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Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Emgality

Explore Florida Blue's policy on Emgality coverage, possible denial reasons, ways to secure coverage, costs without insurance, and FAQs.

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Coverage for Emgality

Florida Blue (Blue Cross Blue Shield of Florida) may cover Emgality, a medication for migraine prevention, depending on the specific health plan and medical necessity.

Basic Criteria

Prior authorization is often required. Patients must demonstrate a history of trying and failing other migraine treatments before approval.

A diagnosis of chronic or episodic migraines, documented by a healthcare provider, is typically necessary.

Prescription Guidelines

Prescriptions must be filled by in-network pharmacies and adhere to quantity limits as defined by the plan.

Patients should consult their specific plan details and speak with a healthcare provider to confirm coverage and obtain any necessary documentation.

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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 Emgality Coverage with Florida Blue (Blue Cross Blue Shield of Florida)

Check Your Florida Blue Plan Details

Log into your Florida Blue account or review your physical insurance documents to understand what your plan covers.
Check if your current plan includes prescription drug coverage, and identify the specific formulary or list of covered medications.
Note any specifics regarding tier levels, co-payments, or pre-authorization requirements for medications like Emgality.

Consult with Your Healthcare Provider

Discuss with your healthcare provider about your intention to use Emgality for managing your condition.
Ask your provider to prepare any necessary medical documentation or justifications required by Florida Blue for coverage.
Ensure that your provider is aware of Florida Blue's procedures for approving specialty drugs, as this can speed up the process.

Contact Florida Blue Customer Service

Call the customer service number found on your Florida Blue insurance card.
Inquire about the process for getting coverage for Emgality. Confirm if Emgality is covered under your current plan and any prerequisites.
Request information on any specific actions you need to take or documentation you need to provide.

Submit a Coverage Request

Work with your healthcare provider to complete any required forms for Emgality prior authorization or exception request.
Submit the completed forms to Florida Blue via their prescribed method, whether by fax, mail, or online submission through their member portal.
Include all necessary supporting documents, such as medical records, physician recommendations, and treatment history.

Follow Up and Navigate Approval

Regularly follow up with Florida Blue regarding the status of your Emgality coverage request. This helps identify any issues promptly.
Consider asking for your provider's assistance in contacting Florida Blue if there are delays or if additional information is needed.
Be prepared to appeal any denials by providing further justification or documentation to support the need for Emgality.

Utilize Florida Blue Resources

Access Florida Blue's pharmaceutical or member services online which may have additional resources or information regarding your coverage.
Speak with a pharmacist or care manager through any Florida Blue-provided assistance programs for additional guidance.

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Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Emgality

Explore Florida Blue's policy on Emgality coverage, possible denial reasons, ways to secure coverage, costs without insurance, and FAQs.

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Is Emgality Covered by Florida Blue (Blue Cross Blue Shield of Florida)

Coverage for Emgality

Florida Blue (Blue Cross Blue Shield of Florida) may cover Emgality, a medication for migraine prevention, depending on the specific health plan and medical necessity.

Basic Criteria

Prior authorization is often required. Patients must demonstrate a history of trying and failing other migraine treatments before approval.

A diagnosis of chronic or episodic migraines, documented by a healthcare provider, is typically necessary.

Prescription Guidelines

Prescriptions must be filled by in-network pharmacies and adhere to quantity limits as defined by the plan.

Patients should consult their specific plan details and speak with a healthcare provider to confirm coverage and obtain any necessary documentation.

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Florida Blue (Blue Cross Blue Shield of Florida)'s Approved Criteria for Emgality Coverage

Emgality Coverage Criteria Under Florida Blue

Emgality is approved for use in adult patients who have been diagnosed with chronic migraine, occurring 15 or more days per month with at least eight migraine days.

Patients must have trialed and demonstrated inadequate response, contraindication, or intolerance to at least two different classes of preventive migraine medications before being eligible for Emgality coverage.

Emgality can also be prescribed to adult patients with episodic migraine, where the frequency of migraine days is between 4 and 14 days per month.

For cluster headaches, Emgality coverage is provided for adult patients with episodic cluster headaches, defined as at least two cluster headache periods lasting from 7 days up to 1 year, separated by pain-free periods of at least 1 month.

Patients must be evaluated by a neurologist or headache specialist to verify the diagnosis and the necessity of Emgality for their condition.

Continuation criteria require that patients must demonstrate a reduction in the number of migraine days or headache episodes by at least 50% after starting treatment with Emgality to maintain coverage.

Documentation of clinical need and treatment response must be provided for continued approval, as Florida Blue requires periodic assessment to ensure the ongoing effectiveness of the therapy.

