Does Blue Cross Blue Shield of Michigan Cover Trelegy

Explore Trelegy coverage by Blue Cross Blue Shield of Michigan. Learn denial reasons, coverage tips, costs without insurance, and FAQs for informed choices.
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Coverage for Trelegy under Blue Cross Blue Shield of Michigan

 

  • Trelegy is typically covered as a prescription medication under Blue Cross Blue Shield of Michigan, primarily for patients with COPD or similar respiratory conditions.
  •  

  • Coverage often requires prior authorization to ensure it's medically necessary. Your physician must provide documentation of your condition and previous treatments tried.
  •  

  • Patients usually need to meet specific criteria, like failing to respond adequately to other inhaled treatments, for Trelegy to be approved for coverage.
  •  

  • Coverage may vary based on the subscriber's particular plan, so it is essential to review your plan's formulary or contact customer service for detailed information.
  •  

  • Copayments and deductibles are likely applicable, and these can vary significantly between different insurance plans and tiers.

 

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Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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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 Michigan

 

Contact Blue Cross Blue Shield of Michigan

 

  • Reach out to Blue Cross Blue Shield of Michigan via their customer service phone number or through their website to inquire about their coverage for Trelegy.
  •  

  • Have your insurance identification number ready, as they may need it to provide specific details about your coverage plan.

 

Review Your Current Plan

 

  • Examine your current health insurance policy documents to understand your prescription drug coverage under Blue Cross Blue Shield of Michigan.
  •  

  • Check if Trelegy is listed on your plan’s formulary or if it falls under any special medication programs.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Trelegy and any prior authorizations that might be required.
  •  

  • Ask your provider to assist with any necessary paperwork or documentation that BCBS might require to approve Trelegy.

 

Submit a Prior Authorization Request

 

  • If Trelegy requires prior authorization, your healthcare provider will need to complete and submit a request form to Blue Cross Blue Shield of Michigan.
  •  

  • Ensure all medical necessity information is included and detailed to facilitate the approval process.

 

Follow Up with BCBS

 

  • Contact Blue Cross Blue Shield of Michigan to confirm receipt of the prior authorization request and to ask for the estimated processing time.
  •  

  • Inquire if there are any additional steps you need to complete to expedite coverage for Trelegy.

 

Check the Outcome

 

  • Once approved, review your coverage details to understand any copayments, deductibles, or restrictions associated with Trelegy.
  •  

  • If the request is denied, request a written explanation from BCBS and discuss alternative options with your healthcare provider.

 

Explore Financial Assistance Programs

 

  • If coverage is denied or if out-of-pocket costs are too high, search for financial assistance programs offered by Trelegy’s manufacturer or other patient aid services.
  •  

  • Consider reaching out to nonprofit organizations that provide support for prescription medication costs.

 

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FAQs

Does Blue Cross Blue Shield of Michigan Cover Trelegy

Explore Trelegy coverage by Blue Cross Blue Shield of Michigan. Learn denial reasons, coverage tips, costs without insurance, and FAQs for informed choices.
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Is Trelegy Covered by Blue Cross Blue Shield of Michigan

 

Coverage for Trelegy under Blue Cross Blue Shield of Michigan

 

  • Trelegy is typically covered as a prescription medication under Blue Cross Blue Shield of Michigan, primarily for patients with COPD or similar respiratory conditions.
  •  

  • Coverage often requires prior authorization to ensure it's medically necessary. Your physician must provide documentation of your condition and previous treatments tried.
  •  

  • Patients usually need to meet specific criteria, like failing to respond adequately to other inhaled treatments, for Trelegy to be approved for coverage.
  •  

  • Coverage may vary based on the subscriber's particular plan, so it is essential to review your plan's formulary or contact customer service for detailed information.
  •  

  • Copayments and deductibles are likely applicable, and these can vary significantly between different insurance plans and tiers.

