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Does CareFirst BlueCross BlueShield Cover Lantus

Explore Lantus coverage with CareFirst BCBS, learn why it might be denied, how to secure approval, costs without insurance, and find FAQs.
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Coverage for Lantus

 

  • CareFirst BlueCross BlueShield generally covers Lantus under most of its plans. Coverage typically falls under the pharmacy benefits.

    •  

  • Patients often need a prescription from their healthcare provider stating a medical necessity for Lantus to ensure coverage.

 

Situations and Criteria

 

  • Lantus is usually covered for patients with type 1 or type 2 diabetes who require long-acting insulin.

    •  

  • Patients may have to provide documentation that other treatment options have been tried and deemed less effective or inappropriate.

    •  

  • Prior authorization might be required, which involves a review of the medical need, dosage, and treatment plan.

 

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Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

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 Lantus Coverage with CareFirst BlueCross BlueShield

 

Gather Important Information

 

  • Ensure you have your CareFirst BlueCross BlueShield member ID card. You will need your member information for any communications with the insurer.

    •  

  • Obtain a recent prescription from your healthcare provider for Lantus, which will be required for submission.

    •  

  • Familiarize yourself with the terms of your specific CareFirst plan to understand potential benefits related to diabetes or chronic condition medications.

 

Contact Customer Service

 

  • Reach out to CareFirst BlueCross BlueShield customer service using the number on your member card. Inquire specifically about coverage details for Lantus.

    •  

  • Ask about preferred pharmacies or mail-order options that might offer savings or direct coverage benefits.

 

Verify Prescription Coverage

 

  • Confirm if Lantus is included in your formulary. A formulary is a list of medications covered under your insurance plan. Coverage can vary based on different plan levels or updates to CareFirst policies.

    •  

  • Ask the representative if any pre-authorization is required for Lantus to be covered under your plan.

 

Submit Necessary Documentation

 

  • If pre-authorization is required, request guidance on how your healthcare provider can submit the required documentation to CareFirst BlueCross BlueShield.

    •  

  • Ensure your healthcare provider is aware of any specific forms or information needed for approval.

 

Understand Cost and Co-pays

 

  • Request detailed information regarding co-pays or out-of-pocket expenses associated with obtaining Lantus through your insurance coverage.

    •  

  • Inquire about any existing savings programs or copay assistance tools that could lower your costs for Lantus.

 

Choose a Pharmacy

 

  • Select a pharmacy aligned with CareFirst's network, where you can process your prescription with the covered benefits. Confirm they are in-network to avoid additional costs.

    •  

  • Consider using a mail-order service if CareFirst recommends it for lower costs or additional benefits.

 

Follow Through

 

  • Once your coverage is verified and pre-authorization (if needed) is complete, have your healthcare provider send your Lantus prescription to the chosen pharmacy.

    •  

  • Prior to pickup, verify with the pharmacy that the medication is ready and confirm your coverage was properly applied.

 

Monitor Coverage Annually

 

  • Review any changes to your CareFirst BlueCross BlueShield plan annually, as formularies or coverage details can change.

    •  

  • Contact customer service if there are changes impacting your Lantus coverage or cost, to explore options or alternative plans.

 

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Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
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FAQs

Does CareFirst BlueCross BlueShield Cover Lantus

Explore Lantus coverage with CareFirst BCBS, learn why it might be denied, how to secure approval, costs without insurance, and find FAQs.
Achieve Your Goals Faster with Curex
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Is Lantus Covered by CareFirst BlueCross BlueShield

 

Coverage for Lantus

 

  • CareFirst BlueCross BlueShield generally covers Lantus under most of its plans. Coverage typically falls under the pharmacy benefits.

    •  

  • Patients often need a prescription from their healthcare provider stating a medical necessity for Lantus to ensure coverage.

 

Situations and Criteria

 

  • Lantus is usually covered for patients with type 1 or type 2 diabetes who require long-acting insulin.

    •  

  • Patients may have to provide documentation that other treatment options have been tried and deemed less effective or inappropriate.

