Does Blue Cross of Idaho Cover Jardiance

Explore Jardiance coverage by Blue Cross of Idaho, reasons for denial, getting coverage, costs without insurance, and find answers to common questions.
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Does Blue Cross of Idaho Cover Jardiance?

 

  • Blue Cross of Idaho may cover Jardiance under certain plans, primarily focusing on individuals diagnosed with Type 2 diabetes.
  •  

  • Coverage often requires that Jardiance is prescribed by a healthcare provider as part of a comprehensive diabetes management plan.
  •  

  • It's important that Jardiance is deemed medically necessary, and other standard treatments have been considered or tried.

 

Basic Rules and Criteria

 

  • Patients may need to provide a prescription from a healthcare provider specializing in endocrinology or diabetes management.
  •  

  • A prior authorization might be required, necessitating the submission of additional medical documentation to justify the need for Jardiance.
  •  

  • Coverage can vary based on the specific health plan, so reviewing the policy details or contacting customer service is recommended for the most accurate information.

 

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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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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 of Idaho

 

Verify Eligibility for Coverage

 

  • Review your current Blue Cross of Idaho insurance policy to check if prescription medications like Jardiance are covered.
  •  

  • Contact Blue Cross of Idaho customer service for assistance in understanding your benefits and eligibility for coverage of Jardiance.

 

Consult with Your Healthcare Provider

 

  • Schedule a meeting with your healthcare provider to discuss your need for Jardiance and obtain a prescription if deemed necessary.
  •  

  • Ask your healthcare provider to provide any required documentation that Blue Cross of Idaho might need to approve coverage.

 

Submit Necessary Documentation

 

  • Ensure you have all necessary forms from your healthcare provider, such as a prior authorization form, if required by Blue Cross of Idaho.
  •  

  • Submit the provided documentation to Blue Cross of Idaho through their required channels, which may include mail, fax, or an online portal.

 

Contact Blue Cross of Idaho

 

  • Reach out to the Blue Cross of Idaho customer service to confirm receipt of your documentation and inquire about any additional information they may need.
  •  

  • Ask about the typical processing time for medication coverage requests, so you can manage your expectations accordingly.

 

Follow Up and Appeal If Necessary

 

  • After submission, follow up with Blue Cross of Idaho to check the status of your coverage request for Jardiance.
  •  

  • If your coverage is denied, discuss with your healthcare provider about submitting an appeal and gather any additional evidence needed to support your case.

 

Pharmacy Coordination

 

  • Once approved, ensure that your pharmacy is aware of the coverage so they can bill Blue Cross of Idaho directly for Jardiance.
  •  

  • Keep your prescription and Blue Cross of Idaho insurance details ready when collecting Jardiance from the pharmacy to facilitate the process.

 

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FAQs

Does Blue Cross of Idaho Cover Jardiance

Explore Jardiance coverage by Blue Cross of Idaho, reasons for denial, getting coverage, costs without insurance, and find answers to common questions.
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Is Jardiance Covered by Blue Cross of Idaho

 

Does Blue Cross of Idaho Cover Jardiance?

 

  • Blue Cross of Idaho may cover Jardiance under certain plans, primarily focusing on individuals diagnosed with Type 2 diabetes.
  •  

  • Coverage often requires that Jardiance is prescribed by a healthcare provider as part of a comprehensive diabetes management plan.
  •  

  • It's important that Jardiance is deemed medically necessary, and other standard treatments have been considered or tried.

 

Basic Rules and Criteria

 

  • Patients may need to provide a prescription from a healthcare provider specializing in endocrinology or diabetes management.
  •  

  • A prior authorization might be required, necessitating the submission of additional medical documentation to justify the need for Jardiance.
  •  

  • Coverage can vary based on the specific health plan, so reviewing the policy details or contacting customer service is recommended for the most accurate information.

 

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Blue Cross of Idaho's Approved Criteria for Jardiance Coverage

 

Eligibility Criteria for Jardiance Coverage

 

  • Patients must be diagnosed with type 2 diabetes mellitus and require additional glycemic control along with diet and exercise management.
  •  

  • Eligible for treatment of heart failure in patients with established cardiovascular disease, or who are at high risk due to type 2 diabetes.
  •  

  • Jardiance may be approved for use in patients with type 2 diabetes, who have a history of cardiovascular events or chronic kidney disease requiring therapy to improve outcomes.
  •  

  • Consideration for coverage requires documentation showing Jardiance as a part of a comprehensive plan for managing diabetes and cardiovascular risks.

