Does Blue Cross Blue Shield of Massachusetts Cover Jardiance

Learn if Blue Cross Blue Shield of Massachusetts covers Jardiance and explore options, costs, and FAQs about getting this medication covered.
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Blue Cross Blue Shield of Massachusetts Coverage for Jardiance

 

  • Jardiance is typically covered under Blue Cross Blue Shield of Massachusetts if it’s prescribed for type 2 diabetes management to lower blood sugar levels or reduce the risk of cardiovascular death.
  •  

  • Coverage may depend on the specific health plan and whether Jardiance is included in the formulary. Checking the formulary list is recommended.
  •  

  • A physician's prescription is necessary, and prior authorization might be required to ensure that Jardiance is a suitable treatment for the patient.
  •  

  • Patients may need to demonstrate a medical necessity, such as not responding adequately to other diabetes medications.
  •  

  • Co-pays and out-of-pocket costs can vary, so reviewing individual plan details is crucial for understanding personal financial responsibility.

 

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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 Jardiance Coverage with Blue Cross Blue Shield of Massachusetts

 

Contact Your Healthcare Provider

 

  • Your healthcare provider is a key resource in determining the necessity of Jardiance for your treatment plan. Discuss your medical condition, treatment options, and the potential for a Jardiance prescription.

 

Review Your Health Plan Coverage

 

  • Visit the Blue Cross Blue Shield of Massachusetts website or contact their customer service to review your specific health plan coverage. Look for prescription drug benefits and determine if Jardiance is listed in their formulary.
  •  

  • If Jardiance is not covered, inquire about the process for requesting an exception or an alternative medication that might be covered.

 

Check Prescription Drug Formulary

 

  • Locate the drug formulary, which is a list of medications covered by your plan. This information is usually available online through your member portal.
  •  

  • Verify if Jardiance is included in the formulary. You can use the search function on the webpage to find Jardiance quickly.

 

Understand Your Plan’s Requirements

 

  • Check if prior authorization is required for Jardiance. Some plans need specific approvals from doctors and the insurance company before covering the medication.
  •  

  • Review any step therapy rules. These may require trying other medications before Jardiance will be covered.

 

Request Prior Authorization

 

  • If prior authorization is needed, your healthcare provider will need to complete and submit the appropriate form through the Blue Cross Blue Shield portal or via fax.
  •  

  • This process typically involves providing medical justification for the prescription, showcasing why Jardiance is necessary for your treatment.

 

Consider Additional Assistance Programs

 

  • Check if you qualify for assistance programs offered by the manufacturer of Jardiance. These programs can help reduce the cost if insurance coverage is limited.
  •  

  • Contact your healthcare provider for information about patient assistance programs or discounts from the pharmaceutical company.

 

Follow Up on Authorization Requests

 

  • After submitting prior authorization requests, stay in touch with your healthcare provider’s office and Blue Cross Blue Shield to ensure your request is processed promptly.
  •  

  • If you encounter delays or denials, ask for detailed reasons and what alternative steps you can take to get approval.

 

Obtain and Fill the Prescription

 

  • Once approval is secured, request a prescription from your healthcare provider to be sent to a pharmacy covered under your plan.
  •  

  • Confirm with the pharmacy that they have Jardiance in stock and that they will process it according to your Blue Cross Blue Shield coverage terms.

 

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FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Jardiance

Learn if Blue Cross Blue Shield of Massachusetts covers Jardiance and explore options, costs, and FAQs about getting this medication covered.
Curex allergy drops unboxing

Is Jardiance Covered by Blue Cross Blue Shield of Massachusetts

 

Blue Cross Blue Shield of Massachusetts Coverage for Jardiance

 

  • Jardiance is typically covered under Blue Cross Blue Shield of Massachusetts if it’s prescribed for type 2 diabetes management to lower blood sugar levels or reduce the risk of cardiovascular death.
  •  

  • Coverage may depend on the specific health plan and whether Jardiance is included in the formulary. Checking the formulary list is recommended.
  •  

  • A physician's prescription is necessary, and prior authorization might be required to ensure that Jardiance is a suitable treatment for the patient.
  •  

  • Patients may need to demonstrate a medical necessity, such as not responding adequately to other diabetes medications.
  •  

  • Co-pays and out-of-pocket costs can vary, so reviewing individual plan details is crucial for understanding personal financial responsibility.

