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Does EmblemHealth Cover Lantus

Explore EmblemHealth's Lantus coverage, reasons for denial, how to secure it, costs without insurance, and answers to common questions.
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EmblemHealth Coverage for Lantus

 

  • EmblemHealth generally covers prescriptions for Lantus, depending on the specific plan you are enrolled in. It's part of the formulary, which includes insulin products.

    •  

  • Coverage often requires a valid prescription from a healthcare provider. This prescription must indicate that Lantus is medically necessary for the management of diabetes.

    •  

  • Some plans might require prior authorization. This means your healthcare provider needs to submit documentation justifying the necessity of Lantus.

    •  

  • Cost-sharing measures like co-pays or deductibles may apply. Specific amounts vary depending on the plan type (HMO, PPO, etc.).

    •  

  • EmblemHealth encourages using in-network pharmacies to minimize out-of-pocket costs. Check the provider's network list for participating pharmacies.

 

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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 EmblemHealth

 

Verify Your Plan

 

  • Log into your EmblemHealth member account online or review your policy documents to confirm your plan includes prescription drug coverage.
  • Look for specifics regarding Tier levels, formularies, or preferred drug lists that may impact Lantus coverage.

 

Consult the Formulary

 

  • Access the EmblemHealth formulary list available on the official website or through your member portal.
  • Check if Lantus is listed under covered medications and understand any restrictions or prior authorization requirements.

 

Contact Customer Service

 

  • If Lantus is not explicitly listed, contact EmblemHealth customer service for clarity on potential coverage and alternatives.
  • Inquire whether pre-authorization, step therapy, or special criteria need to be met for Lantus coverage.

 

Meet With Your Doctor

 

  • Discuss your prescription needs with your healthcare provider. Let them know your insurance plan and any related formulary information.
  • Your doctor can provide necessary documentation or adjust prescriptions if required by EmblemHealth's coverage policies.

 

Submit a Prior Authorization Request

 

  • If prior authorization is needed for Lantus, collaborate with your physician to submit this request. Be sure all medical paperwork accompanies your submission.
  • EmblemHealth will review the request and determine eligibility based on medical necessity.

 

Follow Up on the Decision

 

  • Track the status of the prior authorization request through your EmblemHealth account or by contacting customer service.
  • Once a decision has been made, review it to understand any cost-sharing or conditions imposed for Lantus coverage.

 

Explore Appeals Process

 

  • If coverage is denied, familiarize yourself with EmblemHealth's appeals process.
  • Gather additional evidence or statements from your healthcare provider supporting your need for Lantus and proceed with the appeal.

 

Consider Alternative Options

 

  • If Lantus remains uncovered, discuss generic options or alternative medications with your doctor that might be favored by EmblemHealth's formulary.
  • Research available patient assistance programs through Lantus or third-party organizations for further support.

 

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FAQs

Does EmblemHealth Cover Lantus

Explore EmblemHealth's Lantus coverage, reasons for denial, how to secure it, costs without insurance, and answers to common questions.
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Is Lantus Covered by EmblemHealth

 

EmblemHealth Coverage for Lantus

 

  • EmblemHealth generally covers prescriptions for Lantus, depending on the specific plan you are enrolled in. It's part of the formulary, which includes insulin products.

    •  

  • Coverage often requires a valid prescription from a healthcare provider. This prescription must indicate that Lantus is medically necessary for the management of diabetes.

    •  

  • Some plans might require prior authorization. This means your healthcare provider needs to submit documentation justifying the necessity of Lantus.

    •  

  • Cost-sharing measures like co-pays or deductibles may apply. Specific amounts vary depending on the plan type (HMO, PPO, etc.).

    •  

  • EmblemHealth encourages using in-network pharmacies to minimize out-of-pocket costs. Check the provider's network list for participating pharmacies.

 

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EmblemHealth's Approved Criteria for Lantus Coverage

 

Criteria for Lantus Coverage under EmblemHealth

 

  • **Diagnosis and Indication:** Member must have a diagnosis of diabetes mellitus, which can include both Type 1 or Type 2 diabetes, as documented by a healthcare provider.

    •  

  • **Age Requirement:** Coverage is typically approved for members of all ages, including pediatric patients, who have been diagnosed with diabetes mellitus requiring insulin.

