Does Fallon Community Health Plan (FCHP) Cover Victoza

Explore Victoza coverage by Fallon Community Health Plan, reasons for denial, ways to secure it, costs without insurance, and FAQs.
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Coverage for Victoza Under FCHP

 

  • Victoza, used to treat type 2 diabetes, might be covered under Fallon Community Health Plan, although specific coverage details can vary depending on the particular plan.
  •  

  • Prior authorization is usually required. Patients must demonstrate medical necessity as per FCHP guidelines, which typically involves proof of inadequacy of other diabetes medications.
  •  

  • Patients should consult their healthcare provider to confirm eligibility and application of FCHP medical policy criteria for Victoza coverage.
  •  

  • FCHP members should check with customer service or their pharmacy benefit manager to understand the specifics of their plan regarding Victoza.

 

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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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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 Victoza Coverage with Fallon Community Health Plan (FCHP)

 

Verify Coverage Options

 

  • Contact Fallon Community Health Plan to confirm if Victoza is included in your current policy. You can call their customer service or check the benefits section on their official website.
  •  

  • Review the prescription drug coverage details in your plan's documentation or online portal to ensure Victoza is listed as a covered medication.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of Victoza for your treatment plan to ensure they support your coverage request.
  •  

  • Request a written prescription for Victoza from your healthcare provider to submit to FCHP.

 

Prior Authorization Process

 

  • Find out if Victoza requires prior authorization under your FCHP plan. This information may be available in the plan's formulary or by directly asking an FCHP representative.
  •  

  • If required, have your healthcare provider complete and submit a prior authorization form to FCHP. This typically includes medical justification for the prescription.

 

Submit a Coverage Request

 

  • Download or obtain the necessary forms from the FCHP website or customer service for requesting coverage of a non-standard medication.
  •  

  • Complete the required forms, ensuring all personal, plan, and medication information is accurate and up-to-date.

 

Appeal a Denial

 

  • If FCHP denies your initial request, research their appeals process. Information about appealing a decision should be included in the denial letter or on their website.
  •  

  • Gather any additional documentation or support from your healthcare provider that strengthens the necessity for Victoza in your treatment.
  •  

  • Submit a formal appeal, including all necessary documentation, and follow up regularly to ensure the appeal is processed in a timely manner.

 

Pharmacy Coordination

 

  • Once coverage is approved, coordinate with your pharmacy to ensure they have the necessary information from FCHP to fill your Victoza prescription at the covered rate.
  •  

  • Stay in communication with both FCHP and your pharmacy to address any issues or delays in obtaining your medication.

 

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FAQs

Does Fallon Community Health Plan (FCHP) Cover Victoza

Explore Victoza coverage by Fallon Community Health Plan, reasons for denial, ways to secure it, costs without insurance, and FAQs.
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Is Victoza Covered by Fallon Community Health Plan (FCHP)

 

Coverage for Victoza Under FCHP

 

  • Victoza, used to treat type 2 diabetes, might be covered under Fallon Community Health Plan, although specific coverage details can vary depending on the particular plan.
  •  

  • Prior authorization is usually required. Patients must demonstrate medical necessity as per FCHP guidelines, which typically involves proof of inadequacy of other diabetes medications.
  •  

  • Patients should consult their healthcare provider to confirm eligibility and application of FCHP medical policy criteria for Victoza coverage.
  •  

  • FCHP members should check with customer service or their pharmacy benefit manager to understand the specifics of their plan regarding Victoza.

 

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

 

Eligibility for Victoza Coverage

 

  • Member has a confirmed diagnosis of Type 2 diabetes mellitus.
  •  

  • Victoza is prescribed for the purpose of improving glycemic control in conjunction with diet and exercise.
  •  

  • Prescribed by a healthcare provider specializing in endocrinology or diabetes management.

 

Prior Therapy Requirements

 

  • The member has trialed and failed, or has a contraindication or intolerance to at least one oral antidiabetic medication (e.g., metformin, sulfonylureas, DPP-4 inhibitors).
  •  

  • Continued use of Victoza is expected to be beneficial in achieving targeted HbA1c levels as documented in medical records.

 

Patient Monitoring and Follow-up

 

  • Evidence of regular follow-up appointments with a healthcare provider to monitor glucose levels and overall health status.
  •  

  • Submission of updated medical documentation showing the effectiveness of Victoza treatment, including progress in glycemic control and achievement of therapeutic goals.

 

Age and Dosing Considerations

 

  • Victoza coverage is available for members who are 18 years of age and older.
  •  

  • Prescriptions must align with the FDA-approved dosing recommendations for Victoza, typically starting at 0.6 mg per day for one week, escalating to 1.2 mg per day, and potentially increased to a maximum of 1.8 mg per day as tolerated.

 

Additional Coverage Criteria

 

  • Member must not be currently using another glucagon-like peptide-1 receptor agonist concomitantly with Victoza.
  •  

  • Documentation of lifestyle changes, including dietary adjustments and exercise regimens, supporting the treatment plan with Victoza.

