Does Blue Cross Blue Shield of Michigan Cover Trulicity

Explore coverage details for Trulicity by Blue Cross Blue Shield of Michigan. Learn why coverage may be denied, costs without insurance, and FAQs.
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Does Blue Cross Blue Shield of Michigan Cover Trulicity?

 

  • Coverage for Trulicity by Blue Cross Blue Shield of Michigan may depend on various factors, including your specific plan and medical necessity. It is important to check your individual policy details for precise coverage information.
  •  

  • Trulicity is typically covered under prescription drug benefits when prescribed to manage type 2 diabetes. Prior authorization may be required to ensure the medication is medically necessary.
  •  

  • Patients may need to demonstrate that other diabetes management medicine was insufficient or unsuitable before Trulicity is approved for coverage.
  •  

  • Formulary status and tier placement of Trulicity could affect co-payments and out-of-pocket costs. It is advisable to verify with Blue Cross Blue Shield of Michigan for the most current information.
  •  

  • Consult your healthcare provider and BCBSM representative to understand the full criteria and documents needed for obtaining a Trulicity prescription covered under your plan.

 

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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 Trulicity Coverage with Blue Cross Blue Shield of Michigan

 

Verify Trulicity Coverage

 

  • Visit the Blue Cross Blue Shield of Michigan (BCBSM) official website and log in to your member account.
  •  

  • Look for the section on prescription drug coverage, which may be under your health benefits or pharmacy benefits options.
  •  

  • Search for Trulicity in the formulary tool or prescription drug list. This will confirm if Trulicity is covered under your current plan.

 

Consult with Your Doctor

 

  • Talk to your healthcare provider about your diabetes treatment plan and discuss the necessity of Trulicity.
  •  

  • Ensure your doctor prescribes the correct dosage of Trulicity that aligns with your medical needs and insurance coverage requirements.

 

Complete Prior Authorization if Needed

 

  • Check if Trulicity requires prior authorization by contacting BCBSM customer service or consulting your plan details.
  •  

  • If prior authorization is needed, work with your healthcare provider to submit the necessary paperwork or online form to BCBSM.
  •  

  • Provide thorough medical records and justification from your doctor to support the necessity of Trulicity for your treatment.

 

Contact BCBSM Customer Service

 

  • Call the customer service number on your BCBSM member ID card for more personalized assistance.
  •  

  • Inquire about any specific plan requirements or additional steps for securing Trulicity coverage under your policy.
  •  

  • Ask for clarification on your out-of-pocket costs, copayments, or any deductibles associated with Trulicity coverage.

 

Enroll in a Prescription Drug Plan if Necessary

 

  • If Trulicity isn't covered under your current plan, explore BCBSM's alternative health or prescription plans that include better drug coverage.
  •  

  • Compare different plans to weigh the benefits and costs related to premium payments, drug coverage, and copayments.
  •  

  • Enroll in a plan that offers the best access to Trulicity based on your healthcare needs and budget.

 

Verify Pharmacy Participation

 

  • Ensure that your preferred pharmacy is within the BCBSM network to avoid additional costs.
  •  

  • Confirm that the pharmacy accepts your plan’s drug benefits and can fulfill Trulicity prescriptions under the coverage terms.

 

Monitor Prescription Notices

 

  • Keep track of communications from BCBSM concerning your prescription, including approval notices or changes in coverage terms.
  •  

  • Stay informed about plan renewals or updates that may affect your Trulicity coverage.

 

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FAQs

Does Blue Cross Blue Shield of Michigan Cover Trulicity

Explore coverage details for Trulicity by Blue Cross Blue Shield of Michigan. Learn why coverage may be denied, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Trulicity Covered by Blue Cross Blue Shield of Michigan

 

Does Blue Cross Blue Shield of Michigan Cover Trulicity?

 

  • Coverage for Trulicity by Blue Cross Blue Shield of Michigan may depend on various factors, including your specific plan and medical necessity. It is important to check your individual policy details for precise coverage information.
  •  

  • Trulicity is typically covered under prescription drug benefits when prescribed to manage type 2 diabetes. Prior authorization may be required to ensure the medication is medically necessary.
  •  

  • Patients may need to demonstrate that other diabetes management medicine was insufficient or unsuitable before Trulicity is approved for coverage.
  •  

  • Formulary status and tier placement of Trulicity could affect co-payments and out-of-pocket costs. It is advisable to verify with Blue Cross Blue Shield of Michigan for the most current information.
  •  

  • Consult your healthcare provider and BCBSM representative to understand the full criteria and documents needed for obtaining a Trulicity prescription covered under your plan.

