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Does Blue Cross Blue Shield of North Carolina Cover Jardiance

Explore BCBS of NC coverage for Jardiance, reasons for denial, ways to secure coverage, cost without insurance, and FAQs in this informative article.

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Coverage for Jardiance by Blue Cross Blue Shield of North Carolina

Blue Cross Blue Shield of North Carolina may cover Jardiance for patients diagnosed with type 2 diabetes, particularly if it's used for glycemic control and to reduce cardiovascular risk.

Coverage usually requires meeting certain criteria, such as having a medical necessity prescription from a healthcare provider.

Patients may need to provide documentation illustrating why Jardiance is necessary compared to other medications, often including a prior authorization form.

It's essential to verify specific benefits and coverage details directly with Blue Cross Blue Shield of North Carolina, as coverage can vary based on individual plans and policies.

Patients might be responsible for copayments or coinsurance, depending on their specific health insurance plan and pharmacy benefits.

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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 Jardiance Coverage with Blue Cross Blue Shield of North Carolina

Verify Coverage for Jardiance

Visit the Blue Cross Blue Shield of North Carolina (BCBSNC) website to access your specific health plan details.

Log into your member account using your credentials. Navigate to the "Prescription Drug Coverage" section to see a list of covered medications.

Check if Jardiance is included under your plan's formulary. This information can usually be found in the evidence of coverage or drug list documents available for download.

If the information is unclear, contact BCBSNC customer support for confirmation on Jardiance coverage.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss the need for Jardiance and alternative medications available.

Request a prescription for Jardiance if your provider determines it is necessary for your treatment plan.

Inform your healthcare provider about your insurance coverage with BCBSNC, so they can provide necessary documentation if required.

Submit Prior Authorization, If Needed

Check if Jardiance requires prior authorization with BCBSNC. You can find this information in your plan details or by contacting customer service.

If prior authorization is required, work with your healthcare provider to complete the necessary forms and ensure all required documentation is sent to BCBSNC.

Monitor the status of your prior authorization request by contacting BCBSNC or checking your member account online.

Fill Your Prescription

Once approved, take your prescription for Jardiance to an in-network pharmacy that participates with BCBSNC.

Provide your BCBSNC member ID at the pharmacy to apply your prescription drug benefit and receive the discounted price for Jardiance.

Ensure the prescription is filled according to the terms of your BCBSNC plan, considering any copayments or coinsurance that may apply.

Appeal if Necessary

If your request for Jardiance coverage is denied, review the denial letter for specific reasons provided by BCBSNC.

Gather necessary documentation from your healthcare provider to support an appeal, including evidence of medical need.

Submit a formal appeal to BCBSNC, following their procedure for appeals as outlined in your plan documentation.

Consider Alternative Options

If Jardiance is not covered or denied after appeal, consult your healthcare provider about alternative medications that may be covered under your plan.

Explore BCBSNC's pharmaceutical assistance programs or discounts through third-party services that might reduce your out-of-pocket costs for Jardiance.

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Jardiance

Explore BCBS of NC coverage for Jardiance, reasons for denial, ways to secure coverage, cost without insurance, and FAQs in this informative article.

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Is Jardiance Covered by Blue Cross Blue Shield of North Carolina

Coverage for Jardiance by Blue Cross Blue Shield of North Carolina

Blue Cross Blue Shield of North Carolina may cover Jardiance for patients diagnosed with type 2 diabetes, particularly if it's used for glycemic control and to reduce cardiovascular risk.

Coverage usually requires meeting certain criteria, such as having a medical necessity prescription from a healthcare provider.

Patients may need to provide documentation illustrating why Jardiance is necessary compared to other medications, often including a prior authorization form.

It's essential to verify specific benefits and coverage details directly with Blue Cross Blue Shield of North Carolina, as coverage can vary based on individual plans and policies.

Patients might be responsible for copayments or coinsurance, depending on their specific health insurance plan and pharmacy benefits.

