Does Blue Cross Blue Shield of North Carolina Cover Trulicity

Explore Trulicity coverage under Blue Cross NC, reasons for denial, tips to secure coverage, cost without insurance, and frequently asked questions.
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Coverage Overview for Trulicity

 

  • Blue Cross Blue Shield of North Carolina generally covers Trulicity, a medication used for managing type 2 diabetes, under certain conditions.
  •  

  • Coverage is typically included under their prescription drug plans, subject to formulary policies.

 

Eligibility Criteria

 

  • Patients must have a diagnosis of type 2 diabetes and have tried other diabetes management alternatives such as lifestyle changes or other medications.
  •  

  • Coverage often requires prior authorization, demonstrating medical necessity as outlined by the healthcare provider.

 

Steps to Get Coverage

 

  • Consult your healthcare provider to confirm Trulicity's suitability for your treatment plan.
  •  

  • Ensure your provider submits the necessary documentation and prior authorization request to Blue Cross Blue Shield of North Carolina.
  •  

  • Follow up with Blue Cross Blue Shield for approval status and any required co-payments or deductibles.

 

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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.

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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 Trulicity Coverage with Blue Cross Blue Shield of North Carolina

 

Check Your Current Plan

 

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

  • Look through the list of medications covered under your current plan to check for Trulicity coverage.
  •  

  • If Trulicity is not listed, find out the reasons why it might be excluded by reading through plan documentation or FAQs available on the portal.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider whether Trulicity is the appropriate medication for your treatment.
  •  

  • If yes, request a detailed letter of medical necessity from your healthcare provider, explaining why Trulicity is essential for your health condition.

 

Contact BCBSNC Customer Service

 

  • Call the BCBSNC customer service line using the number found on your insurance card.
  •  

  • Ask to speak with a representative regarding formulary coverage for Trulicity.
  •  

  • Provide them with the letter of medical necessity from your healthcare provider, if required.

 

Explore the Prior Authorization Process

 

  • Inquire if Trulicity requires prior authorization under your plan.
  •  

  • Follow the steps provided by the BCBSNC representative to submit prior authorization requests.
  •  

  • Ensure that necessary forms and medical records are filled out and submitted promptly by your healthcare provider.

 

Review Step Therapy Requirements

 

  • Verify if BCBSNC requires step therapy, where alternative medications are tried before approving Trulicity.
  •  

  • Work with your healthcare provider to document any previous medications tried and their inefficacy or adverse effects.

 

Check for Financial Assistance Programs

 

  • Explore if any financial assistance programs or manufacturer's rebates are available for Trulicity.
  •  

  • Contact the manufacturer if necessary to see if they offer coupons or patient assistance programs.

 

Update Your Coverage If Needed

 

  • If Trulicity is consistently denied under your current plan, consider reviewing annual open enrollment options.
  •  

  • Evaluate new plans that include Trulicity in their formulary, and make changes during the enrollment period if feasible.

 

Appeal Denied Claims

 

  • If your request for Trulicity coverage is denied, carefully review the denial letter received from BCBSNC.
  •  

  • Follow the appeals process outlined in the denial letter or your insurance documentation.
  •  

  • Submit any additional information or documentation requested to support your appeal.

 

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Trulicity

Explore Trulicity coverage under Blue Cross NC, reasons for denial, tips to secure coverage, cost without insurance, and frequently asked questions.
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Is Trulicity Covered by Blue Cross Blue Shield of North Carolina

 

Coverage Overview for Trulicity

 

  • Blue Cross Blue Shield of North Carolina generally covers Trulicity, a medication used for managing type 2 diabetes, under certain conditions.
  •  

  • Coverage is typically included under their prescription drug plans, subject to formulary policies.

 

Eligibility Criteria

 

  • Patients must have a diagnosis of type 2 diabetes and have tried other diabetes management alternatives such as lifestyle changes or other medications.
  •  

  • Coverage often requires prior authorization, demonstrating medical necessity as outlined by the healthcare provider.