 

Documentation Required for Approval

 

  • A written prescription from the treating healthcare provider specifying the need for Jardiance as part of the treatment plan.
  •  

  • Detailed medical history including confirmation of type 2 diabetes diagnosis as well as any related cardiovascular or renal conditions.
  •  

  • Evidence of previous treatments and responses that necessitate the use of Jardiance for further management.

 

Reauthorization Criteria

 

  • Ongoing documentation from healthcare providers showing continued efficacy and clinical necessity of Jardiance in managing the patient's condition.
  •  

  • Submission of updated medical records reflecting current health status, and any notable changes in the management of type 2 diabetes or cardiovascular/renal health.

 

Exclusion from Prior Authorization

 

  • Certain patient groups may be eligible for coverage of Jardiance without prior approval based on predefined guidelines, focusing on immediate clinical needs.
  •  

  • Healthcare providers should check with Blue Cross of Idaho to confirm if their patient qualifies for this streamlined process, reducing the waiting period for coverage initiation.

 

Why Blue Cross of Idaho Might Deny Jardiance Coverage

 

Situations Where Blue Cross of Idaho Might Deny Jardiance Coverage

 

  • **Non-Approved Diagnosis**: Jardiance is primarily prescribed for specific conditions such as type 2 diabetes and heart failure. If the prescribed use does not match one of these approved diagnoses, coverage could be denied.
  •  

  • **Lack of Medical Necessity**: If Blue Cross of Idaho determines that Jardiance is not medically necessary for the patient's condition, perhaps due to the availability of other suitable treatments, they might deny coverage.
  •  

  • **Failure to Follow Step Therapy Requirements**: If Jardiance is being prescribed without first trying more cost-effective treatments as dictated by step therapy protocols, coverage may be refused.
  •  

  • **Exclusion of Certain Prescription Drugs**: Some plans may have specific exclusions for certain medications. If Jardiance falls under these exclusions, the coverage would not be provided.
  •  

  • **Not Following Formulary Guidelines**: Blue Cross of Idaho may have specific formulary guidelines. If Jardiance is outside the formulary, it might not be covered unless special authorization is received.
  •  

  • **Quantity Limits**: If a prescription exceeds the quantity limits established by the coverage plan, additional quantities might not be covered without prior authorization.
  •  

  • **Out-of-Network Provider**: Prescriptions filled through an out-of-network pharmacy or prescribed by an out-of-network provider might not be covered.
  •  

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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.

 

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 Jardiance Coverage with Blue Cross of Idaho

 

Verify Eligibility for Coverage

 

  • Review your current Blue Cross of Idaho insurance policy to check if prescription medications like Jardiance are covered.
  •  

  • Contact Blue Cross of Idaho customer service for assistance in understanding your benefits and eligibility for coverage of Jardiance.

 

Consult with Your Healthcare Provider

 

  • Schedule a meeting with your healthcare provider to discuss your need for Jardiance and obtain a prescription if deemed necessary.
  •  

  • Ask your healthcare provider to provide any required documentation that Blue Cross of Idaho might need to approve coverage.

 

Submit Necessary Documentation

 

  • Ensure you have all necessary forms from your healthcare provider, such as a prior authorization form, if required by Blue Cross of Idaho.
  •  

  • Submit the provided documentation to Blue Cross of Idaho through their required channels, which may include mail, fax, or an online portal.

 

Contact Blue Cross of Idaho

 

  • Reach out to the Blue Cross of Idaho customer service to confirm receipt of your documentation and inquire about any additional information they may need.
  •  

  • Ask about the typical processing time for medication coverage requests, so you can manage your expectations accordingly.

 

Follow Up and Appeal If Necessary

 

  • After submission, follow up with Blue Cross of Idaho to check the status of your coverage request for Jardiance.
  •  

  • If your coverage is denied, discuss with your healthcare provider about submitting an appeal and gather any additional evidence needed to support your case.

 

Pharmacy Coordination

 

  • Once approved, ensure that your pharmacy is aware of the coverage so they can bill Blue Cross of Idaho directly for Jardiance.
  •  

  • Keep your prescription and Blue Cross of Idaho insurance details ready when collecting Jardiance from the pharmacy to facilitate the process.

 

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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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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 (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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