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Does CareFirst BlueCross BlueShield Cover Trelegy

Explore if CareFirst BlueCross BlueShield covers Trelegy, reasons for denial, how to secure coverage, costs without insurance, and FAQs in this detailed guide.
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Does CareFirst BlueCross BlueShield Cover Trelegy?

 

  • CareFirst BlueCross BlueShield generally covers Trelegy, a medication for COPD and asthma treatment, but benefits depend on the specific plan.

    •  

  • Coverage typically requires a prescription from a healthcare provider, and the patient must meet certain medical criteria outlined in the plan’s guidelines.

    •  

  • Patients may need to demonstrate that other treatments were insufficient before Trelegy is approved, as part of step therapy requirements.

    •  

  • Pre-authorization might be required, which means the healthcare provider must justify its necessity for the patient’s health condition before insurance covers the cost.

    •  

  • Co-payments, deductibles, or coinsurance may apply, depending on the individual’s health plan specifics and tier placement of Trelegy.

    •  

  • Members should consult their specific CareFirst plan details or contact customer support for precise information on Trelegy coverage and any associated costs or procedures.

 

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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 Trelegy Coverage with CareFirst BlueCross BlueShield

 

Verify Your Eligibility and Plan Details

 

  • Log into your CareFirst BlueCross BlueShield online account to access your health plan details.
  • Review your plan's prescription drug benefits to confirm if Trelegy is covered and under what tier or category it falls.
  • If your plan documentation is not accessible online, contact CareFirst customer service for detailed information.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Trelegy and ensure it's the right medication for you.
  • Obtain a prescription for Trelegy from your healthcare provider.
  • Discuss whether you need prior authorization for Trelegy coverage with your provider, as they may need to submit supporting documents to CareFirst.

 

Check for Prior Authorization Requirements

 

  • Contact CareFirst BlueCross BlueShield to determine if Trelegy requires prior authorization, which is a common requirement for certain medications.
  • If prior authorization is needed, have your healthcare provider assist by submitting the necessary forms and supporting documentation to CareFirst.
  • Monitor the status of the prior authorization request by directly contacting CareFirst or checking your account online.

 

Filling Your Prescription

 

  • Choose a network pharmacy to fill your Trelegy prescription. Verify that the pharmacy is part of CareFirst BlueCross BlueShield's network to ensure maximum coverage benefits.
  • Present your insurance card at the pharmacy when dropping off your prescription.
  • If applicable, pay the copayment or coinsurance amount required by your insurance plan for the Trelegy prescription.

 

Appeal Denied Coverage (if necessary)

 

  • If CareFirst BlueCross BlueShield denies coverage for Trelegy, review the denial letter to understand the reasons and next steps.
  • Work with your healthcare provider to gather any additional documents or reasons why Trelegy is medically necessary.
  • File an appeal with CareFirst, following the instructions provided in the denial letter.
  • Stay organized and keep copies of all correspondence and submissions related to the appeal process.

 

Explore Cost-Saving Options

 

  • Check if CareFirst BlueCross BlueShield offers any discount programs or patient assistance for Trelegy.
  • Explore the Trelegy manufacturer's website for potential savings programs or discounts for eligible patients.
  • Consult your pharmacy for generic alternatives or additional savings initiatives that may apply to your prescription.

 

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

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FAQs

Does CareFirst BlueCross BlueShield Cover Trelegy

Explore if CareFirst BlueCross BlueShield covers Trelegy, reasons for denial, how to secure coverage, costs without insurance, and FAQs in this detailed guide.
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Is Trelegy Covered by CareFirst BlueCross BlueShield

 

Does CareFirst BlueCross BlueShield Cover Trelegy?

 

  • CareFirst BlueCross BlueShield generally covers Trelegy, a medication for COPD and asthma treatment, but benefits depend on the specific plan.

    •  

  • Coverage typically requires a prescription from a healthcare provider, and the patient must meet certain medical criteria outlined in the plan’s guidelines.

    •  

  • Patients may need to demonstrate that other treatments were insufficient before Trelegy is approved, as part of step therapy requirements.

    •  

  • Pre-authorization might be required, which means the healthcare provider must justify its necessity for the patient’s health condition before insurance covers the cost.

    •  

  • Co-payments, deductibles, or coinsurance may apply, depending on the individual’s health plan specifics and tier placement of Trelegy.

    •  

  • Members should consult their specific CareFirst plan details or contact customer support for precise information on Trelegy coverage and any associated costs or procedures.

 

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CareFirst BlueCross BlueShield's Approved Criteria for Trelegy Coverage

 

Eligibility for Trelegy Coverage

 

  • Trelegy is approved for patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD) or asthma as confirmed by a healthcare professional.

    •  

  • Coverage is available for patients who require maintenance treatment of these diagnosed conditions and have not adequately responded to other therapies.

