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Does Blue Cross Blue Shield of North Carolina Cover Lantus

Explore coverage for Lantus by Blue Cross NC, reasons for denial, cost without insurance, and FAQs. Find strategies to secure the needed approvals.
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Coverage for Lantus

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) typically covers Lantus, which is a prescription insulin product, when it is medically necessary for managing diabetes.

    •  

  • Coverage often requires a physician's prescription and proof of a diabetes diagnosis. BCBSNC may ask for medical documentation supporting the necessity of Lantus for effective diabetes management.

 

Basic Coverage Criteria

 

  • Patients usually need to be enrolled in a Prescription Drug Plan that includes coverage for insulin products under BCBSNC.

    •  

  • Preauthorization might be necessary, where doctors provide prior approval before the Lantus prescription is filled.

 

Utilization Management

 

  • The plan may apply management strategies such as quantity limits or step therapy, requiring patients to try other diabetes medications first.

    •  

  • Co-pays or deductibles might be applicable depending on specific plan details, which can significantly influence out-of-pocket costs.

 

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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

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 Lantus Coverage with Blue Cross Blue Shield of North Carolina

 

Verify Your Plan's Coverage

 

  • Check your specific policy details on the Blue Cross Blue Shield of North Carolina (BCBSNC) website. This will indicate whether Lantus is included in your prescription coverage.

    •  

  • Log into your member account and review the formulary list to confirm if Lantus is listed as a covered medication.

 

Consult Your Healthcare Provider

 

  • Discuss with your doctor the clinical reasons for prescribing Lantus, ensuring they understand it's vital for your health care plan.

    •  

  • Request that your doctor provides any necessary documentation or a detailed medical necessity letter, if required by BCBSNC.

 

Obtain Prior Authorization

 

  • Contact BCBSNC's customer service or use their online portal to understand if prior authorization is required for Lantus.

    •  

  • If required, submit a prior authorization request along with any medical documentation from your healthcare provider.

 

Visit a Participating Pharmacy

 

  • Ensure that you get your prescription filled at a pharmacy within your BCBSNC network to avoid out-of-network charges.

    •  

  • Provide the pharmacist with your insurance card to process the claim through BCBSNC coverage.

 

Appeal If Needed

 

  • If your claim for Lantus coverage is denied, review the denial letter for specific reasons provided by BCBSNC.

    •  

  • Prepare an appeal with any supplementary information or supporting documents from your healthcare provider.

    •  

  • Submit the appeal via the methods provided by BCBSNC, whether online, mail, or phone.

 

Stay Informed About Policy Changes

 

  • Regularly review any updates or changes to your policy that may affect your coverage for Lantus.

    •  

  • Stay in contact with BCBSNC for any new information regarding your prescription benefits.

 

Seek Additional Assistance

 

  • If needed, contact BCBSNC's customer service for further guidance on obtaining coverage for Lantus.

    •  

  • Consider consulting with a patient advocacy group or a health insurance broker if you encounter ongoing issues.

 

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Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Lantus

Explore coverage for Lantus by Blue Cross NC, reasons for denial, cost without insurance, and FAQs. Find strategies to secure the needed approvals.
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Is Lantus Covered by Blue Cross Blue Shield of North Carolina

 

Coverage for Lantus

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) typically covers Lantus, which is a prescription insulin product, when it is medically necessary for managing diabetes.

    •  

  • Coverage often requires a physician's prescription and proof of a diabetes diagnosis. BCBSNC may ask for medical documentation supporting the necessity of Lantus for effective diabetes management.

 

Basic Coverage Criteria

 

  • Patients usually need to be enrolled in a Prescription Drug Plan that includes coverage for insulin products under BCBSNC.

    •  

  • Preauthorization might be necessary, where doctors provide prior approval before the Lantus prescription is filled.

 

Utilization Management

 

  • The plan may apply management strategies such as quantity limits or step therapy, requiring patients to try other diabetes medications first.