 

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

 

Eligibility Criteria for Trulicity Coverage

 

  • The patient must have a documented diagnosis of Type 2 Diabetes Mellitus.
  •  

  • The patient should have inadequate glycemic control on at least two oral anti-diabetic medications, such as metformin and sulfonylurea, unless contraindicated or not tolerated.
  •  

  • Trulicity is covered when used as an adjunct to diet and exercise to improve glycemic control in adults with Type 2 Diabetes Mellitus.
  •  

  • Trulicity may be considered in patients with heart disease or who have established cardiovascular disease for potential additional cardiovascular benefits.
  •  

  • A prescription for Trulicity should be written by or in consultation with an endocrinologist or a healthcare provider specializing in diabetes management.
  •  

  • Initial approval may require documentation supporting the necessity and intended outcome of Trulicity therapy.

 

Renewal Criteria for Continued Coverage

 

  • Evidence of compliance and benefit from Trulicity therapy should be demonstrated, often by a reduction in glycated hemoglobin (A1C) levels.
  •  

  • The patient should not have experienced any significant adverse effects from Trulicity that would necessitate discontinuation or switching of therapy.
  •  

  • Renewal may involve documentation of continued need, absence of contraindications, and effectiveness based on chart notes and laboratory tests.
  •  

  • Regular physician follow-ups should be maintained to ensure appropriate monitoring and adjustment of diabetes management plans.

 

Physician Documentation Requirements

 

  • A detailed medical history and current treatment plan documentation for Type 2 Diabetes Mellitus.
  •  

  • Records of previous diabetic therapies attempted, including the duration and reasons for discontinuation of those not successful or tolerated.
  •  

  • Periodic submission of progress reports and results of relevant laboratory tests, including A1C levels, should be provided at renewal intervals.
  •  

  • Any additional documentation relating to medical necessity and the exclusion of alternative therapy contraindications should be included.

 

Why Blue Cross Blue Shield of Michigan Might Deny Trulicity Coverage

 

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

 

  • Trulicity is prescribed for a condition that is not included in the coverage guidelines. Blue Cross Blue Shield of Michigan may deny coverage if the medication is used to treat non-approved conditions.
  •  

  • Prescription does not meet the required medical necessity criteria. If the necessity for Trulicity is not sufficiently documented or justified by the prescribing physician, coverage can be denied.
  •  

  • The requested dosage of Trulicity exceeds the approved limits. Blue Cross Blue Shield of Michigan may have specific dosage guidelines, and exceeding these can result in a denial.
  •  

  • Lack of prior authorization if required. Some plans may require a prior authorization process for Trulicity, and failing to complete this could lead to denial.
  •  

  • Missing or incomplete documentation when filing a claim for Trulicity. Proper paperwork and detailed patient records are usually necessary to justify coverage.
  •  

  • Use of Trulicity when a preferred alternative treatment is available and appropriate for the patient. If there are other, more cost-effective treatment options on the formulary, the plan might deny the request.
  •  

  • Prescribing outside of the provider network. If the prescribing doctor is not within the specified network, it may result in denial of coverage.
  •  

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How Much Does Trulicity Cost without Insurance?

 

Trulicity Cost Overview

 

  • Trulicity is a brand-name medication commonly used to treat type 2 diabetes. It's administered through a weekly injection.

 

Approximate Cost Without Insurance

 

  • The price of Trulicity can vary depending on the pharmacy or location, but the average cost for one pen of 1.5 mg/0.5 mL solution might run approximately $886 to $1,100.
  • Each box typically contains four pens, which is a month's supply, resulting in the total cost being roughly $3,544 to $4,400.

 

Factors Influencing Pricing

 

  • Pharmacy: Prices may differ from one pharmacy to another, so it’s beneficial to compare costs.
  • Location: Costs may vary based on geographic location due to regional pricing strategies and pharmacy benefits.
  • Discount Programs: Some pharmacies may offer savings programs or coupons that could lower the price.

 

Additional Cost-Saving Tips

 

  • Check for manufacturer discounts or patient assistance programs, which may offer significant savings or even free medication for qualified individuals.
  • Consider discussing alternative medications with your healthcare provider to find a more affordable option suitable for your needs.
  • Utilize pharmacy discount cards or look up savings programs online that specifically cater to diabetes medications.

