Does Blue Shield of California Cover Emgality

Explore Emgality coverage by Blue Shield of California, potential obstacles, costs without insurance, and learn how to secure coverage effectively.
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“Curex is changing the landscape of allergies in 2024”
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Blue Shield of California and Emgality Coverage

 

  • Emgality, a medication for migraine prevention, may be covered by Blue Shield of California under specific conditions.
  •  

  • The coverage typically applies to patients diagnosed with chronic or episodic migraines who have not responded well to at least two other preventive treatments.
  •  

  • Criteria for coverage often include a history of frequent migraine attacks, generally at least 4 days per month.
  •  

  • Prior authorization is usually required; your healthcare provider needs to submit documentation supporting the necessity of Emgality.
  •  

  • Patients should check their specific health plan benefits and guidelines, as coverage and requirements might vary across different plan types.

 

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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 Emgality Coverage with Blue Shield of California

 

Check Your Policy

 

  • Visit the Blue Shield of California's website to log in to your member account or review your policy documents to confirm prescription coverage for Emgality.
  • Contact Blue Shield of California customer service if your documents aren't clear regarding the specific coverage details for Emgality.

 

Consult With Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss whether Emgality is the right medication for your condition.
  • Ask your healthcare provider to provide a prescription and any necessary documentation that may support your case for coverage, such as a treatment plan and medical history.

 

Pre-authorization Process

 

  • Contact Blue Shield of California to inquire whether a pre-authorization is required for Emgality. This may involve your healthcare provider submitting specific information or filling out forms to justify the prescription.
  • If pre-authorization is necessary, ensure that your provider submits the required forms accurately and promptly.

 

Pharmacy Coordination

 

  • Work with your designated pharmacy to confirm that they accept your Blue Shield plan and can process the Emgality prescription.
  • The pharmacy may also handle some of the paperwork required for insurance billing and coverage inquiries.

 

Monitor Your Coverage Status

 

  • Regularly check the status of your Emgality coverage application through Blue Shield of California’s online portal, or by contacting their customer support.
  • If coverage is denied, ask for a detailed explanation of the decision and inquire about the appeals process.

 

File an Appeal if Necessary

 

  • If your coverage is denied, review the denial letter carefully to understand the reasons provided by Blue Shield of California.
  • Work with your doctor to gather additional documentation or information that supports the necessity of Emgality for your treatment.
  • Submit a formal appeal, ensuring that all required documentation and additional supporting information are included.

 

Stay Informed

 

  • Keep detailed records of all communications with Blue Shield of California, including dates, times, and the names of the representatives you speak with.
  • Stay updated about any changes in policy coverage that might affect your prescription for Emgality.

 

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Does Blue Shield of California Cover Emgality

Explore Emgality coverage by Blue Shield of California, potential obstacles, costs without insurance, and learn how to secure coverage effectively.
Curex allergy drops unboxing

Is Emgality Covered by Blue Shield of California

 

Blue Shield of California and Emgality Coverage

 

  • Emgality, a medication for migraine prevention, may be covered by Blue Shield of California under specific conditions.
  •  

  • The coverage typically applies to patients diagnosed with chronic or episodic migraines who have not responded well to at least two other preventive treatments.
  •  

  • Criteria for coverage often include a history of frequent migraine attacks, generally at least 4 days per month.
  •  

  • Prior authorization is usually required; your healthcare provider needs to submit documentation supporting the necessity of Emgality.
  •  

  • Patients should check their specific health plan benefits and guidelines, as coverage and requirements might vary across different plan types.

 

A weight management program tailored to you

Start with Curex

Blue Shield of California's Approved Criteria for Emgality Coverage

 

Eligibility Criteria for Emgality Coverage

 

  • The patient must be diagnosed with either episodic or chronic migraine, which is causing significant impact on their daily life or activities.
  •  

  • A healthcare provider must confirm that the patient has tried and failed, or has a contraindication or intolerance to at least two other preventive migraine medications, whether traditional (e.g., beta-blockers, tricyclic antidepressants) or newer treatments.