    •  

  • Prior authorization might be required, which involves a review of the medical need, dosage, and treatment plan.

 

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Start with Curex

CareFirst BlueCross BlueShield's Approved Criteria for Lantus Coverage

 

Eligibility for Lantus Coverage

 

  • Member must have a confirmed diagnosis of diabetes mellitus, which could be either Type 1 or Type 2, requiring basal insulin therapy.

    •  

  • The healthcare provider must deem Lantus as medically necessary for the patient, especially in cases where blood glucose levels cannot be controlled using oral antidiabetic agents or other forms of insulin.

 

Documentation Requirements

 

  • Submission of medical records demonstrating the need for insulin therapy, including history of prior treatments and their outcomes.

    •  

  • Provide documented evidence of the diagnosis of diabetes mellitus from recent lab results or provider notes.

 

Approval and Renewal Conditions

 

  • Initial approval for Lantus coverage is typically granted for a 6-12 month period, contingent upon the fulfillment of stated medical necessity criteria.

    •  

  • Renewal requests must include documentation showing improvement or successful maintenance of blood glucose levels since starting Lantus therapy.

    •  

  • Continued need for therapy must be verified by the healthcare provider, and documented evidence should accompany renewal requests to show ongoing positive outcomes using Lantus.

 

Age Restrictions and Pediatric Use

 

  • Individuals over the age of 6 are eligible for Lantus coverage based on FDA approval for pediatric use in managing diabetes mellitus.

    •  

  • For children under 6, coverage is determined on a case-by-case basis, often requiring additional documentation or specialist evaluation.

 

Special Considerations

 

  • Members experiencing adverse reactions or unsuccessful management of diabetes with alternative basal insulins may qualify for priority review and expedited coverage.

    •  

  • Lantus may be covered as part of combination therapy for complex diabetes management when prescribed with other diabetes treatments, given substantiated medical need.

 

Why CareFirst BlueCross BlueShield Might Deny Lantus Coverage

 

Reasons for Denial of Lantus Coverage

 

  • **Non-compliance with Step Therapy Requirements:** CareFirst BlueCross BlueShield may require patients to try and fail other preferred treatments before approving Lantus. If these requirements are not fulfilled, coverage may be denied.

    •  

  • **Lack of Pre-Authorization:** Coverage might be denied if prior authorization is required but not obtained before purchasing Lantus.

    •  

  • **Off-Label Use:** If Lantus is prescribed for a condition or in a manner not approved by the FDA, CareFirst BlueCross BlueShield may deny coverage.

    •  

  • **Non-Preferred Drug Tier:** Lantus could be placed in a higher, non-preferred tier without co-pay assistance, leading to denial of coverage unless alternatives are ineffective or inappropriate.

    •  

  • **Expired Prescription:** Submitting claims with a prescription that has expired may cause denial of coverage.

    •  

  • **Incomplete Documentation:** Failure to provide necessary documentation or evidence for the medical necessity of Lantus can result in denial.

    •  

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

  • The price of Lantus (insulin glargine) without insurance can vary based on factors such as the pharmacy, location, and available discounts. Typically, the retail price ranges between $250 and $350 for a 10ml vial at a retail pharmacy.

    •  

  • For the Lantus SoloStar pen, which is a more convenient option for some, the price is generally similar, ranging from $400 to $500 for a pack of five pens.

    •  

  • Prices can fluctuate slightly, so it is advisable to check with local pharmacies or online services for the most current prices and potential savings options.

    •  

  • Consider exploring patient assistance programs offered by the manufacturer or third-party organizations, which might offer Lantus at reduced prices or even for free if you qualify based on income.

 

Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

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 Lantus Coverage with CareFirst BlueCross BlueShield

 

Gather Important Information

 

  • Ensure you have your CareFirst BlueCross BlueShield member ID card. You will need your member information for any communications with the insurer.

    •  

  • Obtain a recent prescription from your healthcare provider for Lantus, which will be required for submission.

    •  

  • Familiarize yourself with the terms of your specific CareFirst plan to understand potential benefits related to diabetes or chronic condition medications.