 

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 Trulicity Coverage with Blue Cross Blue Shield of Michigan

 

Verify Trulicity Coverage

 

  • Visit the Blue Cross Blue Shield of Michigan (BCBSM) official website and log in to your member account.
  •  

  • Look for the section on prescription drug coverage, which may be under your health benefits or pharmacy benefits options.
  •  

  • Search for Trulicity in the formulary tool or prescription drug list. This will confirm if Trulicity is covered under your current plan.

 

Consult with Your Doctor

 

  • Talk to your healthcare provider about your diabetes treatment plan and discuss the necessity of Trulicity.
  •  

  • Ensure your doctor prescribes the correct dosage of Trulicity that aligns with your medical needs and insurance coverage requirements.

 

Complete Prior Authorization if Needed

 

  • Check if Trulicity requires prior authorization by contacting BCBSM customer service or consulting your plan details.
  •  

  • If prior authorization is needed, work with your healthcare provider to submit the necessary paperwork or online form to BCBSM.
  •  

  • Provide thorough medical records and justification from your doctor to support the necessity of Trulicity for your treatment.

 

Contact BCBSM Customer Service

 

  • Call the customer service number on your BCBSM member ID card for more personalized assistance.
  •  

  • Inquire about any specific plan requirements or additional steps for securing Trulicity coverage under your policy.
  •  

  • Ask for clarification on your out-of-pocket costs, copayments, or any deductibles associated with Trulicity coverage.

 

Enroll in a Prescription Drug Plan if Necessary

 

  • If Trulicity isn't covered under your current plan, explore BCBSM's alternative health or prescription plans that include better drug coverage.
  •  

  • Compare different plans to weigh the benefits and costs related to premium payments, drug coverage, and copayments.
  •  

  • Enroll in a plan that offers the best access to Trulicity based on your healthcare needs and budget.

 

Verify Pharmacy Participation

 

  • Ensure that your preferred pharmacy is within the BCBSM network to avoid additional costs.
  •  

  • Confirm that the pharmacy accepts your plan’s drug benefits and can fulfill Trulicity prescriptions under the coverage terms.

 

Monitor Prescription Notices

 

  • Keep track of communications from BCBSM concerning your prescription, including approval notices or changes in coverage terms.
  •  

  • Stay informed about plan renewals or updates that may affect your Trulicity coverage.

 

Premium Medication you can trust

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.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Trulicity FAQ

What are the common side effects of Trulicity?

 

Common Side Effects of Trulicity

 

  • Nausea: Initially, many patients experience nausea, which often lessens over time as the body adjusts.
  •  

  • Vomiting: Some individuals may experience vomiting, particularly in the first few doses.
  •  

  • Diarrhea: Digestive disturbances such as diarrhea are commonly reported.
  •  

  • Abdominal Pain: Discomfort in the abdomen can occur, often subsiding with continued use.
  •  

  • Decreased Appetite: Patients often report a reduction in appetite.
  •  

  • Fatigue: Some individuals may feel unusually tired after starting treatment.
  •  

  • Reduced Blood Sugar: Blood sugar levels may become low, especially when used in conjunction with other diabetes medications.

 

How much weight can you lose on Trulicity?

 

Weight Loss with Trulicity

 

  • Trulicity (dulaglutide) is primarily prescribed for managing type 2 diabetes, but many patients also experience weight loss as an additional benefit.
  •  

  • Clinical trials indicate an average weight loss of around 2-6 pounds, but results differ based on individual factors such as diet, exercise, and adherence to the medication.
  •  

  • Some users report greater weight loss; however, it's important to accompany Trulicity with lifestyle changes for optimal results.
  •  

  • Consult with a healthcare provider to tailor a plan that maximizes benefits based on your health needs.

 

How does Trulicity work for type 2 diabetes?

 

How Trulicity Works

 

  • Trulicity is a GLP-1 receptor agonist, helping to regulate blood sugar levels.
  •  

  • It stimulates insulin release in response to high blood glucose.
  •  

  • It slows gastric emptying, which helps reduce post-meal glucose spikes.
  •  

  • Trulicity suppresses glucagon secretion, lowering glucose production by the liver.

 

Benefits

 

  • Easy-to-use once-weekly injection, improving adherence.
  •  

  • Not associated with causing weight gain; may even promote modest weight loss.
  •  

  • May reduce risk of cardiovascular events in patients with heart disease.

 

Considerations

 

  • May cause gastrointestinal side effects, often resolving over time.
  •  

  • Inform your doctor if you have a history of pancreatitis or gallbladder disease.
  •  

  • Monitor for signs of low blood sugar, especially if using other diabetes medications.

 

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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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