Does Blue Cross Blue Shield of Michigan Cover Humira

Learn about Humira coverage with Blue Cross Blue Shield of Michigan, costs without insurance, reasons for denial, and how to secure approval.
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Coverage of Humira by Blue Cross Blue Shield Michigan

 

  • **Specific Conditions**: Humira is generally covered for autoimmune conditions like rheumatoid arthritis, Crohn’s disease, and psoriasis.
  •  

  • **Pre-Authorization**: Coverage typically requires prior authorization. You must provide medical records and a doctor's recommendation stating the necessity for Humira.
  •  

  • **Step Therapy**: Generic alternatives or preferred medications might be tried before approving Humira.
  •  

  • **In-Network Providers**: Obtaining Humira from network pharmacies or providers usually maximizes benefits and minimizes out-of-pocket costs.
  •  

  • **Co-payments and Deductibles**: Coverage may involve varying co-payments and deductibles based on your specific plan.

 

Please verify these details with Blue Cross Blue Shield of Michigan as policy terms may differ and change over time.

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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.

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 Humira Coverage with Blue Cross Blue Shield of Michigan

 

Review Your Coverage Plan

 

  • Log in to the Blue Cross Blue Shield of Michigan member portal to access your current health coverage details.
  •  

  • Check if Humira is included in your plan's formulary, which is a list of prescription drugs covered.
  •  

  • Review your out-of-pocket costs, such as copays and deductibles, associated with Humira.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Humira. Gather necessary medical documentation and history to support the prescription.
  •  

  • Ensure that your healthcare provider is within the Blue Cross Blue Shield network to avoid additional costs.

 

Get Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request for Humira to Blue Cross Blue Shield of Michigan.
  •  

  • Include all required documents, such as medical necessity forms and any supportive clinical information.
  •  

  • Contact Blue Cross Blue Shield customer service for guidance and to confirm all submitted materials are complete.

 

Submit A Prescription

 

  • Once the prior authorization is approved, obtain your prescription for Humira from your healthcare provider.
  •  

  • Take the prescription to a pharmacy within the Blue Cross network to ensure coverage.
  •  

  • Verify with the pharmacy that your prescription is processed correctly under your insurance to avoid unexpected costs.

 

Discuss Financial Assistance Options

 

  • If you face high out-of-pocket costs, inquire about financial assistance programs offered by AbbVie, the manufacturer of Humira.
  •  

  • Explore other patient assistance programs that may provide additional support based on your income and coverage situation.

 

Monitor Your Coverage and Refill Process

 

  • Stay informed of any changes in your insurance plan during renewal periods that might affect Humira coverage.
  •  

  • Set up reminders and automatic refills to ensure uninterrupted access to Humira, observing any potential policy changes.
  •  

  • Keep communication open with your healthcare provider and insurance company to address changes in coverage or medical needs promptly.

 

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FAQs

Does Blue Cross Blue Shield of Michigan Cover Humira

Learn about Humira coverage with Blue Cross Blue Shield of Michigan, costs without insurance, reasons for denial, and how to secure approval.
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Is Humira Covered by Blue Cross Blue Shield of Michigan

 

Coverage of Humira by Blue Cross Blue Shield Michigan

 

  • **Specific Conditions**: Humira is generally covered for autoimmune conditions like rheumatoid arthritis, Crohn’s disease, and psoriasis.
  •  

  • **Pre-Authorization**: Coverage typically requires prior authorization. You must provide medical records and a doctor's recommendation stating the necessity for Humira.
  •  

  • **Step Therapy**: Generic alternatives or preferred medications might be tried before approving Humira.
  •  

  • **In-Network Providers**: Obtaining Humira from network pharmacies or providers usually maximizes benefits and minimizes out-of-pocket costs.
  •  

  • **Co-payments and Deductibles**: Coverage may involve varying co-payments and deductibles based on your specific plan.

 

Please verify these details with Blue Cross Blue Shield of Michigan as policy terms may differ and change over time.

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Blue Cross Blue Shield of Michigan's Approved Criteria for Humira Coverage

 

General Criteria for Humira Coverage

 

  • Humira is covered for treatment of conditions approved by the FDA. The specific uses include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, ulcerative colitis, hidradenitis suppurativa, juvenile idiopathic arthritis, and plaque psoriasis.
  • Patient must have a confirmed diagnosis for one of the covered conditions by a licensed healthcare provider.
  • Patient must have attempted standard first-line therapies without satisfactory improvement, or they have a contraindication or intolerance to other therapeutic options.

 

Age Requirements

 

  • For patients with juvenile idiopathic arthritis, coverage is provided for patients two years of age and older.
  • For all other conditions, Humira is typically covered for patients of any age if they meet other diagnostic criteria.

 

Prior Authorization and Documentation

 

  • Coverage is generally subject to prior authorization. Healthcare providers must submit a prior authorization request along with supporting medical documentation.
  • Documentation provided must include patients’ medical history, prior treatment records, and rationale for the necessity of Humira therapy.

 

Dosage and Administration

 

  • Coverage is provided based on standard dosing guidelines as per FDA-approved labeling. Deviations may require additional medical justification.
  • Requests for coverage should specify the preferred administration route and schedule, supporting it with evidence for that particular regimen.

 

Re-evaluation and Continuation Criteria

 

  • Continuous coverage requires periodic re-evaluation to ensure therapeutic benefits justify ongoing Humira therapy.
  • Documentation of clinical response, such as improvement in symptoms or maintenance of remission, must be submitted when extending coverage.

