Does Blue Cross Blue Shield of Massachusetts Cover Lantus

Discover why BCBS of Massachusetts might deny Lantus coverage and learn how to secure it. Explore Lantus costs without insurance and find answers to FAQs.
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Coverage for Lantus

 

  • Blue Cross Blue Shield of Massachusetts generally covers Lantus under its prescription drug plans, but coverage specifics can vary based on the plan type.
  •  

  • For Lantus to be covered, it typically needs to be deemed medically necessary by a healthcare provider.

 

Basic Coverage Criteria

 

  • Prior authorization from a healthcare provider might be required for coverage approval.
  •  

  • Patients might need to meet certain clinical criteria, indicating that Lantus is the most suitable treatment for their medical condition.

 

Situations and Steps

 

  • Lantus is often covered for individuals diagnosed with type 1 or type 2 diabetes when other treatments are not effective.
  •  

  • Ensure that the pharmacy you use is within the BCBS network, as this can impact coverage levels.
  •  

  • Review your specific plan details or contact BCBS directly for personalized information about coverage and potential copayments.

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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.

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 Massachusetts

 

Verify Your Plan Details

 

  • Log in to the Blue Cross Blue Shield of Massachusetts (BCBSMA) member portal to access your policy details. This will help you understand your specific coverage options for medications like Lantus.
  •  

  • Review your plan's formulary to see if Lantus is listed as a covered medication. This document provides insight into which medications are preferred and their specific coverage status.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Lantus with your healthcare provider. Ensure that your medical records reflect why Lantus is medically necessary for your treatment plan.
  •  

  • Ask your provider to submit a prescription for Lantus to a pharmacy that is within the BCBSMA network.

 

Understand Prior Authorization Requirements

 

  • If Lantus requires prior authorization, your healthcare provider will need to submit a request. This is a process where BCBSMA reviews the necessity of using Lantus before approving payment coverage.
  •  

  • Ensure that your provider includes detailed medical documentation to support the necessity of Lantus. This might include lab results or a history of other treatments tried.

 

Contact BCBSMA Member Services

 

  • If you encounter issues or need clarification, contact BCBSMA Member Services. They can provide specific details about your plan's coverage and guide you on the necessary steps to get Lantus approved.
  •  

  • Inquire if there are any available cost-saving options, such as generic alternatives or patient assistance programs.

 

Submit a Claim if Necessary

 

  • If Lantus was initially not covered or you had to pay out-of-pocket, you can sometimes submit a claim to BCBSMA. Be sure to follow their exact claim submission procedure for a chance at reimbursement.
  •  

  • Include all necessary documentation, such as receipts and a copy of your prescription, for consideration.

 

Appeal a Denied Request

 

  • If BCBSMA denies coverage for Lantus, you have the right to appeal the decision. Start by carefully reviewing the denial letter for specific reasons why coverage was refused.
  •  

  • Provide a detailed appeal letter, supplemented with supporting medical documentation from your healthcare provider, and submit it as instructed in your denial letter.

 

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FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Lantus

Discover why BCBS of Massachusetts might deny Lantus coverage and learn how to secure it. Explore Lantus costs without insurance and find answers to FAQs.
Curex allergy drops unboxing

Is Lantus Covered by Blue Cross Blue Shield of Massachusetts

 

Coverage for Lantus

 

  • Blue Cross Blue Shield of Massachusetts generally covers Lantus under its prescription drug plans, but coverage specifics can vary based on the plan type.
  •  

  • For Lantus to be covered, it typically needs to be deemed medically necessary by a healthcare provider.

 

Basic Coverage Criteria

 

  • Prior authorization from a healthcare provider might be required for coverage approval.
  •  

  • Patients might need to meet certain clinical criteria, indicating that Lantus is the most suitable treatment for their medical condition.

 

Situations and Steps

 

  • Lantus is often covered for individuals diagnosed with type 1 or type 2 diabetes when other treatments are not effective.
  •  

  • Ensure that the pharmacy you use is within the BCBS network, as this can impact coverage levels.
  •  

  • Review your specific plan details or contact BCBS directly for personalized information about coverage and potential copayments.

