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Does Blue Cross Blue Shield of North Carolina Cover Forteo

Explore Forteo coverage by Blue Cross NC. Learn denial reasons, coverage tips, Forteo costs without insurance, and get answers to FAQs.

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Covers Forteo

Blue Cross Blue Shield of North Carolina may cover Forteo for osteoporosis treatment, but coverage is contingent on medical necessity.

It is typically prescribed for patients with a high risk of fractures, those with osteoporosis due to long-term steroid therapy, or those who have failed or are intolerant to other osteoporosis treatments.

Criteria for Coverage

Prior authorization is often required to ensure that the medication is medically necessary.

Patients may need to provide documentation of prior treatment failures or conditions that support the necessity for Forteo.

Coverage may vary depending on the specific plan, so it is crucial to verify benefits and criteria directly with Blue Cross Blue Shield of North Carolina.

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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.

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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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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 Forteo Coverage with Blue Cross Blue Shield of North Carolina

Verify Your Coverage

Contact Blue Cross Blue Shield of North Carolina customer service to determine if Forteo is covered under your specific plan. You can usually find this information in the insurance details document or by calling the customer service number on the back of your insurance card.

Review your plan documents or the BCBSNC website for any specific requirements or steps necessary to get drug coverage.

Meet with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Forteo and whether it's a medically necessary prescription for you.

Ask your doctor to provide any necessary documentation or justification as to why Forteo is the appropriate treatment for your condition, which may be required by BCBSNC to approve coverage.

Obtain Prior Authorization

Check if Forteo requires prior authorization by BCBSNC. This means your healthcare provider must submit a request for coverage before the prescription can be filled. Your provider should be familiar with this process and can assist in submitting the appropriate forms.

Ensure all necessary medical records and justification are submitted alongside the prior authorization request for review by BCBSNC.

Submit any Required Documentation

If Blue Cross Blue Shield of North Carolina requires it, submit all requested documents, such as proof of medical necessity or a treatment plan, to the insurance company for review.

Ensure your healthcare provider provides detailed documentation about why Forteo is required over other treatments.

Follow Up

Stay in touch with both your healthcare provider and BCBSNC to monitor the status of your prior authorization request.

If BCBSNC requests additional information, promptly coordinate with your healthcare provider to furnish the required details.

Appeal if Necessary

If your request for coverage for Forteo is denied, understand Blue Cross Blue Shield of North Carolina's appeal process and submit an appeal. Gather support from your healthcare provider to make a strong case during the appeal.

Document all communications with BCBSNC and your healthcare provider, as this information can be important during the appeal process.

Review Financial Assistance Options

If you face challenges getting Forteo covered, explore financial assistance programs offered by the manufacturer or other assistance programs which might be able to help with the cost.

Discuss with your healthcare provider about any generic alternatives or other treatment options that may be less costly and still effective.

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Forteo

Explore Forteo coverage by Blue Cross NC. Learn denial reasons, coverage tips, Forteo costs without insurance, and get answers to FAQs.

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Is Forteo Covered by Blue Cross Blue Shield of North Carolina

Covers Forteo

Blue Cross Blue Shield of North Carolina may cover Forteo for osteoporosis treatment, but coverage is contingent on medical necessity.

It is typically prescribed for patients with a high risk of fractures, those with osteoporosis due to long-term steroid therapy, or those who have failed or are intolerant to other osteoporosis treatments.

Criteria for Coverage

Prior authorization is often required to ensure that the medication is medically necessary.

Patients may need to provide documentation of prior treatment failures or conditions that support the necessity for Forteo.

Coverage may vary depending on the specific plan, so it is crucial to verify benefits and criteria directly with Blue Cross Blue Shield of North Carolina.

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Blue Cross Blue Shield of North Carolina's Approved Criteria for Forteo Coverage

Blue Cross Blue Shield of North Carolina's Approved Criteria for Forteo Coverage

**Diagnosis of Osteoporosis:** Documentation confirming a diagnosis of severe osteoporosis. This includes having a bone mineral density (BMD) T-score at or below -2.5, or a history of osteoporotic fracture in individuals with a low bone mass.

**High Fracture Risk:** Evidence that the patient is at high risk for fractures, which may include factors such as age, history of previous fractures, or other medical conditions that contribute to bone weakening.

**Previous Treatment Failures:** A record of inadequate response or intolerance to previous osteoporosis therapies such as bisphosphonates.

**Pre-menopausal Women and Men with Osteoporosis Secondary to Specific Conditions:** Coverage for those who have osteoporosis secondary to conditions like glucocorticoid therapy, hypogonadism, or other relevant medical diagnoses when traditional therapies have failed or are contraindicated.

**Duration of Treatment:** Forteo is generally covered for a maximum treatment duration of 24 months. Continuation beyond this period requires further documentation indicating medical necessity.

**Specialist Prescription:** The medication must be prescribed by or in consultation with an endocrinologist or rheumatologist who specializes in the treatment of osteoporosis.

Why Blue Cross Blue Shield of North Carolina Might Deny Forteo Coverage

Situations When Blue Cross Blue Shield of North Carolina Might Deny Forteo Coverage

**Non-Approved Diagnoses**: Forteo may not be covered if prescribed for conditions outside of the approved osteoporosis treatments. This includes any off-label uses that have not been recognized by the insurer.