 

Steps to Get Coverage

 

  • Consult your healthcare provider to confirm Trulicity's suitability for your treatment plan.
  •  

  • Ensure your provider submits the necessary documentation and prior authorization request to Blue Cross Blue Shield of North Carolina.
  •  

  • Follow up with Blue Cross Blue Shield for approval status and any required co-payments or deductibles.

 

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

 

Eligibility Criteria for Trulicity Coverage

 

  • The patient has a diagnosis of type 2 diabetes mellitus.
  •  

  • The patient is 18 years of age or older.
  •  

  • The patient has a documented inadequate response or contraindication to metformin, unless contraindicated or not clinically appropriate.

 

Additional Requirements for Coverage

 

  • The medication is being prescribed by an endocrinologist or healthcare professional specializing in diabetes management.
  •  

  • There is documented evidence of lifestyle modification efforts, including diet and exercise, in conjunction with medication management for diabetes.
  •  

  • Trulicity is prescribed as part of a comprehensive diabetes management plan, including self-monitoring of blood glucose levels.

 

Renewal Criteria for Continued Coverage

 

  • Evidence of improvement in HbA1c levels or metabolic control since initiation of Trulicity treatment.
  •  

  • No adverse reactions or contraindications that warrant discontinuation of therapy.
  •  

  • Adherence to prescribed Trulicity regimen and ongoing engagement with healthcare provider for diabetes management follow-up.

 

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

 

Situations Where Trulicity Coverage Might Be Denied

 

  • **Non-FDA Approved Uses:** Trulicity might not be covered if prescribed for conditions not approved by the FDA. Off-label uses can lead to denials since they fall outside approved use-cases.
  •  

  • **Lack of Medical Necessity:** Coverage might be denied if the insurance company deems Trulicity not medically necessary based on the individual's health condition or diagnosis.
  •  

  • **Failure to Follow Step Therapy Protocols:** If a patient has not tried and failed to respond adequately to other lower-cost medications as required by Blue Cross Blue Shield of North Carolina's step therapy program, coverage could be denied.
  •  

  • **No Prior Authorization:** If Trulicity is prescribed without obtaining prior authorization from Blue Cross Blue Shield of North Carolina, this can result in coverage denial.
  •  

  • **Duplicate Therapies:** Insurance might not cover Trulicity if the patient is already receiving another GLP-1 receptor agonist, as this would be considered duplicate therapy.
  •  

  • **Plan Exclusions:** If Trulicity falls under a specific exclusion of the health plan or if the patient’s specific policy does not cover any injectable drugs, it won't be covered.
  •  

  • **Non-compliance with Plan Guidelines:** Patients who do not comply with prescribed usage or follow-up care as outlined in plan guidelines might face denial of continued coverage.
  •  

 

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How Much Does Trulicity Cost without Insurance?

 

Trulicity Cost Overview

 

  • Trulicity is a brand-name medication commonly used to treat type 2 diabetes. It's administered through a weekly injection.

 

Approximate Cost Without Insurance

 

  • The price of Trulicity can vary depending on the pharmacy or location, but the average cost for one pen of 1.5 mg/0.5 mL solution might run approximately $886 to $1,100.
  • Each box typically contains four pens, which is a month's supply, resulting in the total cost being roughly $3,544 to $4,400.

 

Factors Influencing Pricing

 

  • Pharmacy: Prices may differ from one pharmacy to another, so it’s beneficial to compare costs.
  • Location: Costs may vary based on geographic location due to regional pricing strategies and pharmacy benefits.
  • Discount Programs: Some pharmacies may offer savings programs or coupons that could lower the price.

 

Additional Cost-Saving Tips

 

  • Check for manufacturer discounts or patient assistance programs, which may offer significant savings or even free medication for qualified individuals.
  • Consider discussing alternative medications with your healthcare provider to find a more affordable option suitable for your needs.
  • Utilize pharmacy discount cards or look up savings programs online that specifically cater to diabetes medications.

 

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 Trulicity Coverage with Blue Cross Blue Shield of North Carolina

 

Check Your Current Plan

 

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

  • Look through the list of medications covered under your current plan to check for Trulicity coverage.
  •  

  • If Trulicity is not listed, find out the reasons why it might be excluded by reading through plan documentation or FAQs available on the portal.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider whether Trulicity is the appropriate medication for your treatment.
  •  

  • If yes, request a detailed letter of medical necessity from your healthcare provider, explaining why Trulicity is essential for your health condition.

