Does Christiana Care Health System Cover Prolia

Explore Prolia coverage with Christiana Care Health System, reasons for denial, ways to secure it, costs without insurance, and more in our informative article.
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Coverage for Prolia with Christiana Care Health System

 

  • Prolia is covered under Christiana Care Health System for patients diagnosed with osteoporosis or other conditions that warrant bone strengthening treatment.
  •  

  • Coverage typically requires a physician's prescription and a demonstration of medical necessity, often substantiated by a bone density test or related diagnostics.
  •  

  • Patients may need to have previously tried and found insufficient results with other treatments before Prolia is considered for coverage.
  •  

  • Christiana Care Health System may also require pre-authorization to confirm eligibility for Prolia, ensuring the treatment complies with their specific guidelines.
  •  

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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 Prolia Coverage with Christiana Care Health System

 

Contact Christiana Care Health System

 

  • Reach out to Christiana Care Health System's customer service to inquire about coverage for Prolia. You can contact them through their official website or helpline numbers.
  •  

  • Make an appointment with a healthcare provider within Christiana Care to discuss your need for Prolia and determine if it's right for you.

 

Verify Your Insurance Plan

 

  • Check your health insurance policy to see if Prolia is covered. Look into your Summary of Benefits and Coverage (SBC) document specifically for prescription coverage.
  •  

  • Contact your health insurance provider directly to get confirmation about Prolia coverage under your plan. Ensure to ask about any pre-authorization requirements.

 

Gather Necessary Documentation

 

  • Collect any medical records, prescriptions, and doctor’s notes supporting the medical necessity of Prolia. This will be useful in advocating for coverage.
  •  

  • Prepare personal identification and insurance documents as these will be required during any insurance processing by Christiana Care.

 

Meet with a Christiana Care Specialist

 

  • Schedule a meeting with a specialist at Christiana Care who can prescribe Prolia and provide medical justification for insurance purposes.
  •  

  • Ensure that your specialist will communicate with your insurance company to expedite the approval process if necessary.

 

Submit a Prior Authorization Request

 

  • If required, have your healthcare provider submit a prior authorization request to the insurance company. This process is necessary for approval before starting the medication.
  •  

  • Stay in contact with Christiana Care and your insurance company to monitor the progress of your authorization request. Be proactive in providing any additional information they may need.

 

Navigate Appeals Process (If Necessary)

 

  • If your initial request is denied, contact the insurance company’s appeals department immediately. Be prepared to provide additional documentation to support your case.
  •  

  • Utilize Christiana Care’s patient services to help you understand the appeals process and provide assistance with resubmitting claims if needed.

 

Confirm Coverage and Schedule Treatment

 

  • Once you receive approval, verify the extent of Prolia coverage, including copays or any costs that will be your responsibility.
  •  

  • Schedule your Prolia treatment with Christiana Care. Ensure all appointments and administration details are confirmed as per their protocol.

 

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Does Christiana Care Health System Cover Prolia

Explore Prolia coverage with Christiana Care Health System, reasons for denial, ways to secure it, costs without insurance, and more in our informative article.
Curex allergy drops unboxing

Is Prolia Covered by Christiana Care Health System

 

Coverage for Prolia with Christiana Care Health System

 

  • Prolia is covered under Christiana Care Health System for patients diagnosed with osteoporosis or other conditions that warrant bone strengthening treatment.
  •  

  • Coverage typically requires a physician's prescription and a demonstration of medical necessity, often substantiated by a bone density test or related diagnostics.
  •  

  • Patients may need to have previously tried and found insufficient results with other treatments before Prolia is considered for coverage.
  •  

  • Christiana Care Health System may also require pre-authorization to confirm eligibility for Prolia, ensuring the treatment complies with their specific guidelines.
  •  

A weight management program tailored to you

Start with Curex

Christiana Care Health System's Approved Criteria for Prolia Coverage

 

Prolia Coverage Criteria at Christiana Care Health System

 

  • Patients must be diagnosed with a condition that results in high risk for fractures due to decreased bone density.
  •  

  • Prolia is covered for postmenopausal women with osteoporosis who have a history of osteoporotic fracture, or multiple risk factors for fracture, or who have failed or have contraindications to other osteoporosis therapies.
  •  

  • Coverage is available for men with osteoporosis who either have a history of osteoporotic fracture or have multiple risk factors for fractures.
  •  

  • Patients with bone loss associated with hormone ablation therapy for breast or prostate cancer may be eligible for Prolia coverage.
  •  

  • Prolia is approved when documented clinical factors suggest high fracture risk, and the patient has contraindications or has had an inadequate response to other osteoporosis therapy options.
  •  

  • Documentation may be required to show previous treatments and responses, providing evidence that Prolia is a suitable option.
  •  

  • Certain laboratory tests results demonstrating compromised bone density might be required to support Prolia coverage claims.

