
  •  

  • Contact Trelegy's manufacturer to inquire about any available patient assistance programs that might provide the medication at a reduced cost or for free.
  • Check if BCBSIL provides information about supplementary coverage or assistance programs for members with medication affordability issues.

 

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Trelegy

Explore Trelegy coverage by Blue Cross Blue Shield of Illinois, learn coverage tips, costs without insurance, and get answers to common questions.
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Is Trelegy Covered by Blue Cross Blue Shield of Illinois

 

Coverage for Trelegy with Blue Cross Blue Shield of Illinois

 

  • Trelegy Ellipta is generally covered under Blue Cross Blue Shield of Illinois' prescription drug plans, though specific coverage may vary based on the individual's plan and formulary.
  •  

  • For Trelegy to be covered, it must be deemed medically necessary. Doctors typically prescribe Trelegy for COPD or asthma treatment when other medications are not sufficient.
  •  

  • Prior authorization might be required. This means the healthcare provider must justify the need for Trelegy to the insurance company.
  •  

  • Patients may be required to try and fail alternative therapies before insurance covers Trelegy, often referred to as "step therapy."
  •  

  • It is essential to confirm coverage specifics by reviewing your policy's drug formulary or contacting Blue Cross Blue Shield of Illinois directly.

 

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

 

Criteria for Coverage of Trelegy

 

  • Trelegy is covered for patients with a confirmed diagnosis of Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and emphysema.
  •  

  • Individuals who demonstrate a history of exacerbations despite treatment with dual bronchodilator inhalation therapy.
  •  

  • Patients aged 18 years and older who have been prescribed Trelegy by a pulmonologist or a healthcare provider experienced in treating COPD.
  •  

  • Documentation of the patient’s current medication history and confirmation that the patient has been on inhaled corticosteroids (ICS), long-acting beta agonists (LABAs), and/or long-acting muscarinic antagonists (LAMAs) prior to starting Trelegy.
  •  

  • Treatment plan should indicate that Trelegy is prescribed as a part of the management strategy to improve lung function and reduce COPD symptoms.
  •  

  • Trelegy is also available to patients who have been stabilized on its three constituent drugs - fluticasone, umeclidinium, and vilanterol - and wish to streamline medication into a single inhaler.
  •  

  • The prescription for Trelegy should be aligned with FDA-approved indications and be following recommended dosing guidelines.

 

Why Blue Cross Blue Shield of Illinois Might Deny Trelegy Coverage

 

Criteria for Denial of Trelegy Coverage by Blue Cross Blue Shield of Illinois

 

  • Trelegy is prescribed for an off-label use that is not approved by the FDA. Insurers often do not cover medications for non-FDA approved uses.
  •  

  • The patient does not meet the specific clinical criteria set by Blue Cross Blue Shield of Illinois. This may include situations where the patient's medical history or diagnosis does not align with the coverage guidelines for Trelegy.
  •  

  • The prescription is not written by a specialist who is authorized under the terms of the plan to prescribe Trelegy. Some insurance policies require prescriptions for certain drugs be written by a specialist in that field.
  •  

  • The patient has not tried or failed to benefit from first-line or alternative therapies prior to prescribing Trelegy. Insurers often require patients to try less expensive drugs before covering more costly options.
  •  

  • The use of Trelegy is determined to be not medically necessary based on the plan's medical policy guidelines. This determination is often based on the clinical documentation submitted by the prescribing physician.
  •  

  • Coverage is denied due to formulary restrictions, meaning Trelegy is not included on the plan's approved drug list. This can also happen if Trelegy is placed on a higher formulary tier, leading to additional denials unless requirements are met.

 

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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 Illinois

 

Verify Your Plan Coverage

 

  • Contact Blue Cross Blue Shield of Illinois (BCBSIL) customer service to verify if your health plan covers Trelegy. You can find the phone number on your insurance card or visit the BCBSIL website for more information.
  •  

  • Inquire about any specific drug formularies and whether Trelegy is listed as a covered medication. This may vary depending on your specific insurance plan.
  •  

  • Check if there are any pre-authorization or step therapy requirements for Trelegy under your plan, which might affect coverage.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Trelegy for your treatment. They should be able to provide justification for its use if required for insurance purposes.
  •  

  • Your doctor may need to provide medical documentation or complete a prior authorization form to ensure coverage by BCBSIL.
  • Ensure that your doctor’s office has the correct insurance information to send necessary documentation to BCBSIL.

 

Prior Authorization Process

 

  • If required, have your healthcare provider initiate the prior authorization process. This often involves submitting a request to BCBSIL that includes your medical history and reasons for prescribing Trelegy.
  •  

  • Your provider's office should be familiar with the steps involved, but you can confirm with BCBSIL about any specific forms or processes that must be followed.
  •  

  • Stay in regular contact with both your healthcare provider and BCBSIL to ensure that the authorization is progressing and to address any potential issues promptly.

 

Pharmacy Coordination

 

  • Once authorization is obtained, coordinate with your pharmacy to fill your Trelegy prescription. Ensure that they are aware that the authorization has been granted.
  •  

  • Verify that the pharmacy has all necessary information to process the claim through BCBSIL, including your insurance details and any authorization numbers.
  •  

  • Check with the pharmacy if there are any copay or coinsurance costs associated with your prescription and explore any available discount programs or plans.

 

Appeal Denials if Necessary

 

  • If coverage is denied, request a written explanation of the decision from BCBSIL. Understanding the reasons can help guide your next steps.
  •  

  • Work with your healthcare provider to gather any additional documentation needed to appeal the decision. This might include additional medical records or letters of medical necessity.
  •  

  • Submit a formal appeal to BCBSIL, following their specific appeals process, and continue to engage with their representatives regularly to track the status of your appeal.

 

Explore Financial Assistance Programs

 

  • If you continue to face challenges with coverage or costs, explore manufacturer assistance programs or other financial aid resources that may help reduce your out-of-pocket expenses for Trelegy.
  •  

  • Contact Trelegy's manufacturer to inquire about any available patient assistance programs that might provide the medication at a reduced cost or for free.
  • Check if BCBSIL provides information about supplementary coverage or assistance programs for members with medication affordability issues.

 

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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.

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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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