Does Blue Cross Blue Shield of North Carolina Cover Ozempic

Explore Ozempic coverage by Blue Cross Blue Shield NC, denial reasons, cost without insurance, and FAQs to help navigate your insurance options.
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Coverage for Ozempic

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) may cover Ozempic if prescribed for Type 2 diabetes mellitus management.
  •  

  • Coverage likely requires prior authorization, demonstrating a medical necessity.
  •  

  • Ozempic must be prescribed by a healthcare provider; eligibility typically involves prior use of other diabetic medications without adequate control.
  •  

  • Patients must meet certain criteria, such as having a specific BMI or other complicating factors.

 

Basic Rules and Criteria

 

  • Check if your specific plan includes Ozempic within the formulary drug list.
  •  

  • Prior to coverage, an assessment by BCBSNC may be necessary to confirm criteria are met.
  •  

  • Potential co-payments or specific cost-sharing requirements could apply depending on 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 Ozempic Coverage with Blue Cross Blue Shield of North Carolina

 

Check Your Plan Details

 

  • Log in to your Blue Cross Blue Shield of North Carolina (BCBSNC) member account to review your specific plan details.
  •  

  • Look for information about prescription drug coverage, and find out whether Ozempic is listed under the covered medications or requires prior authorization.

 

Consult with Your Healthcare Provider

 

  • Speak to your healthcare provider about your need for Ozempic. They can confirm the medical necessity and help you understand the dosage and treatment plans that align with BCBSNC requirements.
  •  

  • Obtain a prescription from your healthcare provider, as it is necessary for any insurance coverage process.

 

Contact Member Services

 

  • Call the BCBSNC member services number located on your insurance card. Verify your benefits for Ozempic and ask any questions about coverage specifics and prior authorization processes.
  •  

  • Inquire about any out-of-pocket costs, copayments, or deductibles that may apply to your prescription.

 

Request Prior Authorization

 

  • If prior authorization is required, your healthcare provider will need to submit a request form to BCBSNC, providing details about your medical condition and the justification for using Ozempic.
  •  

  • Ensure that your healthcare provider includes all necessary documentation to support the medical necessity of the drug. This may include medical records, treatment history, and clinical guidelines.

 

Follow Up on Authorization Status

 

  • After your healthcare provider has submitted the authorization request, follow up with BCBSNC to check the status of the submission.
  •  

  • Keep communication open with both your provider and the insurance company to address any additional information or appeals if necessary.

 

Visit an In-Network Pharmacy

 

  • Once your authorization is approved, or if it is not required, locate an in-network pharmacy to fill your Ozempic prescription, which will minimize your out-of-pocket costs.
  •  

  • Present your insurance ID card at the pharmacy to ensure the claim is processed correctly under your BCBSNC plan.

 

Review and Manage Costs

 

  • Review any copayment or coinsurance amounts at the pharmacy and take necessary steps to manage these costs, such as using health savings accounts (HSAs) if available.
  •  

  • Consider enrolling in any patient assistance programs offered by Novo Nordisk, the manufacturer of Ozempic, if additional financial support is needed.

 

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Ozempic

Explore Ozempic coverage by Blue Cross Blue Shield NC, denial reasons, cost without insurance, and FAQs to help navigate your insurance options.
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Is Ozempic Covered by Blue Cross Blue Shield of North Carolina

 

Coverage for Ozempic

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) may cover Ozempic if prescribed for Type 2 diabetes mellitus management.
  •  

  • Coverage likely requires prior authorization, demonstrating a medical necessity.
  •  

  • Ozempic must be prescribed by a healthcare provider; eligibility typically involves prior use of other diabetic medications without adequate control.
  •  

  • Patients must meet certain criteria, such as having a specific BMI or other complicating factors.

 

Basic Rules and Criteria

 

  • Check if your specific plan includes Ozempic within the formulary drug list.
  •  

  • Prior to coverage, an assessment by BCBSNC may be necessary to confirm criteria are met.
  •  

  • Potential co-payments or specific cost-sharing requirements could apply depending on your plan.