 

Why Christiana Care Health System Might Deny Prolia Coverage

 

Situations Where Christiana Care Health System Might Deny Prolia Coverage

 

  • Patient does not meet the clinical criteria established for Prolia use, such as specific bone density thresholds that are not satisfied.
  •  

  • Treatment with Prolia is considered not medically necessary for the individual according to their diagnosis and medical history.
  •  

  • The healthcare provider managing the patient's case is not within the Christiana Care Health System's approved network of prescribers for Prolia.
  •  

  • Patient has an alternative, less costly treatment option available that is equally effective for their medical condition.
  •  

  • There is insufficient documentation to support the medical necessity or effectiveness of Prolia for the patient's specific condition.
  •  

  • Patient has not completed necessary prerequisite therapies or steps before attempting Prolia, as specified in the health system's guidelines.
  •  

  • Coverage is denied if Prolia is being prescribed for an off-label use that is not supported by evidence accepted by the healthcare system.

 

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

How Much Does Prolia Cost without Insurance?

 

Prolia Cost Without Insurance

 

  • Prolia (denosumab) is a prescription medication primarily used to treat osteoporosis in postmenopausal women and men at high risk of fractures. Without insurance, the cost of Prolia can be significant.
  •  

  • The approximate cost for a single 60mg/ml injection of Prolia is around $1,500 to $2,000. This price may vary based on location, pharmacy pricing, and additional dispensing fees.
  •  

  • It's important to note that prices can fluctuate and might be subject to discounts or coupons offered by pharmacies or through the manufacturer's patient assistance programs.
  •  

  • Patients without insurance coverage for Prolia might also consider reaching out to Amgen, the manufacturer, for potential cost-assistance programs or savings options that may be available.
  •  

  • Pharmacies, including major chains and independent stores, may offer price matching or competitive pricing, so it's advisable to compare prices across different providers.

 

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 Prolia Coverage with Christiana Care Health System

 

Contact Christiana Care Health System

 

  • Reach out to Christiana Care Health System's customer service to inquire about coverage for Prolia. You can contact them through their official website or helpline numbers.
  •  

  • Make an appointment with a healthcare provider within Christiana Care to discuss your need for Prolia and determine if it's right for you.

 

Verify Your Insurance Plan

 

  • Check your health insurance policy to see if Prolia is covered. Look into your Summary of Benefits and Coverage (SBC) document specifically for prescription coverage.
  •  

  • Contact your health insurance provider directly to get confirmation about Prolia coverage under your plan. Ensure to ask about any pre-authorization requirements.

 

Gather Necessary Documentation

 

  • Collect any medical records, prescriptions, and doctor’s notes supporting the medical necessity of Prolia. This will be useful in advocating for coverage.
  •  

  • Prepare personal identification and insurance documents as these will be required during any insurance processing by Christiana Care.

 

Meet with a Christiana Care Specialist

 

  • Schedule a meeting with a specialist at Christiana Care who can prescribe Prolia and provide medical justification for insurance purposes.
  •  

  • Ensure that your specialist will communicate with your insurance company to expedite the approval process if necessary.

 

Submit a Prior Authorization Request

 

  • If required, have your healthcare provider submit a prior authorization request to the insurance company. This process is necessary for approval before starting the medication.
  •  

  • Stay in contact with Christiana Care and your insurance company to monitor the progress of your authorization request. Be proactive in providing any additional information they may need.

 

Navigate Appeals Process (If Necessary)

 

  • If your initial request is denied, contact the insurance company’s appeals department immediately. Be prepared to provide additional documentation to support your case.
  •  

  • Utilize Christiana Care’s patient services to help you understand the appeals process and provide assistance with resubmitting claims if needed.

 

Confirm Coverage and Schedule Treatment

 

  • Once you receive approval, verify the extent of Prolia coverage, including copays or any costs that will be your responsibility.
  •  

  • Schedule your Prolia treatment with Christiana Care. Ensure all appointments and administration details are confirmed as per their protocol.

 

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.

Prolia FAQ

What are the side effects of Prolia?

 

Common Side Effects of Prolia

 

  • Back pain
  • Muscle pain
  • Joint pain
  • Increased cholesterol levels
  • Bladder infection

 

Serious Side Effects

 

  • Serious allergic reactions: Difficulty breathing and rash
  • Severe bone/joint/muscle pain
  • Low blood calcium levels
  • Jawbone problems (osteonecrosis) 
  • Unusual thigh bone fractures

 

Important Notes

 

  • Always report any unusual symptoms to your healthcare provider.
  • Maintain regular follow-up appointments to monitor your health.
  • This is not an exhaustive list; consult your doctor or pharmacist for more information.

 

How long does Prolia stay in your system?

 

How Long Does Prolia Stay in Your System

 

  • Prolia, or denosumab, is a medication used for osteoporosis treatment. After administration, its active effects last around 6 months, which is why it's typically given bi-annually.
  •  

  • The drug's elimination from the body may take longer due to its biological nature and mechanism. Prolia is a monoclonal antibody and is mainly cleared through the reticuloendothelial system, involving processes like protein degradation.
  •  

  • An important factor is the half-life of Prolia, which averages 25 to 28 days. Complete clearance from the system can vary, potentially extending up to 9 months after the last dose.
  •  

  • Individual factors, such as metabolic rate and kidney function, can affect the duration Prolia remains detectable in the body. Consultation with a healthcare professional is advised to understand its impact on specific health concerns.