 

Required Documentation

 

  • Patient's medical history documenting the frequency and severity of migraine attacks, as well as past treatments and responses, must be provided.
  •  

  • Documentation from a healthcare provider indicating that the patient continues to have frequent migraine attacks despite other preventive treatment or is unable to tolerate those treatments.

 

Initial Authorization and Renewal

 

  • Initial coverage for Emgality is typically authorized for a period of up to 6 months to assess the patient's response to the medication.
  •  

  • For renewal coverage, the patient must demonstrate a clinically meaningful reduction in migraine frequency or severity as compared to baseline, as determined by the healthcare provider.
  •  

  • Documentation of the patient's adherence to and compliance with the prescribed Emgality treatment regimen is necessary for continued coverage.

 

Provider and Pharmacy Requirements

 

  • Emgality must be prescribed by a neurologist, headache specialist, or another provider experienced in the diagnosis and management of migraine.
  •  

  • The medication must be dispensed through a pharmacy that is part of Blue Shield of California's network and approved for dispensing specialty medications.

 

Add-on Coverage Considerations

 

  • Patients who are prescribed Emgality in combination with other CGRP inhibitors or additional preventive treatments may require additional documentation to support the rationale for combination therapy.
  •  

  • Specific coverage criteria might apply if the patient has concurrent chronic conditions that affect treatment selection and outcomes.

 

Why Blue Shield of California Might Deny Emgality Coverage

 

Reasons for Denial of Emgality Coverage by Blue Shield of California

 

  • Emgality is not prescribed by a neurologist or headache specialist, as these are the typically required prescribers for migraine treatments.
  •  

  • The patient has not demonstrated an inadequate response, contraindication, or intolerance to at least two other migraine preventive medications.
  •  

  • The dosage prescribed exceeds the recommended quantity limits set by Blue Shield of California.
  •  

  • Emgality is being prescribed for an off-label use that has not been approved by Blue Shield or lacks sufficient evidence for effectiveness and safety.
  •  

  • The patient does not meet the plan's specific medical necessity criteria, such as a certain frequency or severity of migraine episodes.
  •  

  • The prescription does not align with Blue Shield's step therapy requirements, where patients are required to try and fail covered formulary options before approval of Emgality.
  •  

  • Emgality is intended for individuals for whom it is not approved, such as children or those with certain contraindications.
  •  

  • The patient does not have the necessary authorization or prior approval documentation completed by their healthcare provider.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Emgality Cost without Insurance?

 

Approximate Cost of Emgality Without Insurance

 

  • The price of Emgality (galcanezumab-gnlm) for an individual who is paying out-of-pocket can vary widely. On average, the cost for a one-month supply of Emgality, which is typically one syringe or auto-injector, is approximately $600 to $700.
  •  

  • Prices may differ based on the pharmacy and location. It's advisable to compare prices from different pharmacies, as there can be significant variation.
  •  

  • Many pharmaceutical companies, including the makers of Emgality, offer savings programs or patient assistance options for those who might struggle with the full cost of the medication. These programs can sometimes significantly reduce the out-of-pocket expenses for eligible patients.
  •  

  • In addition, discount cards or coupons from third-party services might be available that can reduce the retail price. However, always verify the legitimacy and terms of such offers.

 

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 Emgality Coverage with Blue Shield of California

 

Check Your Policy

 

  • Visit the Blue Shield of California's website to log in to your member account or review your policy documents to confirm prescription coverage for Emgality.
  • Contact Blue Shield of California customer service if your documents aren't clear regarding the specific coverage details for Emgality.

 

Consult With Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss whether Emgality is the right medication for your condition.
  • Ask your healthcare provider to provide a prescription and any necessary documentation that may support your case for coverage, such as a treatment plan and medical history.

 

Pre-authorization Process

 

  • Contact Blue Shield of California to inquire whether a pre-authorization is required for Emgality. This may involve your healthcare provider submitting specific information or filling out forms to justify the prescription.
  • If pre-authorization is necessary, ensure that your provider submits the required forms accurately and promptly.

