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Does Blue Cross Blue Shield of Illinois Cover Trulicity

Discover if Blue Cross Blue Shield of Illinois covers Trulicity, why it might deny, costs without insurance, and FAQs on securing coverage.

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Coverage for Trulicity under Blue Cross Blue Shield of Illinois

Blue Cross Blue Shield of Illinois generally provides coverage for Trulicity (dulaglutide) as part of its prescription drug benefits.

Prior authorization is often required, where a healthcare provider must demonstrate medical necessity.

Patients typically need a diagnosis of Type 2 diabetes and have tried other treatments without achieving adequate glycemic control.

Coverage criteria may include specific HbA1c levels requiring management.

Terms of coverage can vary based on specific benefit plans, so members should verify with their plan details or contact Member Services.

Basic Criteria for Coverage

Trulicity is usually covered for adults aged 18 and older diagnosed with Type 2 diabetes.

Prescription by a licensed healthcare provider is necessary.

Members might face tiered co-payments, impacting affordability based on their specific plan.

A step-therapy protocol could be applied, requiring the use of other diabetes medications prior to Trulicity.

For detailed guidance, patients should consult their healthcare provider or insurance plan documents.

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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.

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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.

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 Trulicity Coverage with Blue Cross Blue Shield of Illinois

Check Your Current Plan

Begin by reviewing your current Blue Cross Blue Shield of Illinois (BCBSIL) plan documentation. Look specifically for sections related to prescription drug coverage.

Access your plan details through the BCBSIL member portal or contact customer service for a detailed explanation of your prescription benefits.

Consult the Formulary

Locate the BCBSIL prescription drug formulary, which is a list of medications covered under your plan. This document is typically available online through the BCBSIL website.

Check if Trulicity (dulaglutide) is listed and note the tier and any specific restrictions or requirements for coverage.

Understand Prior Authorization

If Trulicity requires prior authorization, gather information on what's needed. This generally involves your healthcare provider submitting a request with medical necessity documentation to BCBSIL.

Communicate with your healthcare provider about the requirements for prior authorization and ensure they submit any necessary paperwork promptly.

Meet with Your Healthcare Provider

Schedule a meeting with your healthcare provider to discuss your need for Trulicity and any alternative medications if Trulicity is not covered or requires prior authorization.

During the appointment, ensure that your provider understands your insurance requirements and can help you with the authorization process if needed.

File the Required Forms

If prior authorization is required, work with your healthcare provider to complete and submit the necessary forms to BCBSIL.

Keep copies of all documents submitted and track correspondence between your provider and BCBSIL for future reference.

Contact BCBSIL for Confirmation

After submitting the authorization request, contact BCBSIL to verify receipt and status. They can provide updates on whether additional information is needed or if the authorization process is progressing.

If the request is approved, follow up to ensure you understand your copayment responsibilities and any other stipulations regarding the medication.

Appeal a Denial

If the authorization request is denied, review the provided denial explanation and determine the reason for denial.

Work with your healthcare provider to compile any additional information or documentation needed to submit an appeal.

Follow the BCBSIL appeal process, meeting all deadlines and requirements to ensure your appeal is considered.

Explore Patient Assistance Programs

If coverage is denied and an appeal is unsuccessful, research patient assistance programs that may provide Trulicity at a reduced cost or for free.

Resources like Lilly Cares and other nonprofit organizations may offer additional support depending on your circumstances.

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Trulicity

Discover if Blue Cross Blue Shield of Illinois covers Trulicity, why it might deny, costs without insurance, and FAQs on securing coverage.

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Is Trulicity Covered by Blue Cross Blue Shield of Illinois

Coverage for Trulicity under Blue Cross Blue Shield of Illinois

Blue Cross Blue Shield of Illinois generally provides coverage for Trulicity (dulaglutide) as part of its prescription drug benefits.

Prior authorization is often required, where a healthcare provider must demonstrate medical necessity.

Patients typically need a diagnosis of Type 2 diabetes and have tried other treatments without achieving adequate glycemic control.

Coverage criteria may include specific HbA1c levels requiring management.

Terms of coverage can vary based on specific benefit plans, so members should verify with their plan details or contact Member Services.