 

Is Prolia the same as Reclast?

 

Comparison of Prolia and Reclast

 

  • Prolia: A brand name for denosumab, Prolia is an injectable biophosphonate used to treat osteoporosis by inhibiting bone resorption. It's administered every 6 months as a subcutaneous injection.
  •  

  • Reclast: Known as zoledronic acid, Reclast is also a biophosphonate but given as an intravenous infusion. It works similarly by decreasing bone loss and is typically administered once a year.
  •  

  • Mechanism: While both drugs target bone resorption, Prolia and Reclast function differently at a cellular level. Prolia inhibits RANK ligand, while Reclast inhibits osteoclast activity.
  •  

  • Side Effects: Both medications may cause nausea, fatigue, and joint pain. However, Prolia can also lead to hypocalcemia, while Reclast may cause flu-like symptoms post-infusion.
  •  

 

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“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.

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Everything you need is included:

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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 Christiana Care Health System Cover Prolia

Explore Prolia coverage with Christiana Care Health System, reasons for denial, ways to secure it, costs without insurance, and more in our informative article.
Curex allergy drops unboxing

Does Christiana Care Health System Cover Prolia

 

Coverage for Prolia with Christiana Care Health System

 

  • Prolia is covered under Christiana Care Health System for patients diagnosed with osteoporosis or other conditions that warrant bone strengthening treatment.
  •  

  • Coverage typically requires a physician's prescription and a demonstration of medical necessity, often substantiated by a bone density test or related diagnostics.
  •  

  • Patients may need to have previously tried and found insufficient results with other treatments before Prolia is considered for coverage.
  •  

  • Christiana Care Health System may also require pre-authorization to confirm eligibility for Prolia, ensuring the treatment complies with their specific guidelines.
  •  

A weight management program tailored to you

Start with Curex

Why Christiana Care Health System Might Deny Prolia Coverage

 

Prolia Coverage Criteria at Christiana Care Health System

 

  • Patients must be diagnosed with a condition that results in high risk for fractures due to decreased bone density.
  •  

  • Prolia is covered for postmenopausal women with osteoporosis who have a history of osteoporotic fracture, or multiple risk factors for fracture, or who have failed or have contraindications to other osteoporosis therapies.
  •  

  • Coverage is available for men with osteoporosis who either have a history of osteoporotic fracture or have multiple risk factors for fractures.
  •  

  • Patients with bone loss associated with hormone ablation therapy for breast or prostate cancer may be eligible for Prolia coverage.
  •  

  • Prolia is approved when documented clinical factors suggest high fracture risk, and the patient has contraindications or has had an inadequate response to other osteoporosis therapy options.
  •  

  • Documentation may be required to show previous treatments and responses, providing evidence that Prolia is a suitable option.
  •  

  • Certain laboratory tests results demonstrating compromised bone density might be required to support Prolia coverage claims.

 

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

Prolia FAQ

 

Situations Where Christiana Care Health System Might Deny Prolia Coverage

 

  • Patient does not meet the clinical criteria established for Prolia use, such as specific bone density thresholds that are not satisfied.
  •  

  • Treatment with Prolia is considered not medically necessary for the individual according to their diagnosis and medical history.
  •  

  • The healthcare provider managing the patient's case is not within the Christiana Care Health System's approved network of prescribers for Prolia.
  •  

  • Patient has an alternative, less costly treatment option available that is equally effective for their medical condition.
  •  

  • There is insufficient documentation to support the medical necessity or effectiveness of Prolia for the patient's specific condition.
  •  

  • Patient has not completed necessary prerequisite therapies or steps before attempting Prolia, as specified in the health system's guidelines.
  •  

  • Coverage is denied if Prolia is being prescribed for an off-label use that is not supported by evidence accepted by the healthcare system.

 

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 Prolia Cost without Insurance?

 

Prolia Cost Without Insurance

 

  • Prolia (denosumab) is a prescription medication primarily used to treat osteoporosis in postmenopausal women and men at high risk of fractures. Without insurance, the cost of Prolia can be significant.
  •  

  • The approximate cost for a single 60mg/ml injection of Prolia is around $1,500 to $2,000. This price may vary based on location, pharmacy pricing, and additional dispensing fees.
  •  

  • It's important to note that prices can fluctuate and might be subject to discounts or coupons offered by pharmacies or through the manufacturer's patient assistance programs.
  •  

  • Patients without insurance coverage for Prolia might also consider reaching out to Amgen, the manufacturer, for potential cost-assistance programs or savings options that may be available.
  •  

  • Pharmacies, including major chains and independent stores, may offer price matching or competitive pricing, so it's advisable to compare prices across different providers.

 

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.