    •  

  • **Treatment Necessity:** Member must demonstrate a medical necessity for long-acting insulin therapy as part of their diabetes management plan, as determined by a healthcare provider.

    •  

  • **Prescribing Provider:** The prescription for Lantus must be written by an endocrinologist, diabetologist, or a licensed healthcare provider specializing in diabetes care.

    •  

  • **Previous Treatments:** Member may need to demonstrate that they have tried and failed, or cannot tolerate, one or more previous insulin therapies or have a documented clinical reason for not using other therapies.

    •  

  • **Dosage and Administration:** The prescribed dosage and frequency must follow the FDA-approved labeling, and the treatment plan should be consistent with current medical standards for insulin therapy in diabetes management.

    •  

  • **Documentation Required:** Providers must submit supporting documentation, such as medical records, progress notes, and lab results, to substantiate the diagnosis and necessity for Lantus insulin therapy.

    •  

  • **Prior Authorization:** Coverage for Lantus typically requires prior authorization to ensure all criteria are met and to confirm the medical necessity and appropriateness of therapy.

    •  

  • **Continued Coverage:** Ongoing coverage approvals may necessitate periodic re-evaluation to confirm continued medical necessity, effective response to therapy, and adherence to treatment.

 

Why EmblemHealth Might Deny Lantus Coverage

 

Situations When EmblemHealth Does Not Cover Lantus

 

  • Lantus is considered a non-formulary medication, meaning it is not on the list of approved prescription medications covered by EmblemHealth.

    •  

  • The patient does not meet the medical necessity criteria as defined by EmblemHealth's guidelines. For instance, if Lantus is not deemed necessary for the patient's specific medical condition.

    •  

  • A less expensive, therapeutically equivalent alternative is available and has not been tried or ruled out as ineffective for the patient.

    •  

  • Lantus is prescribed for an off-label use that EmblemHealth does not approve or for treating a condition not recognized by the FDA.

    •  

  • Prescription requests for quantities exceeding the limits set by EmblemHealth's policy without proper justification or prior authorization.

    •  

  • The prescriber is not within the EmblemHealth network or lacks the appropriate credentials as recognized by EmblemHealth's requirements.

    •  

  • Failure to provide requisite documentation for prior authorization demonstrating the need for Lantus as opposed to other formulary alternatives.

    •  

  • Refusal or inability to comply with EmblemHealth's step therapy protocols, which may require trying other medications before Lantus is approved.

 

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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 EmblemHealth

 

Verify Your Plan

 

  • Log into your EmblemHealth member account online or review your policy documents to confirm your plan includes prescription drug coverage.
  • Look for specifics regarding Tier levels, formularies, or preferred drug lists that may impact Lantus coverage.

 

Consult the Formulary

 

  • Access the EmblemHealth formulary list available on the official website or through your member portal.
  • Check if Lantus is listed under covered medications and understand any restrictions or prior authorization requirements.

 

Contact Customer Service

 

  • If Lantus is not explicitly listed, contact EmblemHealth customer service for clarity on potential coverage and alternatives.
  • Inquire whether pre-authorization, step therapy, or special criteria need to be met for Lantus coverage.

 

Meet With Your Doctor

 

  • Discuss your prescription needs with your healthcare provider. Let them know your insurance plan and any related formulary information.
  • Your doctor can provide necessary documentation or adjust prescriptions if required by EmblemHealth's coverage policies.

 

Submit a Prior Authorization Request

 

  • If prior authorization is needed for Lantus, collaborate with your physician to submit this request. Be sure all medical paperwork accompanies your submission.
  • EmblemHealth will review the request and determine eligibility based on medical necessity.

 

Follow Up on the Decision

 

  • Track the status of the prior authorization request through your EmblemHealth account or by contacting customer service.
  • Once a decision has been made, review it to understand any cost-sharing or conditions imposed for Lantus coverage.

 

Explore Appeals Process

 

  • If coverage is denied, familiarize yourself with EmblemHealth's appeals process.
  • Gather additional evidence or statements from your healthcare provider supporting your need for Lantus and proceed with the appeal.

 

Consider Alternative Options

 

  • If Lantus remains uncovered, discuss generic options or alternative medications with your doctor that might be favored by EmblemHealth's formulary.
  • Research available patient assistance programs through Lantus or third-party organizations for further support.

 

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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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