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Does Fallon Community Health Plan (FCHP) Cover Lantus

Explore FCHP's Lantus coverage policies, costs, and how to secure approval in our comprehensive guide.
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Does Fallon Community Health Plan (FCHP) Cover Lantus?

 

  • FCHP generally covers Lantus, subject to prior authorization requirements. It's important to review your specific plan details to confirm coverage.

    •  

  • Coverage typically includes situations where Lantus is deemed medically necessary for managing diabetes, as prescribed by a healthcare provider.

    •  

  • The patient must usually meet certain criteria, such as having a diagnosis of diabetes and needing basal insulin therapy, to get coverage approval.

    •  

  • Prior authorization generally requires documentation from your healthcare provider proving the necessity of Lantus as part of your treatment plan.

    •  

  • Specific rules and criteria might vary, so consulting the FCHP formulary or contacting customer service directly can provide precise information.

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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 Fallon Community Health Plan (FCHP)

 

Verify Your Plan Benefits

 

  • Contact Fallon Community Health Plan (FCHP) Customer Service to confirm your specific plan details and whether Lantus is covered. Use the customer service number on your insurance card or the FCHP website.

    •  

  • Review your policy's drug formulary online or request a hard copy. Lantus may be listed under insulin or diabetes medications.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your prescription for Lantus. Ensure they understand your insurance coverage needs.

    •  

  • Ask your healthcare provider to provide any necessary documentation or justification required by FCHP to support the medical necessity of Lantus.

 

Prescription Verification

 

  • Ask your pharmacist to verify if Lantus is covered under your current FCHP plan when they fill the prescription.

    •  

  • Inquire whether there are any alternative insulins that are preferred by FCHP that could potentially offer easier coverage or lower co-pays.

 

Preauthorization and Prior Approval

 

  • Request your healthcare provider's office to submit a preauthorization request if FCHP requires one for Lantus coverage. This is often necessary to confirm that Lantus is medically necessary.

    •  

  • Follow up with FCHP or your provider's office to ensure that the preauthorization is processed promptly.

 

Appeals Process

 

  • If initial coverage is denied, promptly file an appeal with FCHP. Check their website or contact customer service for specific guidelines on the appeals process.

    •  

  • Work closely with your healthcare provider to gather any supporting documents or letters needed for a successful appeal.

 

Explore Financial Assistance

 

  • Research additional assistance programs such as manufacturer's savings cards or patient assistance programs for Lantus if you encounter high out-of-pocket costs.

    •  

  • Consult with your healthcare provider or pharmacist for additional resources or options available to reduce your medication costs.

 

Regularly Review Policy Updates

 

  • Stay informed about any changes to your FCHP coverage or formulary updates that could impact your Lantus coverage through regular review of policy updates from FCHP.

    •  

  • Update any necessary paperwork with your healthcare provider and FCHP annually to ensure continuous coverage of your prescription.

 

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FAQs

Does Fallon Community Health Plan (FCHP) Cover Lantus

Explore FCHP's Lantus coverage policies, costs, and how to secure approval in our comprehensive guide.
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Is Lantus Covered by Fallon Community Health Plan (FCHP)

 

Does Fallon Community Health Plan (FCHP) Cover Lantus?

 

  • FCHP generally covers Lantus, subject to prior authorization requirements. It's important to review your specific plan details to confirm coverage.

    •  

  • Coverage typically includes situations where Lantus is deemed medically necessary for managing diabetes, as prescribed by a healthcare provider.

    •  

  • The patient must usually meet certain criteria, such as having a diagnosis of diabetes and needing basal insulin therapy, to get coverage approval.

    •  

  • Prior authorization generally requires documentation from your healthcare provider proving the necessity of Lantus as part of your treatment plan.

    •  

  • Specific rules and criteria might vary, so consulting the FCHP formulary or contacting customer service directly can provide precise information.

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Fallon Community Health Plan (FCHP)'s Approved Criteria for Lantus Coverage

 

Approved Criteria for Lantus Coverage by Fallon Community Health Plan (FCHP)

 

  • **Diagnosis Requirement**: The patient must have a diagnosis of diabetes mellitus, which necessitates long-acting insulin therapy. This includes both Type 1 and Type 2 diabetes.

    •  

  • **Age Criteria**: FCHP covers Lantus for individuals of all ages, provided they meet the clinical criteria for diabetes management.