 

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

 

Approved Criteria for Trelegy Coverage

 

  • Members must have a confirmed diagnosis of Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and/or emphysema, or asthma in individuals over 18 years.
  •  

  • The patient should have a documented history of exacerbations requiring systemic corticosteroids, antibiotics, or hospitalization despite the use of a long-acting beta-agonist/long-acting muscarinic antagonist (LABA/LAMA) or inhaled corticosteroid (ICS) therapy.
  •  

  • It is necessary that the patient is receiving stable maintenance treatment with a LABA and an ICS or a LABA/LAMA and requires additional treatment with a LAMA.
  •  

  • Patients must have trialed and shown inadequate response, intolerance, or contraindication to other combination inhaler therapies containing LABA and ICS or LABA/LAMA prior to initiating Trelegy.
  •  

  • An evaluation of the patient’s current inhaler technique and adherence to therapy should have been conducted, demonstrating proper usage but inadequate control of symptoms.
  •  

  • Prescriptions must be initiated by a pulmonologist or a provider with experience in treating chronic pulmonary conditions.
  •  

  • Documentation of spirometry testing within the past year, indicating the necessity for triple therapy based on lung function criteria set forth in established clinical guidelines, should be available.

 

Why Blue Cross Blue Shield of Michigan Might Deny Trelegy Coverage

 

Reasons for Denial of Trelegy Coverage by Blue Cross Blue Shield of Michigan

 

  • **Non-Approved Indications:** Trelegy may be denied if it is prescribed for uses not approved by the FDA. Blue Cross Blue Shield of Michigan generally covers medications for FDA-approved indications only.
  •  

  • **Lack of Pre-Authorization:** If the medication requires pre-authorization and it has not been obtained, coverage can be denied. Health plans often require prior approval to ensure the medication is necessary based on established medical guidelines.
  •  

  • **Failure to Meet Step Therapy Requirements:** Patients may need to try other approved medications first before Trelegy is covered. If these step therapy protocols aren't followed, coverage may be denied.
  •  

  • **Non-Compliance with Dosage and Administration Guidelines:** If Trelegy is prescribed in a manner that does not align with the covered dosing guidelines, coverage might be rejected.
  •  

  • **Absence of Comprehensive Medical Documentation:** Insufficient or lack of proper documentation supporting the medical necessity of Trelegy can lead to denial. Proper documentation must prove the medication is necessary and aligns with the health plan's policies.
  •  

  • **Out-of-Network Provider Prescriptions:** Coverage might be denied if Trelegy is prescribed by an out-of-network provider, as some plans only cover medications prescribed by in-network providers.
  •  

  • **Plan Exclusions:** Some Blue Cross Blue Shield of Michigan plans may have specific exclusions for certain medications, including Trelegy. Reviewing the specific policy is essential to understanding coverage limitations.
  •  

 

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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 Michigan

 

Contact Blue Cross Blue Shield of Michigan

 

  • Reach out to Blue Cross Blue Shield of Michigan via their customer service phone number or through their website to inquire about their coverage for Trelegy.
  •  

  • Have your insurance identification number ready, as they may need it to provide specific details about your coverage plan.

 

Review Your Current Plan

 

  • Examine your current health insurance policy documents to understand your prescription drug coverage under Blue Cross Blue Shield of Michigan.
  •  

  • Check if Trelegy is listed on your plan’s formulary or if it falls under any special medication programs.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Trelegy and any prior authorizations that might be required.
  •  

  • Ask your provider to assist with any necessary paperwork or documentation that BCBS might require to approve Trelegy.

 

Submit a Prior Authorization Request

 

  • If Trelegy requires prior authorization, your healthcare provider will need to complete and submit a request form to Blue Cross Blue Shield of Michigan.
  •  

  • Ensure all medical necessity information is included and detailed to facilitate the approval process.

 

Follow Up with BCBS

 

  • Contact Blue Cross Blue Shield of Michigan to confirm receipt of the prior authorization request and to ask for the estimated processing time.
  •  

  • Inquire if there are any additional steps you need to complete to expedite coverage for Trelegy.

 

Check the Outcome

 

  • Once approved, review your coverage details to understand any copayments, deductibles, or restrictions associated with Trelegy.
  •  

  • If the request is denied, request a written explanation from BCBS and discuss alternative options with your healthcare provider.

 

Explore Financial Assistance Programs

 

  • If coverage is denied or if out-of-pocket costs are too high, search for financial assistance programs offered by Trelegy’s manufacturer or other patient aid services.
  •  

  • Consider reaching out to nonprofit organizations that provide support for prescription medication costs.

 

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

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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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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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