    •  

  • Co-pays or deductibles might be applicable depending on specific plan details, which can significantly influence out-of-pocket costs.

 

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

 

Eligibility Criteria for Lantus Coverage

 

  • Patients must receive a diagnosis of diabetes mellitus, which includes type 1 and type 2 diabetes, from a healthcare professional.

    •  

  • Lantus is prescribed when there is a medical necessity for long-acting insulin therapy in diabetes management.

    •  

  • Patients should have a documented history of unsuccessful glycemic control with alternative long-acting insulins, if applicable.

 

Prescription and Supply Requirements

 

  • The prescription for Lantus must be written by an endocrinologist or a licensed healthcare provider specializing in diabetes care.

    •  

  • Lantus coverage is subject to standard dosing requirements typically initiated and adjusted based on individual patient needs.

    •  

  • Quantity limits may apply based on the patient’s treatment plan and clinical judgment as documented by the prescribing healthcare provider.

 

Health Plan Verification and Documentation

 

  • Patients are required to provide a medical record indicating the necessity of Lantus, including any relevant laboratory results or clinical assessments.

    •  

  • Continuity of treatment considerations must be documented to show a stable regimen or specific medical necessity for continued use of Lantus beyond initial approval.

    •  

  • Coverage is assessed and verified through submission of medical documentation or required pre-authorization forms as specified by the insurance plan.

 

Special Considerations and Additional Support

 

  • Patients within certain age groups, such as pediatric or geriatric, may receive specialized assessment aligning with published clinical guidelines.

    •  

  • Case-by-case exceptions may be considered based on unique patient needs and documented medical necessity beyond typical coverage parameters.

    •  

  • For patients transitioning from other insulin therapies, documented efforts to optimize existing therapies prior to Lantus initiation may favor coverage approval.

 

Coordination with Healthcare Providers

 

  • Effective management outcomes should be communicated between healthcare providers and the insurance plan to ensure continuous coverage support for Lantus.

    •  

  • Routine follow-up assessments or consultations with a diabetes care specialist are encouraged to provide ongoing evaluation and optimization of the therapy.

 

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

 

Reasons for Denial of Lantus Coverage by Blue Cross Blue Shield of North Carolina

 

  • Lantus may not be covered if the patient does not meet the specific medical criteria set forth by Blue Cross Blue Shield of North Carolina. This includes failure to demonstrate the medical necessity for Lantus when alternative, lower-cost treatments may be effective.

    •  

  • Lack of prior authorization may result in denial. If the required prior authorization process is not followed and approved, Blue Cross Blue Shield of North Carolina may deny coverage for Lantus.

    •  

  • If Lantus is not listed on the preferred drug formulary, its coverage might be denied. Plans often have formularies that specify which brand-name drugs are covered without an alternative generic or preferred brand being tried first.

    •  

  • Non-compliance with step therapy protocols can lead to denial of Lantus coverage. Step therapy mandates that patients must try and fail on a less expensive medication before insurance will cover a higher-cost option like Lantus.

    •  

  • Lantus might not be covered if it is prescribed for an off-label use that has not been approved by Blue Cross Blue Shield of North Carolina.

    •  

  • Coverage may be denied if the patient is using more than the recommended amount of Lantus, especially if the amount exceeds what is deemed necessary by the insurer's guidelines.

 

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

  • The price of Lantus (insulin glargine) without insurance can vary based on factors such as the pharmacy, location, and available discounts. Typically, the retail price ranges between $250 and $350 for a 10ml vial at a retail pharmacy.

    •  

  • For the Lantus SoloStar pen, which is a more convenient option for some, the price is generally similar, ranging from $400 to $500 for a pack of five pens.

    •  

  • Prices can fluctuate slightly, so it is advisable to check with local pharmacies or online services for the most current prices and potential savings options.

    •  

  • Consider exploring patient assistance programs offered by the manufacturer or third-party organizations, which might offer Lantus at reduced prices or even for free if you qualify based on income.