 

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

 

Eligibility Criteria for Ozempic Coverage

 

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

  • Documentation of inadequate control with a previous or current sulfonylurea, metformin, or insulin therapy must be provided.
  •  

  • The prescribing physician must be an endocrinologist or a specialist experienced in the management of diabetes.
  •  

 

Medical Necessity Documentation

 

  • Detailed medical history showing efforts to manage Type 2 Diabetes effectively prior to the request for Ozempic.
  •  

  • Physician’s statement of the necessity of therapy with Ozempic based on patient-specific factors (e.g., obesity, high HbA1c levels).
  •  

 

Dosage and Administration Requirements

 

  • Ozempic must be administered in accordance with the FDA-approved prescribing information.
  •  

  • The prescribed dosing regimen should demonstrate compliance with the recommended therapeutic guidelines.
  •  

 

Monitoring and Follow-up Commitment

 

  • Agreement to regular follow-up visits to monitor progress, side effects, and treatment efficacy.
  •  

  • Submission of regular blood glucose and HbA1c levels to verify continued therapeutic benefit from Ozempic use.
  •  

 

Patient Education and Support

 

  • Confirmation that the patient has received education on proper administration and potential side effects of Ozempic.
  •  

  • Verification of access to nutritional and lifestyle counseling as part of a comprehensive diabetes management plan.
  •  

 

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

 

When Blue Cross Blue Shield of North Carolina Might Deny Ozempic Coverage

 

  • **Non-Diabetic Use**: Blue Cross Blue Shield of North Carolina will deny coverage for Ozempic if it is prescribed for conditions other than Type 2 Diabetes, as it is not approved for weight loss or any non-diabetic related conditions.
  •  

  • **Dosage Not in Line with Medical Standards**: If the prescribed dosage of Ozempic exceeds or does not align with standard medical guidelines for Type 2 Diabetes treatment, coverage may be denied.
  •  

  • **Inadequate Medical Documentation**: Requests lacking sufficient medical documentation supporting the necessity of Ozempic for the treatment of Type 2 Diabetes may be denied. This includes a lack of documentation indicating previous treatments and their outcomes.
  •  

  • **Step Therapy Not Followed**: If "step therapy" requirements have not been completed, meaning more cost-effective or traditional medications have not been tried and documented as ineffective, coverage for Ozempic may be denied.
  •  

  • **Lack of Prior Authorization**: Coverage is likely to be denied if there is no prior authorization for Ozempic, especially if the insurance plan specifically includes this requirement for such medications.
  •  

  • **Not Meeting Specific Health Plan Criteria**: Each insurance plan can have specific criteria for coverage. If Ozempic prescriptions do not meet the particular criteria laid out in an individual's health plan, the request for coverage could be denied.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Ozempic Cost without Insurance?

 

Cost of Ozempic Without Insurance

 

  • The approximate cost of Ozempic without insurance is between $800 and $900 for a month's supply. This price can vary based on the pharmacy location and any available manufacturer discounts or special pharmacy promotions.
  •  

  • It's important to note that prices can fluctuate, so checking with multiple pharmacies or online services could provide more precise current pricing.
  •  

  • Patients may also consider enrolling in patient assistance programs offered by the manufacturer, Novo Nordisk, which may provide discounts or support for eligible individuals.

 

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 Ozempic Coverage with Blue Cross Blue Shield of North Carolina

 

Check Your Plan Details

 

  • Log in to your Blue Cross Blue Shield of North Carolina (BCBSNC) member account to review your specific plan details.
  •  

  • Look for information about prescription drug coverage, and find out whether Ozempic is listed under the covered medications or requires prior authorization.

 

Consult with Your Healthcare Provider

 

  • Speak to your healthcare provider about your need for Ozempic. They can confirm the medical necessity and help you understand the dosage and treatment plans that align with BCBSNC requirements.
  •  

  • Obtain a prescription from your healthcare provider, as it is necessary for any insurance coverage process.

