Does Blue Cross Blue Shield of Minnesota Cover Humira

Learn about Humira coverage by Blue Cross Blue Shield of Minnesota, reasons for denial, obtaining coverage, costs without insurance, and FAQs.
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Coverage of Humira

 

  • Blue Cross Blue Shield of Minnesota covers Humira for certain conditions like rheumatoid arthritis, Crohn's disease, and psoriasis.
  • Coverage may require prior authorization, depending on the specific plan and medical necessity.

 

Criteria for Coverage

 

  • Patients must often demonstrate that alternative treatments were ineffective, not tolerated, or contraindicated.
  • Coverage is generally contingent on a prescription from a healthcare provider.

 

Basic Rules

 

  • Members typically need to use an in-network pharmacy to fill Humira prescriptions unless specified otherwise by the plan.
  • There may be limits on the quantity supplied per prescription, subject to insurer policies and healthcare provider guidance.

 

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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 Humira Coverage with Blue Cross Blue Shield of Minnesota

 

Check Your Benefits

 

  • Log into your Blue Cross Blue Shield of Minnesota account online or review your plan documents to understand your specific benefits related to prescription drug coverage.
  •  

  • If you're having trouble finding this information, contact their customer service for assistance on what your plan covers regarding Humira.

 

Consult with Your Physician

 

  • Discuss with your healthcare provider about the necessity of Humira for your condition. Ensure that your doctor is willing to provide the required documentation, such as a prescription and any necessary prior authorization forms.
  •  

  • Ask your physician to submit the prescription to your pharmacy along with any supporting documents needed for insurance approval.

 

Prior Authorization

 

  • Blue Cross Blue Shield of Minnesota may require a prior authorization to cover Humira. This means they must review and approve the medication before coverage is granted.
  •  

  • Work with your doctor to complete and submit any necessary forms to obtain prior authorization from Blue Cross Blue Shield of Minnesota.

 

Contact Customer Service

 

  • Reach out to Blue Cross Blue Shield of Minnesota's customer service department to confirm that they have received your prior authorization request.
  •  

  • Inquire about the typical processing time for prior authorization and ask if any additional information is needed from your doctor.

 

Follow Up

 

  • Regularly follow up with Blue Cross Blue Shield of Minnesota and your doctor's office to ensure that the process is moving forward.
  •  

  • If you encounter any issues or delays, ask if there are alternative ways to expedite the process.

 

Appeal if Necessary

 

  • If your initial request for Humira coverage is denied, don't be discouraged. Find out the reason for denial and work with your doctor to address these concerns in an appeal letter.
  •  

  • Submit the appeal to Blue Cross Blue Shield of Minnesota and continue to follow up for updates on your appeal status.

 

Utilize Prescription Savings Programs

 

  • If there are any hurdles in obtaining coverage through Blue Cross Blue Shield, inquire about AbbVie's Humira savings program or any available rebate cards that might reduce out-of-pocket costs.
  •  

  • Check if there are any state assistance programs in Minnesota or other patient advocacy organizations that can offer additional support.

 

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FAQs

Does Blue Cross Blue Shield of Minnesota Cover Humira

Learn about Humira coverage by Blue Cross Blue Shield of Minnesota, reasons for denial, obtaining coverage, costs without insurance, and FAQs.
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Is Humira Covered by Blue Cross Blue Shield of Minnesota

 

Coverage of Humira

 

  • Blue Cross Blue Shield of Minnesota covers Humira for certain conditions like rheumatoid arthritis, Crohn's disease, and psoriasis.
  • Coverage may require prior authorization, depending on the specific plan and medical necessity.

 

Criteria for Coverage

 

  • Patients must often demonstrate that alternative treatments were ineffective, not tolerated, or contraindicated.
  • Coverage is generally contingent on a prescription from a healthcare provider.

 

Basic Rules

 

  • Members typically need to use an in-network pharmacy to fill Humira prescriptions unless specified otherwise by the plan.
  • There may be limits on the quantity supplied per prescription, subject to insurer policies and healthcare provider guidance.

 

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

 

Criteria for Rheumatoid Arthritis

 

  • Patient must have a diagnosis of moderate to severe rheumatoid arthritis confirmed by a rheumatologist.
  • Patient must have tried and failed, or have contraindications or intolerance to, at least one non-biologic DMARD (Disease-Modifying Antirheumatic Drug), such as methotrexate, unless contraindicated.
  • Prescribed by or in consultation with a rheumatologist.

 

Criteria for Psoriatic Arthritis

 

  • Patient must have a diagnosis of active psoriatic arthritis confirmed by a rheumatologist or dermatologist.
  • Patient must have tried and failed, or have contraindications or intolerance to, at least one non-biologic DMARD, such as methotrexate or sulfasalazine, unless contraindicated.
  • Prescribed by or in consultation with a rheumatologist or dermatologist.