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

Eligibility Criteria for Jardiance Coverage

Jardiance is approved for use in individuals with Type 2 Diabetes Mellitus, as an adjunct to diet and exercise, to improve glycemic control.

The individual must have a documented intolerance to metformin, or there must be a medical contraindication to metformin use.

Jardiance may be prescribed for individuals with chronic heart failure, specifically for reducing the risk of cardiovascular death and hospitalization.

Coverage is granted if the individual is aged 18 years or older and meets other specific health criteria set by a healthcare provider.

In cases of chronic kidney disease, Jardiance is covered for slowing the progression of kidney disease and reducing the risk of cardiovascular death.

Clinical Evaluation and Documentation

Documentation must include a recent evaluation by a healthcare provider detailing the patient's diagnosis, treatment history, and current medical status.

A clear statement from the prescribing provider indicating the necessity of Jardiance based on the individual's health status and previous treatment outcomes is required.

The healthcare provider must specify the anticipated therapeutic benefits and potential risks associated with Jardiance initiation for the individual.

Dosage and Administration Guidelines

Coverage for Jardiance is based on a standard dosing protocol approved by the healthcare provider, consistent with the FDA guidelines for its use.

The initial dose must be documented and any planned dose escalation should be noted, along with clinical justification for such changes.

Reauthorization and Ongoing Coverage

For continued approval, updated medical records showing positive clinical outcomes and regular follow-up with the healthcare provider must be submitted.

Reauthorization requests should include a healthcare provider’s statement on any observed improvements and adherence to therapy as per prescribed guidelines.

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

Reasons for Denial of Jardiance Coverage

**Non-FDA Approved Uses**: Blue Cross Blue Shield of North Carolina may deny coverage for Jardiance if it is prescribed for conditions not approved by the FDA.

**Lack of Medical Necessity**: If Jardiance is deemed not medically necessary according to the plan's criteria or if alternative treatments exist that are deemed more cost-effective and beneficial, coverage might be denied.

**Prescriber Requirements**: Coverage might be denied if Jardiance is not prescribed by an eligible healthcare provider as defined by the insurance plan's policies.

**Step Therapy Protocols**: If a patient has not attempted required alternative medications as part of an established step therapy protocol, Jardiance coverage may be denied.

**Out-of-Network Providers**: Services rendered by out-of-network providers might result in denial of coverage for Jardiance without prior authorization.

**Non-compliance with Prior Authorization**: Failure to obtain necessary prior authorization or failing to meet the required criteria during the authorization process could result in denial.

**Dosage and Administration**: If Jardiance is prescribed in a manner inconsistent with approved dosing guidelines, it may not be covered.

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How Much Does Jardiance Cost without Insurance?

Estimated Cost of Jardiance Without Insurance

The cost of Jardiance can vary depending on the pharmacy you visit, but as an oral medication used primarily to treat type 2 diabetes, it is often priced at a premium. Without insurance, the average monthly cost is approximately $550 to $650 for a 30-day supply of 10 mg or 25 mg tablets.

Prices can also vary based on location, pharmacy discounts, and available manufacturer coupons, so it's advisable to shop around or look for any available patient assistance programs to potentially lower the out-of-pocket cost.

Ways to Lower the Cost of Jardiance

**Pharmacy Discount Cards:** Utilizing pharmacy discount cards can sometimes provide substantial savings on your prescription, reducing the price by a notable percentage.

**Manufacturer Coupons and Programs:** Eli Lilly, the manufacturer of Jardiance, may offer savings cards or assistance programs to help eligible patients reduce their costs. It's worth checking through their official website or consulting with your healthcare provider.

**Generic Alternatives:** Although there may not be a generic version of Jardiance available currently, consulting with your healthcare provider about other generic medications for your condition may offer a more budget-friendly option.

**Bulk Purchasing Options:** Some pharmacies might offer discounts for purchasing a 90-day supply instead of a 30-day supply, which can lead to savings in the long term.