 

Contact Member Services

 

  • Call the BCBSNC member services number located on your insurance card. Verify your benefits for Ozempic and ask any questions about coverage specifics and prior authorization processes.
  •  

  • Inquire about any out-of-pocket costs, copayments, or deductibles that may apply to your prescription.

 

Request Prior Authorization

 

  • If prior authorization is required, your healthcare provider will need to submit a request form to BCBSNC, providing details about your medical condition and the justification for using Ozempic.
  •  

  • Ensure that your healthcare provider includes all necessary documentation to support the medical necessity of the drug. This may include medical records, treatment history, and clinical guidelines.

 

Follow Up on Authorization Status

 

  • After your healthcare provider has submitted the authorization request, follow up with BCBSNC to check the status of the submission.
  •  

  • Keep communication open with both your provider and the insurance company to address any additional information or appeals if necessary.

 

Visit an In-Network Pharmacy

 

  • Once your authorization is approved, or if it is not required, locate an in-network pharmacy to fill your Ozempic prescription, which will minimize your out-of-pocket costs.
  •  

  • Present your insurance ID card at the pharmacy to ensure the claim is processed correctly under your BCBSNC plan.

 

Review and Manage Costs

 

  • Review any copayment or coinsurance amounts at the pharmacy and take necessary steps to manage these costs, such as using health savings accounts (HSAs) if available.
  •  

  • Consider enrolling in any patient assistance programs offered by Novo Nordisk, the manufacturer of Ozempic, if additional financial support is needed.

 

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.

Ozempic FAQ

What are the common side effects of Ozempic?

 

Common Side Effects of Ozempic

 

  • Nausea: The most common side effect, often decreasing over time.
  •  

  • Vomiting: Can occur, especially at higher doses.
  •  

  • Diarrhea: May lead to dehydration; ensure adequate fluid intake.
  •  

  • Stomach (Abdominal) Pain: Often mild but can be bothersome.
  •  

  • Constipation: Can occur; manage with diet and hydration.
  •  

  • Reduced Appetite: May assist in weight loss but monitor nutritional intake.
  •  

  • Fatigue: Generally mild; ensure rest and hydration.
  •  

  • Dizziness: Monitor blood pressure and hydration levels.
  •  

  • Injection Site Reactions: Such as redness or irritation, usually temporary.

 

Ensure to discuss persistent or severe side effects with a healthcare provider.

Can Ozempic help with weight loss?

 

How Ozempic Aids Weight Loss

 

  • Ozempic contains semaglutide, a GLP-1 receptor agonist which enhances insulin release and suppresses appetite, facilitating weight loss.
  •  

  • The medication slows gastric emptying, increasing feelings of fullness and reducing calorie intake.

 

Considerations and Benefits

 

  • Clinical studies demonstrate significant weight reduction in people taking Ozempic, often used adjunctly with diet and exercise.
  •  

  • It can also help manage blood sugar levels, making it beneficial for individuals with type 2 diabetes.

 

Potential Side Effects

 

  • Common side effects include nausea, diarrhea, and vomiting, often decreasing over time.
  •  

  • Discuss with your healthcare provider to determine suitability, considering any existing conditions.

 

How does Ozempic work for diabetes?

 

How Ozempic Works for Diabetes

 

  • **Mechanism of Action:** Ozempic is a GLP-1 receptor agonist that mimics the incretin hormone, which decreases blood sugar levels by enhancing insulin secretion.
  •  

  • **Reducing Glucagon Levels:** It lowers glucagon release when blood glucose levels are high, which helps to reduce glucose production by the liver.
  •  

  • **Slows Gastric Emptying:** By delaying stomach emptying, it reduces the rapid spikes in blood glucose after meals.
  •  

  • **Increases Satiety:** It can suppress appetite, leading to possible weight loss, which is beneficial for type 2 diabetes management.

 

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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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