 

Criteria for Ankylosing Spondylitis

 

  • Patient must have a diagnosis of active ankylosing spondylitis confirmed by a rheumatologist.
  • Patient must have tried and failed, or have contraindications or intolerance to, at least two NSAIDs (Nonsteroidal Anti-inflammatory Drugs).
  • Prescribed by or in consultation with a rheumatologist.

 

Criteria for Crohn's Disease

 

  • Patient must have a diagnosis of moderate to severe Crohn’s disease confirmed by a gastroenterologist.
  • Patient must have tried and failed, or have contraindications or intolerance to, at least one immunosuppressant or corticosteroid.
  • Prescribed by or in consultation with a gastroenterologist.

 

Criteria for Ulcerative Colitis

 

  • Patient must have a diagnosis of moderate to severe ulcerative colitis confirmed by a gastroenterologist.
  • Patient must have tried and failed, or have contraindications or intolerance to, at least one of the following: 5-aminosalicylic acid (5-ASA), immunosuppressant, or corticosteroid.
  • Prescribed by or in consultation with a gastroenterologist.

 

Criteria for Plaque Psoriasis

 

  • Patient must have a diagnosis of moderate to severe chronic plaque psoriasis confirmed by a dermatologist.
  • Patient must have tried and failed, or have contraindications or intolerance to, at least one topical therapy such as corticosteroids or vitamin D analogs, unless contraindicated.
  • Prescribed by or in consultation with a dermatologist.

 

Criteria for Hidradenitis Suppurativa

 

  • Patient must have a diagnosis of moderate to severe hidradenitis suppurativa confirmed by a dermatologist.
  • Patient must exhibit disease symptoms not adequately controlled with conventional treatment options such as antibiotics or surgical intervention.
  • Prescribed by or in consultation with a dermatologist.

 

Why Blue Cross Blue Shield of Minnesota Might Deny Humira Coverage

 

Exclusions for Coverage of Humira

 

  • Blue Cross Blue Shield of Minnesota may deny coverage for Humira if it is deemed not medically necessary according to their clinical guidelines and policies.
  •  

  • Coverage can be denied if Humira is used for a condition that is not listed as an FDA-approved indication or not considered clinically appropriate for the specific off-label use.
  •  

  • If there is insufficient clinical evidence to support the effectiveness of Humira for a particular condition or treatment plan, coverage might be excluded.
  •  

  • Blue Cross Blue Shield may not cover Humira if it is prescribed at a dosage or frequency higher than approved by the FDA or beyond what is recommended in their medical policies.
  •  

  • Use of Humira solely for the convenience of the patient or healthcare provider, as opposed to medical necessity, could result in a denial of coverage.
  •  

  • Patients who have not attempted or documented failure with other lower-cost treatment options prior to Humira may not be eligible for coverage.
  •  

  • If there are alternative therapies considered to be more cost-effective and have similar clinical outcomes, Blue Cross Blue Shield may deny coverage for Humira.

 

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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 Minnesota

 

Check Your Benefits

 

  • Log into your Blue Cross Blue Shield of Minnesota account online or review your plan documents to understand your specific benefits related to prescription drug coverage.
  •  

  • If you're having trouble finding this information, contact their customer service for assistance on what your plan covers regarding Humira.

 

Consult with Your Physician

 

  • Discuss with your healthcare provider about the necessity of Humira for your condition. Ensure that your doctor is willing to provide the required documentation, such as a prescription and any necessary prior authorization forms.
  •  

  • Ask your physician to submit the prescription to your pharmacy along with any supporting documents needed for insurance approval.

 

Prior Authorization

 

  • Blue Cross Blue Shield of Minnesota may require a prior authorization to cover Humira. This means they must review and approve the medication before coverage is granted.
  •  

  • Work with your doctor to complete and submit any necessary forms to obtain prior authorization from Blue Cross Blue Shield of Minnesota.

 

Contact Customer Service

 

  • Reach out to Blue Cross Blue Shield of Minnesota's customer service department to confirm that they have received your prior authorization request.
  •  

  • Inquire about the typical processing time for prior authorization and ask if any additional information is needed from your doctor.

 

Follow Up

 

  • Regularly follow up with Blue Cross Blue Shield of Minnesota and your doctor's office to ensure that the process is moving forward.
  •  

  • If you encounter any issues or delays, ask if there are alternative ways to expedite the process.

 

Appeal if Necessary

 

  • If your initial request for Humira coverage is denied, don't be discouraged. Find out the reason for denial and work with your doctor to address these concerns in an appeal letter.
  •  

  • Submit the appeal to Blue Cross Blue Shield of Minnesota and continue to follow up for updates on your appeal status.

 

Utilize Prescription Savings Programs

 

  • If there are any hurdles in obtaining coverage through Blue Cross Blue Shield, inquire about AbbVie's Humira savings program or any available rebate cards that might reduce out-of-pocket costs.
  •  

  • Check if there are any state assistance programs in Minnesota or other patient advocacy organizations that can offer additional support.

 

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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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