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 Jardiance Coverage with Blue Cross Blue Shield of North Carolina

Verify Coverage for Jardiance

Visit the Blue Cross Blue Shield of North Carolina (BCBSNC) website to access your specific health plan details.

Log into your member account using your credentials. Navigate to the "Prescription Drug Coverage" section to see a list of covered medications.

Check if Jardiance is included under your plan's formulary. This information can usually be found in the evidence of coverage or drug list documents available for download.

If the information is unclear, contact BCBSNC customer support for confirmation on Jardiance coverage.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss the need for Jardiance and alternative medications available.

Request a prescription for Jardiance if your provider determines it is necessary for your treatment plan.

Inform your healthcare provider about your insurance coverage with BCBSNC, so they can provide necessary documentation if required.

Submit Prior Authorization, If Needed

Check if Jardiance requires prior authorization with BCBSNC. You can find this information in your plan details or by contacting customer service.

If prior authorization is required, work with your healthcare provider to complete the necessary forms and ensure all required documentation is sent to BCBSNC.

Monitor the status of your prior authorization request by contacting BCBSNC or checking your member account online.

Fill Your Prescription

Once approved, take your prescription for Jardiance to an in-network pharmacy that participates with BCBSNC.

Provide your BCBSNC member ID at the pharmacy to apply your prescription drug benefit and receive the discounted price for Jardiance.

Ensure the prescription is filled according to the terms of your BCBSNC plan, considering any copayments or coinsurance that may apply.

Appeal if Necessary

If your request for Jardiance coverage is denied, review the denial letter for specific reasons provided by BCBSNC.

Gather necessary documentation from your healthcare provider to support an appeal, including evidence of medical need.

Submit a formal appeal to BCBSNC, following their procedure for appeals as outlined in your plan documentation.

Consider Alternative Options

If Jardiance is not covered or denied after appeal, consult your healthcare provider about alternative medications that may be covered under your plan.

Explore BCBSNC's pharmaceutical assistance programs or discounts through third-party services that might reduce your out-of-pocket costs for Jardiance.

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Jardiance FAQ

What is Jardiance used for?

What is Jardiance Used For?

Jardiance is primarily used to manage type 2 diabetes by helping to lower blood sugar levels in adults.

It works by promoting the excretion of excess glucose through urine, thus reducing the amount of sugar the body absorbs.

In addition to blood sugar management, Jardiance is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.

Patients with heart failure may benefit from Jardiance as it helps in reducing the risk of hospitalization due to heart failure.

What are the side effects of Jardiance?

Common Side Effects of Jardiance

Urinary tract infections: Symptoms may include burning sensation while urinating and frequent urges.
Increased urination: This is due to Jardiance's mechanism of removing excess glucose via urine.

Serious Side Effects

Ketoacidosis: This rare condition might present as difficulty breathing, nausea, or confusion.
Dehydration: Symptoms can be dizziness or light-headedness, especially upon standing.

Allergic Reactions

Rash or hives can occur, requiring immediate medical attention.

Precautions

Consult your healthcare provider before starting if you have kidney issues or are on diuretics.

Can Jardiance cause weight loss?

Can Jardiance Cause Weight Loss?

Yes, Jardiance (empagliflozin) can lead to weight loss. This medication is primarily used to treat type 2 diabetes.

It works by preventing glucose reabsorption in the kidneys, leading to glucose excretion through urine, which may also result in calorie loss.

Clinical trials have shown weight reduction as a common side effect, often averaging 2-3 kg.

This loss can differ among individuals; factors like diet and exercise may influence the extent of weight change.

Always consult with healthcare professionals to understand the benefits and risks associated with your specific health condition.

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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.

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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 Jardiance

Explore BCBS of NC coverage for Jardiance, reasons for denial, ways to secure coverage, cost without insurance, and FAQs in this informative article.

Achieve Your Goals Faster with Curex