 

Contact Customer Service

 

  • Reach out to CareFirst BlueCross BlueShield customer service using the number on your member card. Inquire specifically about coverage details for Lantus.

    •  

  • Ask about preferred pharmacies or mail-order options that might offer savings or direct coverage benefits.

 

Verify Prescription Coverage

 

  • Confirm if Lantus is included in your formulary. A formulary is a list of medications covered under your insurance plan. Coverage can vary based on different plan levels or updates to CareFirst policies.

    •  

  • Ask the representative if any pre-authorization is required for Lantus to be covered under your plan.

 

Submit Necessary Documentation

 

  • If pre-authorization is required, request guidance on how your healthcare provider can submit the required documentation to CareFirst BlueCross BlueShield.

    •  

  • Ensure your healthcare provider is aware of any specific forms or information needed for approval.

 

Understand Cost and Co-pays

 

  • Request detailed information regarding co-pays or out-of-pocket expenses associated with obtaining Lantus through your insurance coverage.

    •  

  • Inquire about any existing savings programs or copay assistance tools that could lower your costs for Lantus.

 

Choose a Pharmacy

 

  • Select a pharmacy aligned with CareFirst's network, where you can process your prescription with the covered benefits. Confirm they are in-network to avoid additional costs.

    •  

  • Consider using a mail-order service if CareFirst recommends it for lower costs or additional benefits.

 

Follow Through

 

  • Once your coverage is verified and pre-authorization (if needed) is complete, have your healthcare provider send your Lantus prescription to the chosen pharmacy.

    •  

  • Prior to pickup, verify with the pharmacy that the medication is ready and confirm your coverage was properly applied.

 

Monitor Coverage Annually

 

  • Review any changes to your CareFirst BlueCross BlueShield plan annually, as formularies or coverage details can change.

    •  

  • Contact customer service if there are changes impacting your Lantus coverage or cost, to explore options or alternative plans.

 

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.

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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.

Lantus FAQ

What is Lantus used for?

 

What is Lantus Used For?

 

  • Lantus is primarily used to manage blood sugar levels in individuals with type 1 and type 2 diabetes.

    •  

  • It is a long-acting insulin, providing a steady release of insulin over a 24-hour period with no pronounced peak, mimicking natural insulin secretion.

    •  

  • It's taken once daily, often at the same time each day, helping to maintain consistent blood glucose control.

    •  

  • Beneficial for patients requiring basal insulin to prevent hyperglycemia between meals and overnight.

    •  

  • Alongside diet and exercise, Lantus is vital for comprehensive diabetes management.

 

How does Lantus work in the body?

 

How Lantus Works

 

  • Lantus is a long-acting insulin, also known as insulin glargine. It provides a stable and continuous release of insulin to control blood sugar levels.

    •  

  • The formulation of Lantus enables it to dissolve slowly upon injection, creating a slow and steady insulin level that lasts up to 24 hours.

    •  

  • This minimizes the risk of blood sugar peaks and troughs, providing more consistent blood glucose management.

    •  

  • Lantus mimics the basal level of insulin production in the pancreas, thus helping to maintain glucose balance between meals and overnight.

    •  

  • It binds to insulin receptors, facilitating glucose uptake into muscle and fat tissues, while inhibiting hepatic glucose production.

 

What are the side effects of Lantus?

 

Common Side Effects

 

  • Injection site reactions such as redness, swelling, or itching can occur.
  • Hypoglycemia, or low blood sugar, is a frequent side effect.
  • Weight gain may happen due to improved glucose utilization.

 

Less Common Side Effects

 

  • Allergic reactions like rash or itching may occur but are rare.
  • Systemic reactions such as swelling of hands/feet can occur.
  • Visual changes might be experienced during initial treatment.

 

Serious Side Effects

 

  • Severe hypoglycemia requiring intervention.
  • Signs of allergic reactions like difficulty breathing, require immediate attention.
  • Hypokalemia may develop, leading to muscle weakness or cramps.

 

Have questions left?

‍

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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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 (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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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