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Does Blue Cross Blue Shield of Texas Cover Jardiance

Explore coverage options for Jardiance with Blue Cross Blue Shield of Texas and learn costs, denials, and FAQs in this comprehensive guide.

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Coverage Overview

Blue Cross Blue Shield of Texas (BCBSTX) may cover Jardiance, a prescription medication used primarily for type 2 diabetes management.

Coverage often depends on the specific health plan, the medication's tier, and if prior authorization is required.

Eligibility Criteria

Patients typically need a documented diagnosis of type 2 diabetes. Jardiance might be covered if it's deemed medically necessary and other treatments have been insufficient.

Healthcare providers may need to supply justification, such as previous treatment attempts and relevant health conditions.

Steps to Ensure Coverage

Contact BCBSTX customer service to verify if Jardiance is included in your plan's formulary and understand any requirements.

Work with your healthcare provider to complete any necessary prior authorizations or appeals needed for exceptions.

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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 Texas

Understanding Your Coverage

Contact Blue Cross Blue Shield of Texas (BCBSTX) customer service to inquire about your specific health plan's coverage policies for Jardiance. You can call the number on your insurance card or visit their official website for this information.

Review your insurance policy documents to understand specifics about drug coverage, tier levels, copays, and any prior authorization requirements associated with Jardiance.

Consult Your Healthcare Provider

Schedule a consultation with your healthcare provider to discuss the necessity of Jardiance in your treatment plan, and to ensure they are aware of your insurance provider's requirements.

Ask your doctor to provide necessary documentation that supports your need for Jardiance, as this may be required by BCBSTX for coverage approval.

Prescription and Prior Authorization

Have your healthcare provider write a prescription for Jardiance. They can often electronically submit this to your pharmacy, which will then forward a request to BCBSTX if prior authorization is required.

If prior authorization is required, your doctor will need to complete necessary forms provided by BCBSTX. This process substantiates your need for Jardiance and aligns with the insurance company's clinical guidelines.

Approval Process

BCBSTX will review the prior authorization request. This process might involve assessing the submitted medical justification and your medical history.

Keep in contact with both your pharmacy and healthcare provider throughout this process to ensure timely responses to any additional requests from the insurance company.

Check Your Pharmacy Benefits

Verify your pharmacy benefits either through the BCBSTX member portal or by contacting customer service. This will confirm whether Jardiance is covered and any associated out-of-pocket costs.

Inquire if there are generic or alternative drugs covered that might offer lower copays if cost is an issue.

Appeal If Necessary

If your request for Jardiance coverage is denied, familiarize yourself with BCBSTX's appeals process. This information can typically be found on your denial letter and the company’s website.

Work closely with your healthcare provider to provide further documentation or clarification that supports the necessity of Jardiance for your treatment.

Regular Follow-Up

Upon receiving approval, use BCBSTX's resources to keep track of your prescriptions and refills, ensuring no lapses in medication availability.

Regularly review your plan benefits and any notifications from BCBSTX regarding changes in prescription coverage to stay updated.

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FAQs

Does Blue Cross Blue Shield of Texas Cover Jardiance

Explore coverage options for Jardiance with Blue Cross Blue Shield of Texas and learn costs, denials, and FAQs in this comprehensive guide.

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Is Jardiance Covered by Blue Cross Blue Shield of Texas

Coverage Overview

Blue Cross Blue Shield of Texas (BCBSTX) may cover Jardiance, a prescription medication used primarily for type 2 diabetes management.

Coverage often depends on the specific health plan, the medication's tier, and if prior authorization is required.

Eligibility Criteria

Patients typically need a documented diagnosis of type 2 diabetes. Jardiance might be covered if it's deemed medically necessary and other treatments have been insufficient.

Healthcare providers may need to supply justification, such as previous treatment attempts and relevant health conditions.

Steps to Ensure Coverage

Contact BCBSTX customer service to verify if Jardiance is included in your plan's formulary and understand any requirements.

Work with your healthcare provider to complete any necessary prior authorizations or appeals needed for exceptions.

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Blue Cross Blue Shield of Texas's Approved Criteria for Jardiance Coverage

Eligibility Criteria for Jardiance Coverage

Patients must have a documented diagnosis of type 2 diabetes mellitus.

Individuals should demonstrate an inadequate response or intolerance to prior antidiabetic therapy, aligning with clinical guidelines for the treatment of type 2 diabetes.

The patient must be 18 years or older.

Prescribing by a licensed healthcare provider with expertise in the management of diabetes or endocrinology is required.

