Does Christiana Care Health System Cover Trelegy

Explore Trelegy coverage with Christiana Care, understand potential denial reasons, costs without insurance, and FAQs to ensure you get the treatment you need.
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Coverage of Trelegy

 

  • Trelegy is often considered under Christiana Care Health System's prescription drug plan. Coverage depends on the specific health plan and policy terms.

 

 

Scenarios Covered

 

  • COPD Treatment: Trelegy is usually covered for FDA-approved indications like chronic obstructive pulmonary disease (COPD).
  • Asthma Management: Another common scenario includes coverage for asthma patients, subject to prior authorization.

 

 

Eligibility and Criteria

 

  • Physician Prescription: A valid prescription from a healthcare provider within the network is essential.
  • Prior Authorization: Many plans require prior authorization to ensure that Trelegy is medically necessary.
  • Step Therapy: Some plans may require trying other medications first before approving Trelegy.
  • Formulary Inclusion: Check if Trelegy is on the plan's formulary list, which details covered medications.

 

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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.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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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 Christiana Care Health System

 

Initial Consultation with Christiana Care Health System

 

  • Contact the Christiana Care Health System to schedule an appointment with a primary care physician or a pulmonologist, depending on your current health care provider.
  •  

  • Discuss your need for Trelegy with the physician and obtain a prescription if deemed suitable for your condition.

 

Verify Insurance Coverage

 

  • Contact your insurance provider directly or visit their website to verify if Trelegy is included in your current plan's formulary.
  •  

  • Ask specific questions regarding copay amounts, coverage limits, and any prior authorization requirements.

 

Coordinate with the Christiana Care Health System Pharmacy Services

 

  • Engage the pharmacy services team of Christiana Care Health System to assist in determining your eligibility for coverage under your insurance plan.
  •  

  • Provide them with any necessary information, such as insurance details and the Trelegy prescription.

 

Check for Patient Assistance Programs

 

  • Explore Trelegy's official patient assistance programs by visiting their website or inquiring through Christiana Care Health System.
  •  

  • Apply for such programs if you meet the criteria, to help lower the cost not covered by insurance.

 

Obtain Prior Authorization if Required

 

  • If your insurance requires it, work with your healthcare provider to fill out and submit any necessary prior authorization forms to demonstrate medical necessity for Trelegy.
  •  

  • Follow up with the insurance company or your physician’s office regularly to check the status of the authorization.

 

Fill Your Prescription

 

  • Once coverage is confirmed and any prior authorizations are approved, take your prescription to a Christiana Care Health System-affiliated pharmacy.
  •  

  • Ensure the pharmacy processes the prescription using your insurance for the benefits to apply.

 

Continuous Monitoring and Follow-up

 

  • Regularly review your insurance coverage for any changes that might affect your Trelegy coverage.
  •  

  • Schedule follow-up appointments with your healthcare provider to assess the effectiveness of Trelegy for your condition.

 

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FAQs

Does Christiana Care Health System Cover Trelegy

Explore Trelegy coverage with Christiana Care, understand potential denial reasons, costs without insurance, and FAQs to ensure you get the treatment you need.
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Is Trelegy Covered by Christiana Care Health System

 

Coverage of Trelegy

 

  • Trelegy is often considered under Christiana Care Health System's prescription drug plan. Coverage depends on the specific health plan and policy terms.

 

 

Scenarios Covered

 

  • COPD Treatment: Trelegy is usually covered for FDA-approved indications like chronic obstructive pulmonary disease (COPD).
  • Asthma Management: Another common scenario includes coverage for asthma patients, subject to prior authorization.

 

 

Eligibility and Criteria

 

  • Physician Prescription: A valid prescription from a healthcare provider within the network is essential.
  • Prior Authorization: Many plans require prior authorization to ensure that Trelegy is medically necessary.
  • Step Therapy: Some plans may require trying other medications first before approving Trelegy.
  • Formulary Inclusion: Check if Trelegy is on the plan's formulary list, which details covered medications.

 

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Christiana Care Health System's Approved Criteria for Trelegy Coverage

 

Eligibility Criteria for Trelegy Coverage

 

  • Patients must have a confirmed diagnosis of Chronic Obstructive Pulmonary Disease (COPD) or Asthma, as documented by a healthcare professional.
  •  

  • The patient should have shown past treatment failure or had an inadequate response to prior therapies, which may include single or dual inhaled medication regimens.
  •  

  • An explicit prescription from a licensed healthcare provider, indicating the necessity for Trelegy based on symptom severity or frequency of exacerbations, is required.

 

Prior Authorization Requirements

 

  • A completed prior authorization form must be submitted by the prescribing healthcare professional, demonstrating the patient's medical necessity criteria and history of previous treatments.
  •  

  • Documentation that includes spirometry results, specialist consultation notes if applicable, and a detailed medical history should accompany the authorization request.

 

Pharmacist Consultation and Medication Management

 

  • Eligible patients are required to engage in an initial consultation with a pharmacist to discuss medication adherence strategies and address any concerns regarding Trelegy use.
  •  

  • Follow-up evaluations with the pharmacist are encouraged to ensure continued medication effectiveness and assess any adverse reactions or need for adjustments.

 

Continuous Monitoring and Follow-Up

 

  • Coverage is contingent upon regular follow-up appointments with the prescribing healthcare provider to evaluate the patient's response to Trelegy and adjust treatment as necessary.
  •  

  • Documentation of routine monitoring and assessment should be updated in the patient's medical records, including any relevant tests or examinations that support ongoing therapy with Trelegy.

