Does Blue Cross Blue Shield of Texas Cover Trelegy

Discover if Blue Cross Blue Shield of Texas covers Trelegy, learn about costs, and understand the steps to secure coverage. Explore FAQs and more insights.
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Coverage of Trelegy by Blue Cross Blue Shield of Texas

 

  • Trelegy is commonly covered for patients with chronic obstructive pulmonary disease (COPD) or asthma when prescribed by a healthcare provider.
  •  

  • Coverage depends on the specific insurance plan; check your policy's formulary or contact customer service for precise details.
  •  

  • A prior authorization may be required, involving documentation from the prescribing doctor to confirm the necessity based on the patient's condition.
  •  

  • Patients may need to demonstrate that other treatments have been ineffective before Trelegy is approved.
  •  

  • Costs and coverage can vary based on whether you choose a preferred pharmacy or mail-order service affiliated with 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 Trelegy Coverage with Blue Cross Blue Shield of Texas

 

Check Your Current Plan Details

 

  • Log into your Blue Cross Blue Shield of Texas (BCBSTX) member account online to view the specifics of your current insurance plan.
  • Look through your policy documents or contact customer service to determine if Trelegy is included in your formulary—the list of covered medications.

 

Consult with Your Doctor

 

  • Discuss your prescription needs with your healthcare provider to confirm that Trelegy is medically necessary for your treatment.
  • Ask your provider if there are any generic or alternative medications that might be covered more easily or at a lower cost.

 

Understand Formularies and Tiers

 

  • Learn the tier system of BCBSTX’s formulary as higher-tier drugs typically have higher co-pays or may require additional authorization.
  • Check if Trelegy is classified under a higher tier and requires prior authorization or a step therapy process (trying less expensive drugs first).

 

Contact Blue Cross Blue Shield of Texas

 

  • Call the customer service number on the back of your member ID card to get detailed information on Trelegy coverage.
  • Request a list of documents or forms you may need for prior authorization, if required for your plan.

 

Submit a Prior Authorization Request

 

  • Work with your doctor to complete and submit any necessary forms or documents for prior authorization.
  • Ensure all medical records that justify the necessity of Trelegy are included to improve your chances of approval.

 

Explore Cost-Saving Options

 

  • Investigate manufacturer discount programs or patient assistance services that may help reduce the out-of-pocket cost for Trelegy.
  • Ask BCBSTX about any available quantity or dosage options that may be more affordable under your plan.

 

Review Appeals Process

 

  • If your initial request for coverage is denied, understand the appeals process that BCBSTX provides to contest the decision.
  • Gather additional supporting documentation from your healthcare provider and submit it within the specified timeframe outlined by BCBSTX for appeals.

 

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FAQs

Does Blue Cross Blue Shield of Texas Cover Trelegy

Discover if Blue Cross Blue Shield of Texas covers Trelegy, learn about costs, and understand the steps to secure coverage. Explore FAQs and more insights.
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Is Trelegy Covered by Blue Cross Blue Shield of Texas

 

Coverage of Trelegy by Blue Cross Blue Shield of Texas

 

  • Trelegy is commonly covered for patients with chronic obstructive pulmonary disease (COPD) or asthma when prescribed by a healthcare provider.
  •  

  • Coverage depends on the specific insurance plan; check your policy's formulary or contact customer service for precise details.
  •  

  • A prior authorization may be required, involving documentation from the prescribing doctor to confirm the necessity based on the patient's condition.
  •  

  • Patients may need to demonstrate that other treatments have been ineffective before Trelegy is approved.
  •  

  • Costs and coverage can vary based on whether you choose a preferred pharmacy or mail-order service affiliated with your plan.

 

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

 

Approved Criteria for Trelegy Coverage by Blue Cross Blue Shield of Texas

 

  • Trelegy is covered for patients with a confirmed diagnosis of Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and/or emphysema.
  •  

  • Coverage applies when Trelegy is prescribed for patients who require treatment with more than one inhaled medication and where the condition is not adequately controlled with existing therapy.
  •  

  • Patients must have documented spirometric evidence demonstrating airflow limitation, typically a post-bronchodilator FEV1/FVC ratio <0.70.
  •  

  • The prescribing physician should provide evidence that the patient has previously been treated with dual therapy (such as an inhaled corticosteroid combined with a long-acting beta agonist or long-acting muscarinic antagonist) without achieving adequate symptom control.
  •  

  • Coverage may require documented exacerbation history with at least two exacerbations per year requiring systemic corticosteroids or a recent history of hospitalization for a COPD exacerbation.
  •  

  • For continuation of therapy, physician documentation should indicate that Trelegy has resulted in a positive clinical response, including improvement in lung function, reduction in exacerbation rate, or better quality of life.
  •  

  • Trelegy may also be covered for use in the management of asthma patients aged 18 years and older, subject to a confirmed diagnosis of asthma and inadequately controlled symptoms despite previous therapies.
  •  

  • Prior authorization may be required, ensuring that all above criteria are met along with justification from the treating physician.