**Non-Compliance with Prior Therapies**: If there is evidence that a patient has not adhered to or tried alternative, less costly osteoporosis treatments before Forteo, coverage may be denied.

**Exceeding Recommended Duration**: Coverage might be denied if Forteo is used beyond the recommended treatment duration, generally for more than two years, as per FDA-approved guidelines.

**Lack of Required Documentation**: If the necessary paperwork, such as lab results, previous treatment records, or justification for the need for Forteo, is incomplete or not provided, Blue Cross Blue Shield of North Carolina might deny coverage.

**Pre-Authorization Not Obtained**: Coverage may also be denied if pre-authorization was not secured before starting Forteo, as required by the insurance policy provisions.

**Non-Covered Population**: Forteo is generally not approved for pediatric use or for people with certain types of cancer histories. Therefore, coverage might be denied if prescribed for these populations.

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How Much Does Forteo Cost without Insurance?

Cost of Forteo Without Insurance

The price of Forteo (teriparatide injection) without insurance is quite substantial, typically ranging between $3,500 and $4,000 for a 28-day supply, which is a 2.4 mL pen of 600 mcg per 2.4 mL strength.

Keep in mind that pharmaceutical prices can vary based on the pharmacy, geographical location, and any available discounts or pharmacy-specific savings programs.

Patients can check with specific pharmacies for the most accurate pricing and inquire about any potential savings programs or discounts.

Consider contacting the manufacturer or exploring patient assistance programs, as they sometimes offer help to reduce costs for those without insurance coverage.

Clinical Support

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

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

Kayla Mardaga, NP

How to Get Forteo Coverage with Blue Cross Blue Shield of North Carolina

Verify Your Coverage

Contact Blue Cross Blue Shield of North Carolina customer service to determine if Forteo is covered under your specific plan. You can usually find this information in the insurance details document or by calling the customer service number on the back of your insurance card.

Review your plan documents or the BCBSNC website for any specific requirements or steps necessary to get drug coverage.

Meet with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Forteo and whether it's a medically necessary prescription for you.

Ask your doctor to provide any necessary documentation or justification as to why Forteo is the appropriate treatment for your condition, which may be required by BCBSNC to approve coverage.

Obtain Prior Authorization

Check if Forteo requires prior authorization by BCBSNC. This means your healthcare provider must submit a request for coverage before the prescription can be filled. Your provider should be familiar with this process and can assist in submitting the appropriate forms.

Ensure all necessary medical records and justification are submitted alongside the prior authorization request for review by BCBSNC.

Submit any Required Documentation

If Blue Cross Blue Shield of North Carolina requires it, submit all requested documents, such as proof of medical necessity or a treatment plan, to the insurance company for review.

Ensure your healthcare provider provides detailed documentation about why Forteo is required over other treatments.

Follow Up

Stay in touch with both your healthcare provider and BCBSNC to monitor the status of your prior authorization request.

If BCBSNC requests additional information, promptly coordinate with your healthcare provider to furnish the required details.

Appeal if Necessary

If your request for coverage for Forteo is denied, understand Blue Cross Blue Shield of North Carolina's appeal process and submit an appeal. Gather support from your healthcare provider to make a strong case during the appeal.

Document all communications with BCBSNC and your healthcare provider, as this information can be important during the appeal process.

Review Financial Assistance Options

If you face challenges getting Forteo covered, explore financial assistance programs offered by the manufacturer or other assistance programs which might be able to help with the cost.

Discuss with your healthcare provider about any generic alternatives or other treatment options that may be less costly and still effective.

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Forteo FAQ

What are the common side effects of Forteo?

Common Side Effects of Forteo

Nausea: A frequent complaint among users, often resolves as your body adjusts to the medication.

Dizziness: Usually occurs after an injection, so sitting or lying down shortly afterward can help.

Leg Cramps: Regular stretching exercises may alleviate this discomfort.

Joint Pain: May be managed by over-the-counter painkillers, but consult your doctor first.

Injection Site Reactions: Mild redness or itching at the injection site is common, often soothed by cold compresses.

How does Forteo work for osteoporosis?

How Forteo Works

Forteo, or teriparatide, is a form of parathyroid hormone that helps stimulate new bone formation.

It works by increasing bone remodeling, which is crucial for improving bone density.

Osteoporosis Effectiveness

Used primarily for osteoporosis patients who have a high risk of fractures.

Improves bone microarchitecture, which enhances bone strength.

Administration

Administered via daily subcutaneous injection for up to 2 years.

Patients should follow their doctor’s instructions for the correct administration.

How long can you safely take Forteo?

Duration of Forteo Use

Forteo (teriparatide) is recommended for a maximum duration of 2 years over a patient's lifetime.

This limitation is based on studies that show an increased risk of osteosarcoma in rats. Though this risk hasn't been confirmed in humans, the duration is restricted for safety.

Considerations and Monitoring

During treatment, regular bone density scans and evaluations for potential side effects are necessary.

Patients should ensure they are not taking medications or have conditions that could further exacerbate potential risks.

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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. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does Blue Cross Blue Shield of North Carolina Cover Forteo

Explore Forteo coverage by Blue Cross NC. Learn denial reasons, coverage tips, Forteo costs without insurance, and get answers to FAQs.

Achieve Your Goals Faster with Curex