    •  

  • Patients must have a documented history of using one or more other inhaled medications without sufficient control of the symptoms.

 

Prescription Requirements

 

  • A proper diagnosis and prescription must be provided by a licensed healthcare provider specializing in respiratory care.

    •  

  • The patient's healthcare provider should confirm the necessity of Trelegy after previous treatments have failed or were insufficient.

    •  

  • The prescription should be for an FDA-approved dose of Trelegy, aligned with the patient's specific medical condition and severity.

 

Documentation and Review Process

 

  • Documentation from the healthcare provider must include details of the patient's medical history, treatments that have been tried, and the outcomes of those treatments.

    •  

  • The healthcare provider should also include any test results or assessments used to diagnose the patient’s condition and the decision to recommend Trelegy.

    •  

  • A periodic review may be required to assess the continued necessity and effectiveness of the medication.

 

Special Cases and Considerations

 

  • Patients entering end-of-life care or with unique needs may receive consideration outside typical criteria, requiring detailed justification from a healthcare professional.

    •  

  • Cases involving children under 18 years might require additional documentation and evidence of necessity for Trelegy use.

    •  

  • Patients with comorbid conditions might need a specialized assessment to ensure Trelegy is an appropriate choice given their broader medical picture.

 

Why CareFirst BlueCross BlueShield Might Deny Trelegy Coverage

 

Reasons for Denying Trelegy Coverage by CareFirst BlueCross BlueShield

 

  • The patient does not meet the necessary medical criteria as outlined by CareFirst for Trelegy usage, such as having a confirmed diagnosis that matches the medication's prescribed use.

    •  

  • The prescription is not considered medically necessary according to the specific policies outlined by CareFirst, potentially due to alternative treatments being available.

    •  

  • The prescribed dosage or form of Trelegy exceeds the guidelines set by CareFirst, resulting in denial due to non-compliance with standard dosing policies.

    •  

  • The patient has not tried and failed other first-line therapies that are typically required before coverage of Trelegy is considered.

    •  

  • The prescription is outside of the plan's coverage network, meaning it's prescribed by a non-network provider or filled at an out-of-network pharmacy.

    •  

  • Lack of prior authorization or failure in securing necessary pre-approval from CareFirst, which is often required for covering certain medications like Trelegy.

    •  

  • The patient's insurance policy excludes the particular medication without an applicable exception or rider that includes Trelegy in coverage.

    •  

  • The patient’s current health plan coverage tier does not include Trelegy, making it financially accountable for the individual to purchase independently.

 

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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.

 

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 Trelegy Coverage with CareFirst BlueCross BlueShield

 

Verify Your Eligibility and Plan Details

 

  • Log into your CareFirst BlueCross BlueShield online account to access your health plan details.
  • Review your plan's prescription drug benefits to confirm if Trelegy is covered and under what tier or category it falls.
  • If your plan documentation is not accessible online, contact CareFirst customer service for detailed information.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Trelegy and ensure it's the right medication for you.
  • Obtain a prescription for Trelegy from your healthcare provider.
  • Discuss whether you need prior authorization for Trelegy coverage with your provider, as they may need to submit supporting documents to CareFirst.

 

Check for Prior Authorization Requirements

 

  • Contact CareFirst BlueCross BlueShield to determine if Trelegy requires prior authorization, which is a common requirement for certain medications.
  • If prior authorization is needed, have your healthcare provider assist by submitting the necessary forms and supporting documentation to CareFirst.
  • Monitor the status of the prior authorization request by directly contacting CareFirst or checking your account online.

 

Filling Your Prescription

 

  • Choose a network pharmacy to fill your Trelegy prescription. Verify that the pharmacy is part of CareFirst BlueCross BlueShield's network to ensure maximum coverage benefits.
  • Present your insurance card at the pharmacy when dropping off your prescription.
  • If applicable, pay the copayment or coinsurance amount required by your insurance plan for the Trelegy prescription.

 

Appeal Denied Coverage (if necessary)

 

  • If CareFirst BlueCross BlueShield denies coverage for Trelegy, review the denial letter to understand the reasons and next steps.
  • Work with your healthcare provider to gather any additional documents or reasons why Trelegy is medically necessary.
  • File an appeal with CareFirst, following the instructions provided in the denial letter.
  • Stay organized and keep copies of all correspondence and submissions related to the appeal process.

 

Explore Cost-Saving Options

 

  • Check if CareFirst BlueCross BlueShield offers any discount programs or patient assistance for Trelegy.
  • Explore the Trelegy manufacturer's website for potential savings programs or discounts for eligible patients.
  • Consult your pharmacy for generic alternatives or additional savings initiatives that may apply to your prescription.

 

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.

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.

 

Have questions left?

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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.
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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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