 

Why Blue Cross Blue Shield of Texas Might Deny Trelegy Coverage

 

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

 

  • Trelegy is prescribed for a condition not approved by the FDA. Insurance coverage often only extends to medications for their FDA-approved uses.
  •  

  • The patient does not meet the specific medical necessity criteria outlined by Blue Cross Blue Shield of Texas for Trelegy. Coverage may require additional documentation proving necessity.
  •  

  • Trelegy is not included in the plan's formulary, which is the list of medications covered by the policy. If a drug is not on this list, it might not be covered.
  •  

  • The prescribed dosage or quantity exceeds the amount covered by the insurance policy. Policies may limit coverage to standard dosages unless further authorization is obtained.
  •  

  • The patient's plan requires prior authorization for Trelegy, but authorization was not obtained before the prescription was filled.
  •  

  • The patient is using a pharmacy that is out-of-network according to their specific health plan. Coverage typically requires using in-network providers/pharmacies.
  •  

  • The patient's existing medical records do not support a diagnosis that warrants the use of Trelegy, as per the insurer's guidelines.

 

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How Much Does Trelegy Cost without Insurance?

 

Approximate Cost of Trelegy Without Insurance

 

  • The cost of Trelegy Ellipta, without insurance, can vary significantly based on several factors like the pharmacy, geographical location, or available discounts. On average, patients can expect to pay between $550 to $650 for a 30-day supply.
  •  

  • Prices may also fluctuate depending on ongoing promotions or pharmacy memberships that can provide additional savings.
  •  

  • It’s advisable for patients to use discount cards, check for manufacturer coupons, or explore patient assistance programs to lower the out-of-pocket expense.
  •  

  • Shopping around, comparing prices at different pharmacies, or using online price comparison tools can also result in significant cost savings for Trelegy.

 

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 Trelegy Coverage with Blue Cross Blue Shield of Texas

 

Check Your Current Plan Details

 

  • Log into your Blue Cross Blue Shield of Texas (BCBSTX) member account online to view the specifics of your current insurance plan.
  • Look through your policy documents or contact customer service to determine if Trelegy is included in your formulary—the list of covered medications.

 

Consult with Your Doctor

 

  • Discuss your prescription needs with your healthcare provider to confirm that Trelegy is medically necessary for your treatment.
  • Ask your provider if there are any generic or alternative medications that might be covered more easily or at a lower cost.

 

Understand Formularies and Tiers

 

  • Learn the tier system of BCBSTX’s formulary as higher-tier drugs typically have higher co-pays or may require additional authorization.
  • Check if Trelegy is classified under a higher tier and requires prior authorization or a step therapy process (trying less expensive drugs first).

 

Contact Blue Cross Blue Shield of Texas

 

  • Call the customer service number on the back of your member ID card to get detailed information on Trelegy coverage.
  • Request a list of documents or forms you may need for prior authorization, if required for your plan.

 

Submit a Prior Authorization Request

 

  • Work with your doctor to complete and submit any necessary forms or documents for prior authorization.
  • Ensure all medical records that justify the necessity of Trelegy are included to improve your chances of approval.

 

Explore Cost-Saving Options

 

  • Investigate manufacturer discount programs or patient assistance services that may help reduce the out-of-pocket cost for Trelegy.
  • Ask BCBSTX about any available quantity or dosage options that may be more affordable under your plan.

 

Review Appeals Process

 

  • If your initial request for coverage is denied, understand the appeals process that BCBSTX provides to contest the decision.
  • Gather additional supporting documentation from your healthcare provider and submit it within the specified timeframe outlined by BCBSTX for appeals.

 

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Trelegy FAQ

1. What are the side effects of Trelegy?

 

Common Side Effects of Trelegy

 

  • Headaches
  • Back pain
  • Hoarseness
  • Oral thrush

 

Serious Side Effects

 

  • Increased heart rate
  • Chest pain
  • High blood pressure
  • Pneumonia in COPD patients

 

Less Common Side Effects

 

  • Diarrhea
  • Cough
  • Sore throat
  • Gastrointestinal discomfort

 

Precautions

 

  • Monitor for worsening symptoms.
  • Consult a doctor for persistent side effects.

 

2. How does Trelegy compare to Breo?

 

Comparison of Trelegy and Breo

 

  • Trelegy combines three active ingredients: fluticasone furoate (a corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Breo contains only two: fluticasone furoate and vilanterol.
  •  

  • This combination in Trelegy allows for better control of symptoms for COPD patients requiring more comprehensive therapy, whereas Breo is more suitable for those requiring less intensive treatment.
  •  

  • Both medications are administered once daily via inhalation, but Trelegy’s triple therapy provides a broader mechanism of action.
  •  

  • Side effects are generally similar, though patients transitioning from Breo to Trelegy may experience different responses due to the added component.

 

3. Is Trelegy a steroid?

 

Is Trelegy a Steroid?

 

  • Components: Trelegy contains three active ingredients: fluticasone furoate, umeclidinium, and vilanterol. Fluticasone furoate is a corticosteroid.
  •  

  • Steroid Role: The corticosteroid in Trelegy helps reduce inflammation in the airways, which is crucial for treating conditions like COPD and asthma.
  •  

  • Multi-Action: In addition to the steroid, umeclidinium (an anticholinergic) and vilanterol (a long-acting beta-agonist) work to relax and open the airways.
  •  

  • Usage: Trelegy is inhaled, delivering these components directly to the lungs for targeted action, minimizing systemic steroid exposure.

 

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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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