    •  

  • **Previous Treatment**: The patient should have tried and had an inadequate response or intolerance to other forms of insulin therapy or diabetes medications, unless otherwise contraindicated or clinically inappropriate.

    •  

  • **Physician Prescription**: Coverage requires a prescription and medical rationale from a licensed healthcare provider specializing in diabetes management, such as an endocrinologist or primary care physician with expertise in treating diabetes.

    •  

  • **Individualized Treatment Plan**: The prescription must be part of a comprehensive and individualized treatment plan that addresses dietary, lifestyle, and pharmacological needs specific to the patient's diabetic condition.

    •  

  • **Monitoring and Documentation**: Regular monitoring of blood glucose levels and documentation of Lantus' effectiveness and necessity in managing diabetes is required for continued coverage. This includes HbA1c test results to demonstrate control of blood sugar levels.

    •  

  • **Insurance Verification and Prior Authorization**: FCHP requires verification of insurance and may necessitate prior authorization, ensuring that all the above criteria are met before Lantus is approved for coverage.

Why Fallon Community Health Plan (FCHP) Might Deny Lantus Coverage

 

Reasons for Denial of Lantus Coverage by Fallon Community Health Plan (FCHP)

 

  • **Formulary Exclusion**: FCHP may not cover Lantus if it is not included in the plan's formulary, which is a list of prescription drugs approved for coverage.

    •  

  • **Lack of Medical Necessity**: Coverage for Lantus may be denied if the prescribing doctor has not sufficiently documented the medical necessity for using Lantus over other insulin options.

    •  

  • **Non-Compliance with Prior Authorization**: If prior authorization is required and not obtained before the prescription is filled, coverage for Lantus can be denied.

    •  

  • **Step Therapy Requirement**: FCHP might deny Lantus if the step therapy process has not been followed, such as trying and failing with alternative medications before approving Lantus.

    •  

  • **Out-of-Network Pharmacy**: Coverage might not be provided if Lantus is purchased from a pharmacy that is not within FCHP's network unless explicitly stated otherwise.

    •  

  • **Age Restrictions**: There may be specific age-related criteria impacting the coverage of Lantus, and if the patient does not meet these criteria, denial may occur.

    •  

  • **Quantity Limits**: Exceeding pre-set quantity limits for Lantus, without the appropriate exception granted, can result in coverage denial.

 

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

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

    •  

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

    •  

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

    •  

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

 

Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Lantus Coverage with Fallon Community Health Plan (FCHP)

 

Verify Your Plan Benefits

 

  • Contact Fallon Community Health Plan (FCHP) Customer Service to confirm your specific plan details and whether Lantus is covered. Use the customer service number on your insurance card or the FCHP website.

    •  

  • Review your policy's drug formulary online or request a hard copy. Lantus may be listed under insulin or diabetes medications.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your prescription for Lantus. Ensure they understand your insurance coverage needs.

    •  

  • Ask your healthcare provider to provide any necessary documentation or justification required by FCHP to support the medical necessity of Lantus.

 

Prescription Verification

 

  • Ask your pharmacist to verify if Lantus is covered under your current FCHP plan when they fill the prescription.

    •  

  • Inquire whether there are any alternative insulins that are preferred by FCHP that could potentially offer easier coverage or lower co-pays.

 

Preauthorization and Prior Approval

 

  • Request your healthcare provider's office to submit a preauthorization request if FCHP requires one for Lantus coverage. This is often necessary to confirm that Lantus is medically necessary.

    •  

  • Follow up with FCHP or your provider's office to ensure that the preauthorization is processed promptly.

 

Appeals Process

 

  • If initial coverage is denied, promptly file an appeal with FCHP. Check their website or contact customer service for specific guidelines on the appeals process.

    •  

  • Work closely with your healthcare provider to gather any supporting documents or letters needed for a successful appeal.

 

Explore Financial Assistance

 

  • Research additional assistance programs such as manufacturer's savings cards or patient assistance programs for Lantus if you encounter high out-of-pocket costs.

    •  

  • Consult with your healthcare provider or pharmacist for additional resources or options available to reduce your medication costs.

 

Regularly Review Policy Updates

 

  • Stay informed about any changes to your FCHP coverage or formulary updates that could impact your Lantus coverage through regular review of policy updates from FCHP.

    •  

  • Update any necessary paperwork with your healthcare provider and FCHP annually to ensure continuous coverage of your prescription.

 

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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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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.
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Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

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