Does Blue Cross Blue Shield of Massachusetts Cover Trelegy

Discover if Blue Cross Blue Shield of Massachusetts covers Trelegy, why it may deny coverage, tips to get it, costs without insurance, and FAQs.
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Coverage for Trelegy

 

  • Blue Cross Blue Shield of Massachusetts generally covers Trelegy, a medication often prescribed for chronic obstructive pulmonary disease (COPD) and asthma, under prescription drug plans.
  •  
  • The coverage may require prior authorization, meaning your healthcare provider must establish that Trelegy is medically necessary.

 

Basic Rules and Criteria

 

  • Patients must typically have a documented history of COPD or asthma, with a possible requirement of trying other medications first.
  •  
  • Policyholders should verify specific terms with Blue Cross Blue Shield of Massachusetts as coverage can vary based on individual plans and patient conditions.

 

Additional Considerations

 

  • Check if Trelegy is on the formulary list, as its placement affects the cost and coverage level.
  •  
  • Discuss with your healthcare provider to ensure all necessary documentation is provided to meet insurance criteria.

 

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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 Trelegy Coverage with Blue Cross Blue Shield of Massachusetts

 

Check Your Health Plan Details

 

  • Log into your Blue Cross Blue Shield of Massachusetts member account through their website or contact their customer service to review your specific health plan's benefits.
  •  

  • Verify the coverage for prescription medications, particularly those under the respiratory categories.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about Trelegy and its benefits for your condition.
  •  

  • Ensure that your healthcare provider is aware of your health insurance plan and any specific requirements for coverage.

 

Obtain a Prescription

 

  • Your healthcare provider should write a prescription for Trelegy, including any necessary information such as dosage and frequency.
  •  

  • Make sure the prescription complies with Blue Cross Blue Shield of Massachusetts’ formulary or list of covered drugs.

 

Review the Drug Formulary

 

  • Access the drug formulary provided by Blue Cross Blue Shield of Massachusetts to confirm that Trelegy is covered.
  •  

  • If Trelegy is not listed, check for any required prior authorization or preferred alternatives.

 

Gather Required Documentation

 

  • If prior authorization is needed, have your healthcare provider complete and submit any required forms.
  •  

  • Collect any additional documents or information that may support your need for Trelegy, such as medical history or other relevant details.

 

Contact Customer Service

 

  • Reach out to Blue Cross Blue Shield of Massachusetts customer service for any specific questions about coverage for Trelegy.
  •  

  • Request clarification on any steps needed to obtain coverage or address any issues that may arise.

 

Visit an In-Network Pharmacy

 

  • Fill your prescription at a pharmacy that is within the Blue Cross Blue Shield of Massachusetts network to minimize out-of-pocket costs.
  •  

  • Ensure the pharmacy has your current insurance information to process the coverage accurately.

 

Monitor the Approval Process

 

  • Keep track of any notifications from your insurance about the status of your Trelegy coverage.
  •  

  • If the coverage is denied, inquire about the appeals process and what additional information may be required for reconsideration.

 

Refill and Manage Your Medication

 

  • Once coverage is confirmed, keep track of your dosage and refill requirements as per your plan.
  •  

  • Continue consultations with your healthcare provider to ensure Trelegy meets your health needs effectively.

 

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FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Trelegy

Discover if Blue Cross Blue Shield of Massachusetts covers Trelegy, why it may deny coverage, tips to get it, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Trelegy Covered by Blue Cross Blue Shield of Massachusetts

 

Coverage for Trelegy

 

  • Blue Cross Blue Shield of Massachusetts generally covers Trelegy, a medication often prescribed for chronic obstructive pulmonary disease (COPD) and asthma, under prescription drug plans.
  •  
  • The coverage may require prior authorization, meaning your healthcare provider must establish that Trelegy is medically necessary.

 

Basic Rules and Criteria

 

  • Patients must typically have a documented history of COPD or asthma, with a possible requirement of trying other medications first.
  •  
  • Policyholders should verify specific terms with Blue Cross Blue Shield of Massachusetts as coverage can vary based on individual plans and patient conditions.

 

Additional Considerations

 

  • Check if Trelegy is on the formulary list, as its placement affects the cost and coverage level.
  •  
  • Discuss with your healthcare provider to ensure all necessary documentation is provided to meet insurance criteria.