 

Why Blue Cross Blue Shield of Michigan Might Deny Humira Coverage

 

Criteria for Denial of Humira Coverage

 

  • Humira prescription does not meet the FDA-approved guidelines for its use in treating specific conditions.
  •  

  • The patient has not tried and failed less costly alternative treatments as required by the insurance policy.
  •  

  • The prescribed use of Humira is considered experimental or investigational for a condition not supported by sufficient clinical evidence.
  •  

  • The patient's medical documentation does not adequately demonstrate the necessity of Humira for the specified condition.
  •  

  • Humira is prescribed in a dosage or frequency that exceeds what is deemed safe or necessary according to medical standards.
  •  

  • The requested Humira treatment is for a non-FDA-approved condition or off-label usage not routinely covered by the policy.
  •  

  • The prescribed duration of therapy exceeds the insurance plan’s benefit limits for biologic medications.
  •  

  • There are discrepancies or missing information in the authorization request, such as incorrect patient information or insufficient medical records.
  •  

  • The patient is using Humira concurrently with another biologic therapy, which is against policy guidelines without prior authorization.

 

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How Much Does Humira Cost without Insurance?

 

Understanding Humira's Cost

 

  • Humira, a medication used to treat various autoimmune conditions, can be quite expensive without insurance coverage.
  •  

  • The cost for a single 40 mg/0.4 ml pen of Humira is typically priced between $5,000 and $6,000, depending on the pharmacy and location.
  •  

  • Patients often require multiple pens per month, so monthly costs can range from $10,000 to $24,000 or more, depending on dosage and frequency of use.
  •  

  • Pharmaceutical companies may offer financial assistance programs or patient support to help lower these costs for eligible patients.
  •  

  • Discount programs and manufacturer coupons could sometimes reduce the cost for patients who qualify.

 

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 Humira Coverage with Blue Cross Blue Shield of Michigan

 

Review Your Coverage Plan

 

  • Log in to the Blue Cross Blue Shield of Michigan member portal to access your current health coverage details.
  •  

  • Check if Humira is included in your plan's formulary, which is a list of prescription drugs covered.
  •  

  • Review your out-of-pocket costs, such as copays and deductibles, associated with Humira.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Humira. Gather necessary medical documentation and history to support the prescription.
  •  

  • Ensure that your healthcare provider is within the Blue Cross Blue Shield network to avoid additional costs.

 

Get Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request for Humira to Blue Cross Blue Shield of Michigan.
  •  

  • Include all required documents, such as medical necessity forms and any supportive clinical information.
  •  

  • Contact Blue Cross Blue Shield customer service for guidance and to confirm all submitted materials are complete.

 

Submit A Prescription

 

  • Once the prior authorization is approved, obtain your prescription for Humira from your healthcare provider.
  •  

  • Take the prescription to a pharmacy within the Blue Cross network to ensure coverage.
  •  

  • Verify with the pharmacy that your prescription is processed correctly under your insurance to avoid unexpected costs.

 

Discuss Financial Assistance Options

 

  • If you face high out-of-pocket costs, inquire about financial assistance programs offered by AbbVie, the manufacturer of Humira.
  •  

  • Explore other patient assistance programs that may provide additional support based on your income and coverage situation.

 

Monitor Your Coverage and Refill Process

 

  • Stay informed of any changes in your insurance plan during renewal periods that might affect Humira coverage.
  •  

  • Set up reminders and automatic refills to ensure uninterrupted access to Humira, observing any potential policy changes.
  •  

  • Keep communication open with your healthcare provider and insurance company to address changes in coverage or medical needs promptly.

 

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Humira FAQ

What are the side effects of Humira?

 

Common Side Effects of Humira

 

  • Injection site reactions: redness, itching, or swelling.
  • Upper respiratory infections: sinus congestion and sore throat.
  • Headaches and nausea.

 

Serious Side Effects

 

  • Severe allergic reactions: difficulty breathing, chest pain, or swelling of the face.
  • Risk of infections: tuberculosis, fungal, or viral infections.
  • Blood disorders: unusual bruising or bleeding, pale skin.
  • Heart problems: shortness of breath, swelling of ankles/feet.

 

Long-term Considerations

 

  • Increased risk of certain cancers, particularly lymphomas.
  • Possible liver issues: jaundice or dark urine.

 

How does Humira work for rheumatoid arthritis?

 

How Humira Works

 

  • Humira is a TNF inhibitor. TNF, or tumor necrosis factor, is a substance in the body that causes inflammation.
  •  

  • By blocking TNF, Humira helps reduce inflammation and slow disease progression in rheumatoid arthritis patients.
  •  

  • It targets the underlying cause of inflammation instead of just managing symptoms, providing longer-term relief from discomfort and joint damage.

 

Administration and Effects

 

  • Administered as a subcutaneous injection, typically every two weeks.
  •  

  • Many patients start experiencing relief within a few weeks, though full benefits may take longer.
  •  

  • Consistent use can lead to improved mobility, reduced pain, and decreased swelling, assisting in daily activities.

How often do you take Humira injections?

 

Frequency of Humira Injections

 

  • **Initial Dose**: Typically, patients start with a loading dose. For example, in rheumatoid arthritis, a patient may begin with 160 mg on day 1, followed by 80 mg on day 15.
  •  

  • **Maintenance Dose**: After the initial period, the standard maintenance dose is usually 40 mg every other week. However, some patients may benefit from a weekly dose, depending on the condition and doctor's advice.
  •  

  • **Adjustments**: Dosage frequency may be adjusted based on response and tolerability, making healthcare provider consultation crucial.

 

Consulting Your Physician

 

  • Due to the varying nature of autoimmune conditions, always consult your healthcare professional to determine the appropriate regimen for your specific situation.

 

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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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