 

Pharmacy Coordination

 

  • Work with your designated pharmacy to confirm that they accept your Blue Shield plan and can process the Emgality prescription.
  • The pharmacy may also handle some of the paperwork required for insurance billing and coverage inquiries.

 

Monitor Your Coverage Status

 

  • Regularly check the status of your Emgality coverage application through Blue Shield of California’s online portal, or by contacting their customer support.
  • If coverage is denied, ask for a detailed explanation of the decision and inquire about the appeals process.

 

File an Appeal if Necessary

 

  • If your coverage is denied, review the denial letter carefully to understand the reasons provided by Blue Shield of California.
  • Work with your doctor to gather additional documentation or information that supports the necessity of Emgality for your treatment.
  • Submit a formal appeal, ensuring that all required documentation and additional supporting information are included.

 

Stay Informed

 

  • Keep detailed records of all communications with Blue Shield of California, including dates, times, and the names of the representatives you speak with.
  • Stay updated about any changes in policy coverage that might affect your prescription for Emgality.

 

Premium Medication you can trust

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.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Emgality FAQ

1. What are the common side effects of Emgality?

 

Common Side Effects of Emgality

 

  • Injection site reactions: including pain, redness, and itching at the injection site.
  •  

  • Constipation: a relatively frequent digestive side effect experienced by some patients.
  •  

  • Hypersensitivity reactions: such as rash, itching, or swelling in some individuals.
  •  

  • Respiratory effects: includes symptoms like cough or shortness of breath.
  •  

  • Fatigue: feelings of tiredness or lethargy reported by a number of users.
  •  

  • Difficulty sleeping: some patients may experience insomnia or sleep disturbances.

 

Consult Healthcare Provider

 

  • If side effects are severe or persistent, it is crucial to consult with a healthcare provider.

 

2. How long does it take for Emgality to start working?

 

How Emgality Works

 

  • Emgality is a monoclonal antibody that targets CGRP, a protein linked to migraine.
  •  

  • It's used for migraine prevention and treatment of cluster headaches.

 

Timeline for Effectiveness

 

  • Some patients report migraine reduction within 1 week of initial injection.
  •  

  • Maximum benefits typically observed after 2-3 months of consistent use.
  •  

  • Individual response varies; some might experience quicker relief than others.

 

Factors Influencing Effectiveness

 

  • Variability in individual biology and metabolism affects onset of relief.
  •  

  • Concurrent medications and overall health may also play a role.

 

Considerations

 

  • Consult with your healthcare provider for tailored advice based on your health profile.
  •  

  • Be consistent with your dosing schedule for optimal results.

 

3. Can Emgality be used for both prevention and treatment of migraines?

 

Usage of Emgality

 

  • Emgality is primarily approved for use as a preventive treatment for migraine. It is designed to reduce the frequency of migraine headaches in adults.
  •  

  • Emgality works by targeting and blocking the calcitonin gene-related peptide (CGRP), a molecule involved in migraine attacks.

 

Not for Acute Treatment

 

  • Emgality is not used for the acute treatment of migraine attacks once they've started. Other medications are typically prescribed for immediate relief.
  •  

  • Consult a healthcare provider for recommendations on acute migraine management options.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

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. 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 Shield of California Cover Emgality

Explore Emgality coverage by Blue Shield of California, potential obstacles, costs without insurance, and learn how to secure coverage effectively.
Curex allergy drops unboxing

Does Blue Shield of California Cover Emgality

 

Blue Shield of California and Emgality Coverage

 

  • Emgality, a medication for migraine prevention, may be covered by Blue Shield of California under specific conditions.
  •  

  • The coverage typically applies to patients diagnosed with chronic or episodic migraines who have not responded well to at least two other preventive treatments.
  •  

  • Criteria for coverage often include a history of frequent migraine attacks, generally at least 4 days per month.
  •  

  • Prior authorization is usually required; your healthcare provider needs to submit documentation supporting the necessity of Emgality.
  •  

  • Patients should check their specific health plan benefits and guidelines, as coverage and requirements might vary across different plan types.