 

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

 

Criteria for Trelegy Coverage by Blue Cross Blue Shield of Massachusetts

 

  • **Diagnosis Requirement**: The patient must have a confirmed diagnosis of Chronic Obstructive Pulmonary Disease (COPD) or Asthma as per medical records.
  •  

  • **Age Specification**: The patient must be within the approved age limit for Trelegy based on the FDA guidelines, usually 18 years and older.
  •  

  • **Prior Treatment Documentation**: Documentation must be provided showing that the patient has tried and found ineffective or intolerant to at least two other formulary medications for COPD or Asthma.
  •  

  • **Medical Records Submission**: Submission of relevant medical records that support the necessity of Trelegy for the patient, including spirometry tests and history of COPD or Asthma exacerbations.
  •  

  • **Physician's Note**: A physician's note stating that Trelegy is medically necessary for the treatment of the patient’s condition and providing justification for its use over other available treatment options.
  •  

  • **Prescription Guidelines**: Trelegy must be prescribed according to the approved dosing guidelines. Deviations require additional justification.
  •  

  • **Compliance Monitoring**: The patient should be willing to adhere to the treatment regimen and follow-up appointments to assess the effectiveness and any adverse effects.
  •  

  • **Coordination of Care**: The treatment plan involving Trelegy must include a coordinated approach with other therapies the patient is receiving, ensuring integrated care for COPD or Asthma.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Trelegy Coverage

 

Criteria for Non-Coverage of Trelegy by Blue Cross Blue Shield of Massachusetts

 

  • **Non-Formulary Status:** Blue Cross Blue Shield of Massachusetts may deny coverage if Trelegy is not on their approved drug formulary or preferred drug list.
  •  

  • **Lack of Medical Necessity:** If Trelegy is not deemed medically necessary based on their clinical guidelines, coverage may be denied. This can include scenarios where alternative treatments are considered suitable.
  •  

  • **Absence of Prior Authorization:** Coverage can be denied if the necessary prior authorization has not been obtained or if the request does not demonstrate sufficient justification for using Trelegy over other options.
  •  

  • **Off-Label Uses:** If Trelegy is prescribed for conditions other than those for which it is FDA approved and the insurer does not accept such use, coverage may be declined.
  •  

  • **Dosage and Quantity Limits:** Requests exceeding the approved dosages or quantities without sufficient clinical justification might lead to denial.
  •  

  • **Failure to Meet Diagnostic Criteria:** If the patient's diagnosis does not align with the insurer’s criteria for Trelegy use, such as specific lung functioning test results, coverage might be refused.
  •  

  • **Non-Compliance with Step Therapy Protocols:** If a patient has not followed the insurer’s step therapy requirements, which may include trying and failing alternative therapies, this can result in denial.
  •  

  • **Lapsed Coverage:** Trelegy might not be covered if the individual’s policy is not active or premiums have not been paid, leading to a lapse in coverage.

 

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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 Massachusetts

 

Check Your Health Plan Details

 

  • Log into your Blue Cross Blue Shield of Massachusetts member account through their website or contact their customer service to review your specific health plan's benefits.
  •  

  • Verify the coverage for prescription medications, particularly those under the respiratory categories.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about Trelegy and its benefits for your condition.
  •  

  • Ensure that your healthcare provider is aware of your health insurance plan and any specific requirements for coverage.

 

Obtain a Prescription

 

  • Your healthcare provider should write a prescription for Trelegy, including any necessary information such as dosage and frequency.
  •  

  • Make sure the prescription complies with Blue Cross Blue Shield of Massachusetts’ formulary or list of covered drugs.

 

Review the Drug Formulary

 

  • Access the drug formulary provided by Blue Cross Blue Shield of Massachusetts to confirm that Trelegy is covered.
  •  

  • If Trelegy is not listed, check for any required prior authorization or preferred alternatives.

 

Gather Required Documentation

 

  • If prior authorization is needed, have your healthcare provider complete and submit any required forms.
  •  

  • Collect any additional documents or information that may support your need for Trelegy, such as medical history or other relevant details.

 

Contact Customer Service

 

  • Reach out to Blue Cross Blue Shield of Massachusetts customer service for any specific questions about coverage for Trelegy.
  •  

  • Request clarification on any steps needed to obtain coverage or address any issues that may arise.

 

Visit an In-Network Pharmacy

 

  • Fill your prescription at a pharmacy that is within the Blue Cross Blue Shield of Massachusetts network to minimize out-of-pocket costs.
  •  

  • Ensure the pharmacy has your current insurance information to process the coverage accurately.

 

Monitor the Approval Process

 

  • Keep track of any notifications from your insurance about the status of your Trelegy coverage.
  •  

  • If the coverage is denied, inquire about the appeals process and what additional information may be required for reconsideration.

 

Refill and Manage Your Medication

 

  • Once coverage is confirmed, keep track of your dosage and refill requirements as per your plan.
  •  

  • Continue consultations with your healthcare provider to ensure Trelegy meets your health needs effectively.

 

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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.

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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