Basic Criteria for Coverage

Trulicity is usually covered for adults aged 18 and older diagnosed with Type 2 diabetes.

Prescription by a licensed healthcare provider is necessary.

Members might face tiered co-payments, impacting affordability based on their specific plan.

A step-therapy protocol could be applied, requiring the use of other diabetes medications prior to Trulicity.

For detailed guidance, patients should consult their healthcare provider or insurance plan documents.

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

Eligibility Criteria for Trulicity Coverage

The individual must have a confirmed diagnosis of Type 2 Diabetes Mellitus. Trulicity is used adjunctively to improve glycemic control.

Patient must be 18 years of age or older. Pediatric use of Trulicity is not part of the approved criteria for coverage.

Trulicity can be covered when prescribed as a part of a comprehensive treatment plan which includes diet and exercise.

The patient must not have a history of pancreatitis or thyroid carcinoma, as these conditions fall outside approved safety concerns for Trulicity use.

Prior Authorization Requirements

A detailed medical history documenting Type 2 Diabetes and the necessity for Trulicity as part of the treatment is required.

Documentation of prior use of other antidiabetic medication is required, demonstrating inadequate glycemic control with non-Trulicity options.

Physician attestation confirming that the patient has been counseled on the potential risks and benefits of Trulicity use.

Continuing Coverage

Periodic evaluation of the patient's HbA1c levels must indicate a positive response to therapy with Trulicity.

The treating physician must provide regular updates verifying the absence of adverse effects directly attributable to Trulicity.

Ongoing adherence to a prescribed diet and exercise routine as part of the comprehensive management plan for diabetes.

Why Blue Cross Blue Shield of Illinois Might Deny Trulicity Coverage

Trulicity Coverage Exclusions by Blue Cross Blue Shield of Illinois

If Trulicity is prescribed for conditions that are non-diabetic related, Blue Cross Blue Shield of Illinois may deny coverage, as the medication is primarily indicated for type 2 diabetes treatment.

Lack of prior authorization can result in a denial; this means that if the necessary pre-approval procedures are not completed, coverage might be refused.

Coverage might be denied if the patient does not meet the criteria set by the insurance plan, such as a specific HbA1c threshold or other medical benchmarks that are required but not met for Trulicity prescription.

In situations where less costly alternative treatments or therapies have not been exhausted or appropriately considered, the insurance plan might deny coverage for Trulicity.

Usage of Trulicity outside of FDA approved indications or dosages might lead to a coverage denial by Blue Cross Blue Shield of Illinois.

In cases where the patient has not demonstrated a lack of response or intolerance to other approved diabetes medications, the insurance provider may deny access to Trulicity.

Failure to provide sufficient medical documentation supporting the necessity of Trulicity use can result in noncoverage by the insurance company.

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How Much Does Trulicity Cost without Insurance?

Trulicity Cost Overview

Trulicity is a brand-name medication commonly used to treat type 2 diabetes. It's administered through a weekly injection.

Approximate Cost Without Insurance

The price of Trulicity can vary depending on the pharmacy or location, but the average cost for one pen of 1.5 mg/0.5 mL solution might run approximately $886 to $1,100.
Each box typically contains four pens, which is a month's supply, resulting in the total cost being roughly $3,544 to $4,400.

Factors Influencing Pricing

Pharmacy: Prices may differ from one pharmacy to another, so it’s beneficial to compare costs.
Location: Costs may vary based on geographic location due to regional pricing strategies and pharmacy benefits.
Discount Programs: Some pharmacies may offer savings programs or coupons that could lower the price.

Additional Cost-Saving Tips

Check for manufacturer discounts or patient assistance programs, which may offer significant savings or even free medication for qualified individuals.
Consider discussing alternative medications with your healthcare provider to find a more affordable option suitable for your needs.
Utilize pharmacy discount cards or look up savings programs online that specifically cater to diabetes medications.

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 Trulicity Coverage with Blue Cross Blue Shield of Illinois

Check Your Current Plan

Begin by reviewing your current Blue Cross Blue Shield of Illinois (BCBSIL) plan documentation. Look specifically for sections related to prescription drug coverage.