 

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

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 Lantus Coverage with Blue Cross Blue Shield of North Carolina

 

Verify Your Plan's Coverage

 

  • Check your specific policy details on the Blue Cross Blue Shield of North Carolina (BCBSNC) website. This will indicate whether Lantus is included in your prescription coverage.

    •  

  • Log into your member account and review the formulary list to confirm if Lantus is listed as a covered medication.

 

Consult Your Healthcare Provider

 

  • Discuss with your doctor the clinical reasons for prescribing Lantus, ensuring they understand it's vital for your health care plan.

    •  

  • Request that your doctor provides any necessary documentation or a detailed medical necessity letter, if required by BCBSNC.

 

Obtain Prior Authorization

 

  • Contact BCBSNC's customer service or use their online portal to understand if prior authorization is required for Lantus.

    •  

  • If required, submit a prior authorization request along with any medical documentation from your healthcare provider.

 

Visit a Participating Pharmacy

 

  • Ensure that you get your prescription filled at a pharmacy within your BCBSNC network to avoid out-of-network charges.

    •  

  • Provide the pharmacist with your insurance card to process the claim through BCBSNC coverage.

 

Appeal If Needed

 

  • If your claim for Lantus coverage is denied, review the denial letter for specific reasons provided by BCBSNC.

    •  

  • Prepare an appeal with any supplementary information or supporting documents from your healthcare provider.

    •  

  • Submit the appeal via the methods provided by BCBSNC, whether online, mail, or phone.

 

Stay Informed About Policy Changes

 

  • Regularly review any updates or changes to your policy that may affect your coverage for Lantus.

    •  

  • Stay in contact with BCBSNC for any new information regarding your prescription benefits.

 

Seek Additional Assistance

 

  • If needed, contact BCBSNC's customer service for further guidance on obtaining coverage for Lantus.

    •  

  • Consider consulting with a patient advocacy group or a health insurance broker if you encounter ongoing issues.

 

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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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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.

Lantus FAQ

What is Lantus used for?

 

What is Lantus Used For?

 

  • Lantus is primarily used to manage blood sugar levels in individuals with type 1 and type 2 diabetes.

    •  

  • It is a long-acting insulin, providing a steady release of insulin over a 24-hour period with no pronounced peak, mimicking natural insulin secretion.

    •  

  • It's taken once daily, often at the same time each day, helping to maintain consistent blood glucose control.

    •  

  • Beneficial for patients requiring basal insulin to prevent hyperglycemia between meals and overnight.

    •  

  • Alongside diet and exercise, Lantus is vital for comprehensive diabetes management.

 

How does Lantus work in the body?

 

How Lantus Works

 

  • Lantus is a long-acting insulin, also known as insulin glargine. It provides a stable and continuous release of insulin to control blood sugar levels.

    •  

  • The formulation of Lantus enables it to dissolve slowly upon injection, creating a slow and steady insulin level that lasts up to 24 hours.

    •  

  • This minimizes the risk of blood sugar peaks and troughs, providing more consistent blood glucose management.

    •  

  • Lantus mimics the basal level of insulin production in the pancreas, thus helping to maintain glucose balance between meals and overnight.

    •  

  • It binds to insulin receptors, facilitating glucose uptake into muscle and fat tissues, while inhibiting hepatic glucose production.

 

What are the side effects of Lantus?

 

Common Side Effects

 

  • Injection site reactions such as redness, swelling, or itching can occur.
  • Hypoglycemia, or low blood sugar, is a frequent side effect.
  • Weight gain may happen due to improved glucose utilization.

 

Less Common Side Effects

 

  • Allergic reactions like rash or itching may occur but are rare.
  • Systemic reactions such as swelling of hands/feet can occur.
  • Visual changes might be experienced during initial treatment.

 

Serious Side Effects

 

  • Severe hypoglycemia requiring intervention.
  • Signs of allergic reactions like difficulty breathing, require immediate attention.
  • Hypokalemia may develop, leading to muscle weakness or cramps.

 

Have questions left?

‍

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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A weight management program tailored to you

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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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