 

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

 

Reasons for Denial of Victoza Coverage by FCHP

 

  • Victoza is prescribed for off-label uses that are not approved by the FDA.
  •  

  • The patient does not meet the specific clinical criteria set by FCHP, which may include particular health conditions or a preferred list of treatments to try before Victoza.
  •  

  • The patient has not participated in mandatory step therapy, attempting first-line treatments as required by FCHP guidelines.
  •  

  • There is an absence of necessary documentation from the healthcare provider supporting the medical necessity for Victoza.
  •  

  • The prescription is outside of FCHP's formulary, which lists the covered medications and their approved conditions for use.
  •  

  • The quantity or dosage prescribed does not align with FCHP’s limits for Victoza, which might require prior authorization for different amounts.
  •  

 

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How Much Does Victoza Cost without Insurance?

 

Understanding Victoza Costs Without Insurance

 

  • The cost of Victoza without insurance can vary depending on the pharmacy and location, but typically it ranges from $900 to $1,200 for a 30-day supply.
  •  

  • Prices can fluctuate slightly due to different pharmacy pricing policies, geographic location, and available discounts or membership programs.
  •  

  • It's advisable to check with multiple pharmacies for the most accurate and competitive pricing if paying out-of-pocket.
  •  

  • Some pharmacies or pharmaceutical discount programs might offer lower prices or savings cards, so it could be beneficial to explore these options.

 

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 Victoza Coverage with Fallon Community Health Plan (FCHP)

 

Verify Coverage Options

 

  • Contact Fallon Community Health Plan to confirm if Victoza is included in your current policy. You can call their customer service or check the benefits section on their official website.
  •  

  • Review the prescription drug coverage details in your plan's documentation or online portal to ensure Victoza is listed as a covered medication.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of Victoza for your treatment plan to ensure they support your coverage request.
  •  

  • Request a written prescription for Victoza from your healthcare provider to submit to FCHP.

 

Prior Authorization Process

 

  • Find out if Victoza requires prior authorization under your FCHP plan. This information may be available in the plan's formulary or by directly asking an FCHP representative.
  •  

  • If required, have your healthcare provider complete and submit a prior authorization form to FCHP. This typically includes medical justification for the prescription.

 

Submit a Coverage Request

 

  • Download or obtain the necessary forms from the FCHP website or customer service for requesting coverage of a non-standard medication.
  •  

  • Complete the required forms, ensuring all personal, plan, and medication information is accurate and up-to-date.

 

Appeal a Denial

 

  • If FCHP denies your initial request, research their appeals process. Information about appealing a decision should be included in the denial letter or on their website.
  •  

  • Gather any additional documentation or support from your healthcare provider that strengthens the necessity for Victoza in your treatment.
  •  

  • Submit a formal appeal, including all necessary documentation, and follow up regularly to ensure the appeal is processed in a timely manner.

 

Pharmacy Coordination

 

  • Once coverage is approved, coordinate with your pharmacy to ensure they have the necessary information from FCHP to fill your Victoza prescription at the covered rate.
  •  

  • Stay in communication with both FCHP and your pharmacy to address any issues or delays in obtaining your medication.

 

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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.

Victoza FAQ

What are the common side effects of Victoza?

 

Common Side Effects of Victoza

 

  • Gastrointestinal Issues: Nausea, vomiting, diarrhea, and constipation are frequent side effects, typically subsiding after a few weeks.
  •  

  • Headaches: Some individuals may experience mild to moderate headaches.
  •  

  • Fatigue: Feeling tired or weak can occur, especially during initial treatment.
  •  

  • Hypoglycemia: Though rarer, low blood sugar may happen, particularly if combined with other diabetes medications.
  •  

  • Injection Site Reactions: Redness, itching, or swelling at the site of injection can arise.

 

Note

 

  • Consult your healthcare provider if side effects persist or worsen.

 

How does Victoza help with weight loss?

 

How Victoza Assists in Weight Reduction

 

  • Appetite Suppression: Victoza (liraglutide), a GLP-1 receptor agonist, influences brain regions that regulate appetite, reducing hunger and food intake.
  •  

  • Delayed Gastric Emptying: It slows stomach emptying, contributing to prolonged feelings of fullness after meals, which helps reduce calorie consumption.
  •  

  • Improved Insulin Sensitivity: Enhances insulin efficiency, promoting better glucose utilization and reduced fat storage, supporting weight loss.
  •  

  • Fat Metabolism: Encourages the breakdown of stored fat for energy usage, facilitating gradual weight reduction.

 

Can Victoza be used for type 1 diabetes?

 

Can Victoza Be Used for Type 1 Diabetes?

 

  • Victoza (liraglutide) is primarily prescribed for Type 2 diabetes management. It works by stimulating insulin secretion and delaying gastric emptying.
  •  

  • For Type 1 diabetes, the body doesn't produce insulin, making Victoza ineffective as a sole treatment. Patients require insulin replacement therapy.
  •  

  • Some studies explore adjunctive use of GLP-1 receptor agonists like Victoza to improve glycemic control and reduce insulin doses in Type 1, but it's not standard.

 

Recommendation

 

  • Consult a healthcare provider before considering Victoza for Type 1 diabetes, focusing on its potential benefits and risks within individual treatment plans.

 

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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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