Does Blue Cross of Idaho Cover Trelegy

Explore if Blue Cross of Idaho covers Trelegy. Learn about coverage challenges, cost, and steps to secure medication. Discover answers to common Trelegy questions.
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Blue Cross of Idaho Coverage for Trelegy

 

  • Blue Cross of Idaho generally covers Trelegy for the treatment of chronic obstructive pulmonary disease (COPD) and asthma. Coverage often requires prior authorization to ensure medical necessity.

 

Criteria for Coverage

 

  • Trelegy may be covered if prescribed for patients who have moderate to severe COPD or asthma and have tried other treatments without success.
  • Documentation from your healthcare provider may be needed to demonstrate that Trelegy is medically necessary.

 

Basic Rules for Getting Coverage

 

  • Ensure that Trelegy is part of your specific plan's formulary. Formularies can vary, so it's crucial to confirm.
  • Your healthcare provider must submit a prior authorization request if required by your plan.
  • Patients might need to prove they have tried and failed with other similar medications to qualify for Trelegy under certain insurance policies.
  • Costs may vary based on your specific plan and whether you have met your deductible or out-of-pocket maximum.

 

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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 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 of Idaho

 

Check Your Current Coverage

 

  • Contact Blue Cross of Idaho by calling the customer service number on the back of your insurance card to inquire about your current prescription coverage.
  •  

  • Log in to your member account on the Blue Cross of Idaho website to review your pharmacy benefits and see if Trelegy is listed as a covered medication.
  •  

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Trelegy with your healthcare provider. Ensure that Trelegy is the appropriate medication for your condition.
  •  

  • Your doctor may need to provide documentation or write a letter of medical necessity to assist with coverage approval.
  •  

 

Understand Your Plan's Formulary

 

  • Familiarize yourself with your plan's drug formulary, which is a list of covered prescription drugs. You can find this information in your insurance plan documents or on the Blue Cross of Idaho website.
  •  

  • If Trelegy is not covered, check if there are any alternative medications in the same drug class that are covered.
  •  

 

Submit a Prior Authorization Request

 

  • If required, your doctor will need to submit a prior authorization request. This is often needed for medications that are not routinely covered.
  •  

  • Follow up with Blue Cross of Idaho and your doctor to ensure all necessary paperwork is completed promptly.
  •  

 

Appeal a Denied Request

 

  • If your initial request is denied, familiarizing yourself with the appeals process is crucial. You can review your plan's guide on how to file an appeal.
  •  

  • Work with your healthcare provider to prepare a comprehensive appeal, including additional medical documentation if necessary.
  •  

 

Check for Prescription Assistance Programs

 

  • Explore any available manufacturer assistance programs or other resources that may help reduce the cost of Trelegy if it is not covered.
  •  

  • Your pharmacy or doctor's office may have information on these programs or assistance with enrollment.
  •  

 

Regularly Review Your Coverage

 

  • Insurance plans and formularies can change annually, so it's important to review your benefits each year during the open enrollment period.
  •  

  • Consider contacting Blue Cross of Idaho each year to understand any changes in your coverage options for Trelegy.
  •  

 

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FAQs

Does Blue Cross of Idaho Cover Trelegy

Explore if Blue Cross of Idaho covers Trelegy. Learn about coverage challenges, cost, and steps to secure medication. Discover answers to common Trelegy questions.
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Is Trelegy Covered by Blue Cross of Idaho

 

Blue Cross of Idaho Coverage for Trelegy

 

  • Blue Cross of Idaho generally covers Trelegy for the treatment of chronic obstructive pulmonary disease (COPD) and asthma. Coverage often requires prior authorization to ensure medical necessity.

 

Criteria for Coverage

 

  • Trelegy may be covered if prescribed for patients who have moderate to severe COPD or asthma and have tried other treatments without success.
  • Documentation from your healthcare provider may be needed to demonstrate that Trelegy is medically necessary.

 

Basic Rules for Getting Coverage

 

  • Ensure that Trelegy is part of your specific plan's formulary. Formularies can vary, so it's crucial to confirm.
  • Your healthcare provider must submit a prior authorization request if required by your plan.
  • Patients might need to prove they have tried and failed with other similar medications to qualify for Trelegy under certain insurance policies.
  • Costs may vary based on your specific plan and whether you have met your deductible or out-of-pocket maximum.