 

A weight management program tailored to you

Start with Curex

Why Blue Shield of California Might Deny Emgality Coverage

 

Eligibility Criteria for Emgality Coverage

 

  • The patient must be diagnosed with either episodic or chronic migraine, which is causing significant impact on their daily life or activities.
  •  

  • A healthcare provider must confirm that the patient has tried and failed, or has a contraindication or intolerance to at least two other preventive migraine medications, whether traditional (e.g., beta-blockers, tricyclic antidepressants) or newer treatments.

 

Required Documentation

 

  • Patient's medical history documenting the frequency and severity of migraine attacks, as well as past treatments and responses, must be provided.
  •  

  • Documentation from a healthcare provider indicating that the patient continues to have frequent migraine attacks despite other preventive treatment or is unable to tolerate those treatments.

 

Initial Authorization and Renewal

 

  • Initial coverage for Emgality is typically authorized for a period of up to 6 months to assess the patient's response to the medication.
  •  

  • For renewal coverage, the patient must demonstrate a clinically meaningful reduction in migraine frequency or severity as compared to baseline, as determined by the healthcare provider.
  •  

  • Documentation of the patient's adherence to and compliance with the prescribed Emgality treatment regimen is necessary for continued coverage.

 

Provider and Pharmacy Requirements

 

  • Emgality must be prescribed by a neurologist, headache specialist, or another provider experienced in the diagnosis and management of migraine.
  •  

  • The medication must be dispensed through a pharmacy that is part of Blue Shield of California's network and approved for dispensing specialty medications.

 

Add-on Coverage Considerations

 

  • Patients who are prescribed Emgality in combination with other CGRP inhibitors or additional preventive treatments may require additional documentation to support the rationale for combination therapy.
  •  

  • Specific coverage criteria might apply if the patient has concurrent chronic conditions that affect treatment selection and outcomes.

 

Together with our partners we have changed the lives of over 300,000 patients.

Emgality FAQ

 

Reasons for Denial of Emgality Coverage by Blue Shield of California

 

  • Emgality is not prescribed by a neurologist or headache specialist, as these are the typically required prescribers for migraine treatments.
  •  

  • The patient has not demonstrated an inadequate response, contraindication, or intolerance to at least two other migraine preventive medications.
  •  

  • The dosage prescribed exceeds the recommended quantity limits set by Blue Shield of California.
  •  

  • Emgality is being prescribed for an off-label use that has not been approved by Blue Shield or lacks sufficient evidence for effectiveness and safety.
  •  

  • The patient does not meet the plan's specific medical necessity criteria, such as a certain frequency or severity of migraine episodes.
  •  

  • The prescription does not align with Blue Shield's step therapy requirements, where patients are required to try and fail covered formulary options before approval of Emgality.
  •  

  • Emgality is intended for individuals for whom it is not approved, such as children or those with certain contraindications.
  •  

  • The patient does not have the necessary authorization or prior approval documentation completed by their healthcare provider.

 

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 Much Does Emgality Cost without Insurance?

 

Approximate Cost of Emgality Without Insurance

 

  • The price of Emgality (galcanezumab-gnlm) for an individual who is paying out-of-pocket can vary widely. On average, the cost for a one-month supply of Emgality, which is typically one syringe or auto-injector, is approximately $600 to $700.
  •  

  • Prices may differ based on the pharmacy and location. It's advisable to compare prices from different pharmacies, as there can be significant variation.
  •  

  • Many pharmaceutical companies, including the makers of Emgality, offer savings programs or patient assistance options for those who might struggle with the full cost of the medication. These programs can sometimes significantly reduce the out-of-pocket expenses for eligible patients.
  •  

  • In addition, discount cards or coupons from third-party services might be available that can reduce the retail price. However, always verify the legitimacy and terms of such offers.

 

Premium Medication you can trust

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.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

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.