Medical Necessity

Jardiance must be prescribed for the management of blood glucose levels as part of a comprehensive diabetes management plan that includes diet and exercise.

Documentation of the healthcare provider's rationale for selecting Jardiance over other SGLT2 inhibitors must be provided, emphasizing its role in therapeutic strategy.

Evidence must be presented indicating that treatment with Jardiance is expected to yield positive outcomes in glycemic control and/or weight management.

Coverage Duration

Initial approval for coverage is typically for a period of 12 months.

Continuation of coverage may require evidence of clinical benefit, necessitating periodic review and documentation of the patient’s response to therapy.

Additional Considerations for Cardiovascular and Renal Benefits

Approval may be extended to individuals with established cardiovascular disease or at risk for cardiovascular events, supported by documentation of potential therapeutic advantages of Jardiance in reducing cardiovascular risk.

Patients with chronic kidney disease may qualify for Jardiance coverage, contingent upon evidence of its capacity to slow kidney disease progression or enhance renal outcomes.

Why Blue Cross Blue Shield of Texas Might Deny Jardiance Coverage

Reasons for Denial of Jardiance Coverage by Blue Cross Blue Shield of Texas

Jardiance is not included in the formulary, which is the list of medications covered under the insurance plan. If the plan's formulary does not include Jardiance, coverage may be denied.

The patient does not meet the specific medical criteria set by Blue Cross Blue Shield of Texas that qualifies them for Jardiance coverage. This may include not having a documented diagnosis for type 2 diabetes or heart failure when these are the required conditions for the coverage of Jardiance.

The usage of Jardiance is considered "off-label," meaning it is being prescribed for a condition not approved by the FDA or outside of the FDA-approved guidelines for treatment.

The Jardiance prescription does not follow the step therapy requirements outlined by Blue Cross Blue Shield of Texas, where a patient must try other designated therapies first before coverage for Jardiance is approved.

The prescribed dosage or quantity of Jardiance exceeds the limitations set forth in the coverage policy. Typically, insurers may have restrictions on the maximum amount of the medication covered over a certain period.

The patient lacks prior authorization for Jardiance, which is often required to ensure the medication is deemed necessary and cost-effective before coverage is approved by the insurer.

Insurance coverage is considered inactive or is not in effect at the time of the Jardiance prescription request.

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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 Texas

Understanding Your Coverage

Contact Blue Cross Blue Shield of Texas (BCBSTX) customer service to inquire about your specific health plan's coverage policies for Jardiance. You can call the number on your insurance card or visit their official website for this information.

Review your insurance policy documents to understand specifics about drug coverage, tier levels, copays, and any prior authorization requirements associated with Jardiance.

Consult Your Healthcare Provider

Schedule a consultation with your healthcare provider to discuss the necessity of Jardiance in your treatment plan, and to ensure they are aware of your insurance provider's requirements.

Ask your doctor to provide necessary documentation that supports your need for Jardiance, as this may be required by BCBSTX for coverage approval.

Prescription and Prior Authorization

Have your healthcare provider write a prescription for Jardiance. They can often electronically submit this to your pharmacy, which will then forward a request to BCBSTX if prior authorization is required.

If prior authorization is required, your doctor will need to complete necessary forms provided by BCBSTX. This process substantiates your need for Jardiance and aligns with the insurance company's clinical guidelines.

Approval Process

BCBSTX will review the prior authorization request. This process might involve assessing the submitted medical justification and your medical history.

Keep in contact with both your pharmacy and healthcare provider throughout this process to ensure timely responses to any additional requests from the insurance company.

Check Your Pharmacy Benefits

Verify your pharmacy benefits either through the BCBSTX member portal or by contacting customer service. This will confirm whether Jardiance is covered and any associated out-of-pocket costs.

Inquire if there are generic or alternative drugs covered that might offer lower copays if cost is an issue.

Appeal If Necessary

If your request for Jardiance coverage is denied, familiarize yourself with BCBSTX's appeals process. This information can typically be found on your denial letter and the company’s website.

Work closely with your healthcare provider to provide further documentation or clarification that supports the necessity of Jardiance for your treatment.

Regular Follow-Up

Upon receiving approval, use BCBSTX's resources to keep track of your prescriptions and refills, ensuring no lapses in medication availability.

Regularly review your plan benefits and any notifications from BCBSTX regarding changes in prescription coverage to stay updated.

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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 Texas Cover Jardiance

Explore coverage options for Jardiance with Blue Cross Blue Shield of Texas and learn costs, denials, and FAQs in this comprehensive guide.

Achieve Your Goals Faster with Curex