 

Contact BCBSNC Customer Service

 

  • Call the BCBSNC customer service line using the number found on your insurance card.
  •  

  • Ask to speak with a representative regarding formulary coverage for Trulicity.
  •  

  • Provide them with the letter of medical necessity from your healthcare provider, if required.

 

Explore the Prior Authorization Process

 

  • Inquire if Trulicity requires prior authorization under your plan.
  •  

  • Follow the steps provided by the BCBSNC representative to submit prior authorization requests.
  •  

  • Ensure that necessary forms and medical records are filled out and submitted promptly by your healthcare provider.

 

Review Step Therapy Requirements

 

  • Verify if BCBSNC requires step therapy, where alternative medications are tried before approving Trulicity.
  •  

  • Work with your healthcare provider to document any previous medications tried and their inefficacy or adverse effects.

 

Check for Financial Assistance Programs

 

  • Explore if any financial assistance programs or manufacturer's rebates are available for Trulicity.
  •  

  • Contact the manufacturer if necessary to see if they offer coupons or patient assistance programs.

 

Update Your Coverage If Needed

 

  • If Trulicity is consistently denied under your current plan, consider reviewing annual open enrollment options.
  •  

  • Evaluate new plans that include Trulicity in their formulary, and make changes during the enrollment period if feasible.

 

Appeal Denied Claims

 

  • If your request for Trulicity coverage is denied, carefully review the denial letter received from BCBSNC.
  •  

  • Follow the appeals process outlined in the denial letter or your insurance documentation.
  •  

  • Submit any additional information or documentation requested to support your appeal.

 

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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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Trulicity FAQ

What are the common side effects of Trulicity?

 

Common Side Effects of Trulicity

 

  • Nausea: Initially, many patients experience nausea, which often lessens over time as the body adjusts.
  •  

  • Vomiting: Some individuals may experience vomiting, particularly in the first few doses.
  •  

  • Diarrhea: Digestive disturbances such as diarrhea are commonly reported.
  •  

  • Abdominal Pain: Discomfort in the abdomen can occur, often subsiding with continued use.
  •  

  • Decreased Appetite: Patients often report a reduction in appetite.
  •  

  • Fatigue: Some individuals may feel unusually tired after starting treatment.
  •  

  • Reduced Blood Sugar: Blood sugar levels may become low, especially when used in conjunction with other diabetes medications.

 

How much weight can you lose on Trulicity?

 

Weight Loss with Trulicity

 

  • Trulicity (dulaglutide) is primarily prescribed for managing type 2 diabetes, but many patients also experience weight loss as an additional benefit.
  •  

  • Clinical trials indicate an average weight loss of around 2-6 pounds, but results differ based on individual factors such as diet, exercise, and adherence to the medication.
  •  

  • Some users report greater weight loss; however, it's important to accompany Trulicity with lifestyle changes for optimal results.
  •  

  • Consult with a healthcare provider to tailor a plan that maximizes benefits based on your health needs.

 

How does Trulicity work for type 2 diabetes?

 

How Trulicity Works

 

  • Trulicity is a GLP-1 receptor agonist, helping to regulate blood sugar levels.
  •  

  • It stimulates insulin release in response to high blood glucose.
  •  

  • It slows gastric emptying, which helps reduce post-meal glucose spikes.
  •  

  • Trulicity suppresses glucagon secretion, lowering glucose production by the liver.

 

Benefits

 

  • Easy-to-use once-weekly injection, improving adherence.
  •  

  • Not associated with causing weight gain; may even promote modest weight loss.
  •  

  • May reduce risk of cardiovascular events in patients with heart disease.

 

Considerations

 

  • May cause gastrointestinal side effects, often resolving over time.
  •  

  • Inform your doctor if you have a history of pancreatitis or gallbladder disease.
  •  

  • Monitor for signs of low blood sugar, especially if using other diabetes medications.

 

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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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