 

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Blue Cross of Idaho's Approved Criteria for Trelegy Coverage

 

Approved Criteria for Trelegy Coverage by Blue Cross of Idaho

 

  • The patient is diagnosed with Chronic Obstructive Pulmonary Disease (COPD) and requires ongoing medication to manage the condition.
  •  

  • The patient must have a documented history of exposure to risk factors associated with COPD, such as smoking or occupational dust and chemicals.
  •  

  • The patient has undergone a recent spirometry test confirming COPD diagnosis with FEV1/FVC ratio below normal levels, indicating airflow obstruction.
  •  

  • Previous treatment with a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) does not adequately manage symptoms, warranting a combination therapy approach.
  •  

  • The patient's healthcare provider has determined that the use of Trelegy is medically necessary to manage the patient's COPD symptoms effectively.
  •  

  • No contraindications are present to using Trelegy, such as known hypersensitivity to any active or inactive components of the drug.
  •  

  • The patient is advised to use Trelegy as a part of a comprehensive treatment plan that includes lifestyle modifications and regular follow-ups with the healthcare provider.
  •  

  • Prior authorization procedures have been followed correctly, including submission of all necessary documentation and clinical rationale for Trelegy use by the healthcare provider.

 

Why Blue Cross of Idaho Might Deny Trelegy Coverage

 

Situations Where Trelegy is Not Covered by Blue Cross of Idaho

 

  • Trelegy may not be covered if it is prescribed for conditions outside its approved usage by the FDA, such as diseases not specifically related to chronic obstructive pulmonary disease (COPD) and asthma.
  • Coverage might be denied if the medication is not listed on Blue Cross of Idaho's formulary or if it is in a tier that requires prior authorization and such authorization is not obtained.
  • The insurance might not cover Trelegy if the patient fails to meet specified clinical criteria, such as having baseline documentation of lung function tests or past use of other medications to manage conditions before progressing to Trelegy.
  • Blue Cross of Idaho may not cover Trelegy if the prescription has not been filled at an in-network pharmacy or by an approved supplier.
  • If the prescribed dosage exceeds the recommended limits without necessary justification or documentation from a healthcare provider, coverage might be denied.
  • Trelegy coverage may not be available if the patient is not enrolled in a plan that includes coverage for prescription medications, or if the policy specifically excludes it.
  • Refusal of coverage might also occur if there is insufficient evidence of the necessity as deemed by a medical review conducted by Blue Cross of Idaho.
  • If the prescribed Trelegy is for experimental use or part of a clinical trial, coverage is likely not provided.

 

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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 of Idaho

 

Check Your Current Coverage

 

  • Contact Blue Cross of Idaho by calling the customer service number on the back of your insurance card to inquire about your current prescription coverage.
  •  

  • Log in to your member account on the Blue Cross of Idaho website to review your pharmacy benefits and see if Trelegy is listed as a covered medication.
  •  

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Trelegy with your healthcare provider. Ensure that Trelegy is the appropriate medication for your condition.
  •  

  • Your doctor may need to provide documentation or write a letter of medical necessity to assist with coverage approval.
  •  

 

Understand Your Plan's Formulary

 

  • Familiarize yourself with your plan's drug formulary, which is a list of covered prescription drugs. You can find this information in your insurance plan documents or on the Blue Cross of Idaho website.
  •  

  • If Trelegy is not covered, check if there are any alternative medications in the same drug class that are covered.
  •  

 

Submit a Prior Authorization Request

 

  • If required, your doctor will need to submit a prior authorization request. This is often needed for medications that are not routinely covered.
  •  

  • Follow up with Blue Cross of Idaho and your doctor to ensure all necessary paperwork is completed promptly.
  •  

 

Appeal a Denied Request

 

  • If your initial request is denied, familiarizing yourself with the appeals process is crucial. You can review your plan's guide on how to file an appeal.
  •  

  • Work with your healthcare provider to prepare a comprehensive appeal, including additional medical documentation if necessary.
  •  

 

Check for Prescription Assistance Programs

 

  • Explore any available manufacturer assistance programs or other resources that may help reduce the cost of Trelegy if it is not covered.
  •  

  • Your pharmacy or doctor's office may have information on these programs or assistance with enrollment.
  •  

 

Regularly Review Your Coverage

 

  • Insurance plans and formularies can change annually, so it's important to review your benefits each year during the open enrollment period.
  •  

  • Consider contacting Blue Cross of Idaho each year to understand any changes in your coverage options for Trelegy.
  •  

 

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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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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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