 

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

 

Criteria for Coverage of Jardiance

 

  • Jardiance is covered for patients who have been diagnosed with Type 2 Diabetes Mellitus as an adjunct to diet and exercise to improve glycemic control.
  •  

  • Patients must have documented insufficient control of blood glucose levels despite a trial of host standard treatments such as metformin or sulfonylureas.
  •  

  • Jardiance is approved for patients with a history of cardiovascular disease as it helps to reduce the risk of cardiovascular death.
  •  

  • Evidence of renal function is required, showing a suitable Glomerular Filtration Rate (GFR) for the safe use of Jardiance, typically GFR ≥ 45 mL/min/1.73 m².
  •  

  • Continuation criteria require documented evidence of benefit such as improved HbA1c levels, and comprehensive clinical assessment for efficacy and safety.

 

Prescription and Dosage Requirements

 

  • Jardiance must be prescribed by a healthcare provider experienced in the management of diabetes or cardiovascular disease.
  •  

  • Appropriate initial and maintenance dosages should align with FDA recommendations and incorporate adjustment for renal function.
  •  

  • Documentation must reflect regular follow-ups to monitor patient response and potential side effects of the medication.

 

Additional Benefit Coverage

 

  • Coverage may extend to include research-backed benefits such as improved heart failure outcomes in patients with Type 2 Diabetes Mellitus and established cardiovascular disease.
  •  

  • Consideration for coverage in certain cases of heart failure or chronic kidney disease, even in the absence of Type 2 Diabetes Mellitus, provided supporting clinical evidence and evaluations are presented.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Jardiance Coverage

 

Reasons for Denial of Jardiance Coverage

 

  • Jardiance is not medically necessary according to Blue Cross Blue Shield of Massachusetts guidelines, which may require specific diagnostic evidence or failed alternative treatments.
  •  

  • The prescription does not meet the outlined criteria for diabetes management or associated conditions as defined by Blue Cross Blue Shield of Massachusetts.
  •  

  • There is a lack of documented clinical trial evidence or studies supporting the use of Jardiance for the patient's specific medical condition.
  •  

  • The prescribed dosage of Jardiance does not adhere to the formulary or guideline maximum limits.
  •  

  • The patient has a prior authorization requirement that has not been met or approved for Jardiance.
  •  

  • Alternative, less costly medications that achieve the same therapeutic outcomes are available and have not been tried.
  •  

  • The patient has not met the step therapy requirement, which involves trying specified medications before approving Jardiance.
  •  

  • The insurance policy excludes coverage for weight loss, heart failure, or other off-label uses of Jardiance not explicitly covered under the plan.

 

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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.

 

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 Jardiance Coverage with Blue Cross Blue Shield of Massachusetts

 

Contact Your Healthcare Provider

 

  • Your healthcare provider is a key resource in determining the necessity of Jardiance for your treatment plan. Discuss your medical condition, treatment options, and the potential for a Jardiance prescription.

 

Review Your Health Plan Coverage

 

  • Visit the Blue Cross Blue Shield of Massachusetts website or contact their customer service to review your specific health plan coverage. Look for prescription drug benefits and determine if Jardiance is listed in their formulary.
  •  

  • If Jardiance is not covered, inquire about the process for requesting an exception or an alternative medication that might be covered.

 

Check Prescription Drug Formulary

 

  • Locate the drug formulary, which is a list of medications covered by your plan. This information is usually available online through your member portal.
  •  

  • Verify if Jardiance is included in the formulary. You can use the search function on the webpage to find Jardiance quickly.

 

Understand Your Plan’s Requirements

 

  • Check if prior authorization is required for Jardiance. Some plans need specific approvals from doctors and the insurance company before covering the medication.
  •  

  • Review any step therapy rules. These may require trying other medications before Jardiance will be covered.

 

Request Prior Authorization

 

  • If prior authorization is needed, your healthcare provider will need to complete and submit the appropriate form through the Blue Cross Blue Shield portal or via fax.
  •  

  • This process typically involves providing medical justification for the prescription, showcasing why Jardiance is necessary for your treatment.

 

Consider Additional Assistance Programs

 

  • Check if you qualify for assistance programs offered by the manufacturer of Jardiance. These programs can help reduce the cost if insurance coverage is limited.
  •  

  • Contact your healthcare provider for information about patient assistance programs or discounts from the pharmaceutical company.

 

Follow Up on Authorization Requests

 

  • After submitting prior authorization requests, stay in touch with your healthcare provider’s office and Blue Cross Blue Shield to ensure your request is processed promptly.
  •  

  • If you encounter delays or denials, ask for detailed reasons and what alternative steps you can take to get approval.

 

Obtain and Fill the Prescription

 

  • Once approval is secured, request a prescription from your healthcare provider to be sent to a pharmacy covered under your plan.
  •  

  • Confirm with the pharmacy that they have Jardiance in stock and that they will process it according to your Blue Cross Blue Shield coverage terms.

 

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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 (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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