Access your plan details through the BCBSIL member portal or contact customer service for a detailed explanation of your prescription benefits.

Consult the Formulary

Locate the BCBSIL prescription drug formulary, which is a list of medications covered under your plan. This document is typically available online through the BCBSIL website.

Check if Trulicity (dulaglutide) is listed and note the tier and any specific restrictions or requirements for coverage.

Understand Prior Authorization

If Trulicity requires prior authorization, gather information on what's needed. This generally involves your healthcare provider submitting a request with medical necessity documentation to BCBSIL.

Communicate with your healthcare provider about the requirements for prior authorization and ensure they submit any necessary paperwork promptly.

Meet with Your Healthcare Provider

Schedule a meeting with your healthcare provider to discuss your need for Trulicity and any alternative medications if Trulicity is not covered or requires prior authorization.

During the appointment, ensure that your provider understands your insurance requirements and can help you with the authorization process if needed.

File the Required Forms

If prior authorization is required, work with your healthcare provider to complete and submit the necessary forms to BCBSIL.

Keep copies of all documents submitted and track correspondence between your provider and BCBSIL for future reference.

Contact BCBSIL for Confirmation

After submitting the authorization request, contact BCBSIL to verify receipt and status. They can provide updates on whether additional information is needed or if the authorization process is progressing.

If the request is approved, follow up to ensure you understand your copayment responsibilities and any other stipulations regarding the medication.

Appeal a Denial

If the authorization request is denied, review the provided denial explanation and determine the reason for denial.

Work with your healthcare provider to compile any additional information or documentation needed to submit an appeal.

Follow the BCBSIL appeal process, meeting all deadlines and requirements to ensure your appeal is considered.

Explore Patient Assistance Programs

If coverage is denied and an appeal is unsuccessful, research patient assistance programs that may provide Trulicity at a reduced cost or for free.

Resources like Lilly Cares and other nonprofit organizations may offer additional support depending on your circumstances.

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Trulicity FAQ

What are the common side effects of Trulicity?

Common Side Effects of Trulicity

Nausea: Initially, many patients experience nausea, which often lessens over time as the body adjusts.

Vomiting: Some individuals may experience vomiting, particularly in the first few doses.

Diarrhea: Digestive disturbances such as diarrhea are commonly reported.

Abdominal Pain: Discomfort in the abdomen can occur, often subsiding with continued use.

Decreased Appetite: Patients often report a reduction in appetite.

Fatigue: Some individuals may feel unusually tired after starting treatment.

Reduced Blood Sugar: Blood sugar levels may become low, especially when used in conjunction with other diabetes medications.

How much weight can you lose on Trulicity?

Weight Loss with Trulicity

Trulicity (dulaglutide) is primarily prescribed for managing type 2 diabetes, but many patients also experience weight loss as an additional benefit.

Clinical trials indicate an average weight loss of around 2-6 pounds, but results differ based on individual factors such as diet, exercise, and adherence to the medication.

Some users report greater weight loss; however, it's important to accompany Trulicity with lifestyle changes for optimal results.

Consult with a healthcare provider to tailor a plan that maximizes benefits based on your health needs.

How does Trulicity work for type 2 diabetes?

How Trulicity Works

Trulicity is a GLP-1 receptor agonist, helping to regulate blood sugar levels.

It stimulates insulin release in response to high blood glucose.

It slows gastric emptying, which helps reduce post-meal glucose spikes.

Trulicity suppresses glucagon secretion, lowering glucose production by the liver.

Benefits

Easy-to-use once-weekly injection, improving adherence.

Not associated with causing weight gain; may even promote modest weight loss.

May reduce risk of cardiovascular events in patients with heart disease.

Considerations

May cause gastrointestinal side effects, often resolving over time.

Inform your doctor if you have a history of pancreatitis or gallbladder disease.

Monitor for signs of low blood sugar, especially if using other diabetes medications.

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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 Trulicity

Discover if Blue Cross Blue Shield of Illinois covers Trulicity, why it might deny, costs without insurance, and FAQs on securing coverage.

Achieve Your Goals Faster with Curex