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

 

Criteria for Getting Lantus Coverage

 

  • **Diagnosis of Diabetes**: The patient must have a documented diagnosis of diabetes mellitus, type 1 or type 2, requiring basal insulin therapy.
  •  

  • **Previous Insulin Therapy**: The patient has tried other forms of insulin therapy and requires a long-acting insulin, like Lantus, for better blood glucose control.
  •  

  • **Medical Necessity**: The prescribing physician must provide a justification as to why Lantus is necessary for the patient and why alternatives cannot be used.
  •  

  • **Compliance with Treatment Plan**: The patient agrees to adhere to the prescribed diabetic treatment plan, including diet, exercise, and monitoring their blood glucose levels regularly.
  •  

  • **Age Restrictions**: Patients must be within the age limits covered by the plan for Lantus, typically individuals over a certain age with type 1 or type 2 diabetes.
  •  

  • **Exclusion of Conditions**: The patient must not have any overlapping medical conditions that could contraindicate the use of Lantus, such as allergies to insulin glargine.
  •  

  • **Specialist Consultation**: Coverage may be contingent upon consultation or recommendation by an endocrinologist or a diabetes specialist.
  •  

  • **Insurance Policy Guidelines**: Coverage follows the guidelines outlined in the specific health insurance policy offered by Blue Cross Blue Shield of Massachusetts, including any applicable co-pays or deductibles.

 

Prescription Approval Process

 

  • **Submission of Documentation**: The prescribing health care provider must submit appropriate medical documentation and a diabetes management plan showing the need for Lantus.
  •  

  • **Prior Authorization**: In some cases, prior authorization might be required to confirm that the patient meets all necessary criteria and guidelines for coverage.
  •  

  • **Periodic Review**: Continued coverage for Lantus may require regular review and documentation update from the healthcare provider to ensure that the medication remains the best option for the patient's condition.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Lantus Coverage

 

Reasons for Lantus Coverage Denial

 

  • Lantus is not part of the prescribed formulary of the patient's insurance plan tier, leading to non-coverage under that specific plan.
  •  

  • The patient has not complied with step therapy requirements, meaning alternative treatments must first be attempted and proven ineffective before Lantus coverage is approved.
  •  

  • The medication is prescribed outside the approved uses or off-label without sufficient evidence or established medical guideline support.
  •  

  • Lantus is used in combination with other medications that are not approved under the patient's specific coverage policy, leading to denial due to improper use protocol.
  •  

  • Insurance policy restrictions related to the number of refills or dosage increments prevent coverage for amounts exceeding specified limits.
  •  

  • The patient lacks necessary prior authorization or documentation verifying medical necessity as per policy regulations.
  •  

  • Applicable coverage exclusion clauses in the insurance plan explicitly omit Lantus from the list of covered medications.

 

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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 Massachusetts

 

Verify Your Plan Details

 

  • Log in to the Blue Cross Blue Shield of Massachusetts (BCBSMA) member portal to access your policy details. This will help you understand your specific coverage options for medications like Lantus.
  •  

  • Review your plan's formulary to see if Lantus is listed as a covered medication. This document provides insight into which medications are preferred and their specific coverage status.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Lantus with your healthcare provider. Ensure that your medical records reflect why Lantus is medically necessary for your treatment plan.
  •  

  • Ask your provider to submit a prescription for Lantus to a pharmacy that is within the BCBSMA network.

 

Understand Prior Authorization Requirements

 

  • If Lantus requires prior authorization, your healthcare provider will need to submit a request. This is a process where BCBSMA reviews the necessity of using Lantus before approving payment coverage.
  •  

  • Ensure that your provider includes detailed medical documentation to support the necessity of Lantus. This might include lab results or a history of other treatments tried.

 

Contact BCBSMA Member Services

 

  • If you encounter issues or need clarification, contact BCBSMA Member Services. They can provide specific details about your plan's coverage and guide you on the necessary steps to get Lantus approved.
  •  

  • Inquire if there are any available cost-saving options, such as generic alternatives or patient assistance programs.

 

Submit a Claim if Necessary

 

  • If Lantus was initially not covered or you had to pay out-of-pocket, you can sometimes submit a claim to BCBSMA. Be sure to follow their exact claim submission procedure for a chance at reimbursement.
  •  

  • Include all necessary documentation, such as receipts and a copy of your prescription, for consideration.

 

Appeal a Denied Request

 

  • If BCBSMA denies coverage for Lantus, you have the right to appeal the decision. Start by carefully reviewing the denial letter for specific reasons why coverage was refused.
  •  

  • Provide a detailed appeal letter, supplemented with supporting medical documentation from your healthcare provider, and submit it as instructed in your denial letter.

 

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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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