 

Financial Assistance Programs

 

  • Patients who require financial assistance may be eligible for support programs, which must be applied for separately. Verification of income or financial need may be required.
  •  

  • Information about eligible assistance programs should be provided to patients upon approval of Trelegy coverage.

 

Why Christiana Care Health System Might Deny Trelegy Coverage

 

Criteria for Denial of Trelegy Coverage by Christiana Care Health System

 

  • The patient's condition does not meet the severity requirements as defined by the health system's guidelines for Trelegy prescription.
  •  

  • The prescribed use of Trelegy is outside the FDA-approved indications or is considered off-label without sufficient supportive clinical documentation.
  •  

  • The patient has not completed a trial and failure of preferred alternative therapies available within the formulary.
  •  

  • There is a lack of necessary documentation from the healthcare provider to substantiate the medical necessity of Trelegy in the specific case.
  •  

  • The patient does not comply with the required prior authorization process or fails to meet reauthorization criteria.
  •  

  • The patient is not eligible for coverage under the terms and conditions specified in their particular insurance plan offered by Christiana Care Health System.
  •  

  • Trelegy is requested for a condition explicitly excluded under the patient’s specific insurance policy or plan coverage.

 

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How Much Does Trelegy Cost without Insurance?

 

Approximate Cost of Trelegy Without Insurance

 

  • The cost of Trelegy Ellipta, without insurance, can vary significantly based on several factors like the pharmacy, geographical location, or available discounts. On average, patients can expect to pay between $550 to $650 for a 30-day supply.
  •  

  • Prices may also fluctuate depending on ongoing promotions or pharmacy memberships that can provide additional savings.
  •  

  • It’s advisable for patients to use discount cards, check for manufacturer coupons, or explore patient assistance programs to lower the out-of-pocket expense.
  •  

  • Shopping around, comparing prices at different pharmacies, or using online price comparison tools can also result in significant cost savings for Trelegy.

 

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Trelegy Coverage with Christiana Care Health System

 

Initial Consultation with Christiana Care Health System

 

  • Contact the Christiana Care Health System to schedule an appointment with a primary care physician or a pulmonologist, depending on your current health care provider.
  •  

  • Discuss your need for Trelegy with the physician and obtain a prescription if deemed suitable for your condition.

 

Verify Insurance Coverage

 

  • Contact your insurance provider directly or visit their website to verify if Trelegy is included in your current plan's formulary.
  •  

  • Ask specific questions regarding copay amounts, coverage limits, and any prior authorization requirements.

 

Coordinate with the Christiana Care Health System Pharmacy Services

 

  • Engage the pharmacy services team of Christiana Care Health System to assist in determining your eligibility for coverage under your insurance plan.
  •  

  • Provide them with any necessary information, such as insurance details and the Trelegy prescription.

 

Check for Patient Assistance Programs

 

  • Explore Trelegy's official patient assistance programs by visiting their website or inquiring through Christiana Care Health System.
  •  

  • Apply for such programs if you meet the criteria, to help lower the cost not covered by insurance.

 

Obtain Prior Authorization if Required

 

  • If your insurance requires it, work with your healthcare provider to fill out and submit any necessary prior authorization forms to demonstrate medical necessity for Trelegy.
  •  

  • Follow up with the insurance company or your physician’s office regularly to check the status of the authorization.

 

Fill Your Prescription

 

  • Once coverage is confirmed and any prior authorizations are approved, take your prescription to a Christiana Care Health System-affiliated pharmacy.
  •  

  • Ensure the pharmacy processes the prescription using your insurance for the benefits to apply.

 

Continuous Monitoring and Follow-up

 

  • Regularly review your insurance coverage for any changes that might affect your Trelegy coverage.
  •  

  • Schedule follow-up appointments with your healthcare provider to assess the effectiveness of Trelegy for your condition.

 

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Trelegy FAQ

1. What are the side effects of Trelegy?

 

Common Side Effects of Trelegy

 

  • Headaches
  • Back pain
  • Hoarseness
  • Oral thrush

 

Serious Side Effects

 

  • Increased heart rate
  • Chest pain
  • High blood pressure
  • Pneumonia in COPD patients

 

Less Common Side Effects

 

  • Diarrhea
  • Cough
  • Sore throat
  • Gastrointestinal discomfort

 

Precautions

 

  • Monitor for worsening symptoms.
  • Consult a doctor for persistent side effects.

 

2. How does Trelegy compare to Breo?

 

Comparison of Trelegy and Breo

 

  • Trelegy combines three active ingredients: fluticasone furoate (a corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Breo contains only two: fluticasone furoate and vilanterol.
  •  

  • This combination in Trelegy allows for better control of symptoms for COPD patients requiring more comprehensive therapy, whereas Breo is more suitable for those requiring less intensive treatment.
  •  

  • Both medications are administered once daily via inhalation, but Trelegy’s triple therapy provides a broader mechanism of action.
  •  

  • Side effects are generally similar, though patients transitioning from Breo to Trelegy may experience different responses due to the added component.

 

3. Is Trelegy a steroid?

 

Is Trelegy a Steroid?

 

  • Components: Trelegy contains three active ingredients: fluticasone furoate, umeclidinium, and vilanterol. Fluticasone furoate is a corticosteroid.
  •  

  • Steroid Role: The corticosteroid in Trelegy helps reduce inflammation in the airways, which is crucial for treating conditions like COPD and asthma.
  •  

  • Multi-Action: In addition to the steroid, umeclidinium (an anticholinergic) and vilanterol (a long-acting beta-agonist) work to relax and open the airways.
  •  

  • Usage: Trelegy is inhaled, delivering these components directly to the lungs for targeted action, minimizing systemic steroid exposure.

 

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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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