Why Florida Blue (Blue Cross Blue Shield of Florida) Might Deny Emgality Coverage

Situations Where Florida Blue Might Deny Emgality Coverage

**Non-FDA Approved Use**: Emgality may be denied if it is prescribed for a condition that is not approved by the Food and Drug Administration (FDA) for this particular medication.

**Lack of Medical Necessity**: Coverage might be denied if Florida Blue determines that the medication is not medically necessary for the patient's condition, according to their specific criteria for necessity.

**Initial Treatment Failure or Inadequate Trial**: If there is insufficient evidence that the patient has tried other first-line treatments or has not completed an adequate trial period with other migraine-preventative medications, the request for Emgality might be denied.

**Quantity Limits Exceeded**: If the prescription exceeds the quantity limits established by the plan, coverage might be declined unless prior authorization for higher amounts is granted.

**Policy Exclusions**: The patient's specific insurance policy might contain exclusions that deny coverage for Emgality, especially if they have selected a plan that does not cover certain specialty drugs.

**Not Meeting Clinical Criteria**: Emgality requests may be denied if the patient does not meet the clinical criteria established by Florida Blue, such as specific diagnostic testing or documentation requirements.

**Failure to Obtain Prior Authorization**: Coverage could be denied if prior authorization was not obtained before the medication was prescribed, as required by the plan.

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How Much Does Emgality Cost without Insurance?

Approximate Cost of Emgality Without Insurance

The price of Emgality (galcanezumab-gnlm) for an individual who is paying out-of-pocket can vary widely. On average, the cost for a one-month supply of Emgality, which is typically one syringe or auto-injector, is approximately $600 to $700.

Prices may differ based on the pharmacy and location. It's advisable to compare prices from different pharmacies, as there can be significant variation.

Many pharmaceutical companies, including the makers of Emgality, offer savings programs or patient assistance options for those who might struggle with the full cost of the medication. These programs can sometimes significantly reduce the out-of-pocket expenses for eligible patients.

In addition, discount cards or coupons from third-party services might be available that can reduce the retail price. However, always verify the legitimacy and terms of such offers.

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

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

Kayla Mardaga, NP

How to Get Emgality Coverage with Florida Blue (Blue Cross Blue Shield of Florida)

Check Your Florida Blue Plan Details

Log into your Florida Blue account or review your physical insurance documents to understand what your plan covers.
Check if your current plan includes prescription drug coverage, and identify the specific formulary or list of covered medications.
Note any specifics regarding tier levels, co-payments, or pre-authorization requirements for medications like Emgality.

Consult with Your Healthcare Provider

Discuss with your healthcare provider about your intention to use Emgality for managing your condition.
Ask your provider to prepare any necessary medical documentation or justifications required by Florida Blue for coverage.
Ensure that your provider is aware of Florida Blue's procedures for approving specialty drugs, as this can speed up the process.

Contact Florida Blue Customer Service

Call the customer service number found on your Florida Blue insurance card.
Inquire about the process for getting coverage for Emgality. Confirm if Emgality is covered under your current plan and any prerequisites.
Request information on any specific actions you need to take or documentation you need to provide.

Submit a Coverage Request

Work with your healthcare provider to complete any required forms for Emgality prior authorization or exception request.
Submit the completed forms to Florida Blue via their prescribed method, whether by fax, mail, or online submission through their member portal.
Include all necessary supporting documents, such as medical records, physician recommendations, and treatment history.

Follow Up and Navigate Approval

Regularly follow up with Florida Blue regarding the status of your Emgality coverage request. This helps identify any issues promptly.
Consider asking for your provider's assistance in contacting Florida Blue if there are delays or if additional information is needed.
Be prepared to appeal any denials by providing further justification or documentation to support the need for Emgality.

Utilize Florida Blue Resources

Access Florida Blue's pharmaceutical or member services online which may have additional resources or information regarding your coverage.
Speak with a pharmacist or care manager through any Florida Blue-provided assistance programs for additional guidance.

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Emgality FAQ

1. What are the common side effects of Emgality?

Common Side Effects of Emgality

Injection site reactions: including pain, redness, and itching at the injection site.

Constipation: a relatively frequent digestive side effect experienced by some patients.

Hypersensitivity reactions: such as rash, itching, or swelling in some individuals.

Respiratory effects: includes symptoms like cough or shortness of breath.

Fatigue: feelings of tiredness or lethargy reported by a number of users.

Difficulty sleeping: some patients may experience insomnia or sleep disturbances.

Consult Healthcare Provider

If side effects are severe or persistent, it is crucial to consult with a healthcare provider.

2. How long does it take for Emgality to start working?

How Emgality Works

Emgality is a monoclonal antibody that targets CGRP, a protein linked to migraine.

It's used for migraine prevention and treatment of cluster headaches.

Timeline for Effectiveness

Some patients report migraine reduction within 1 week of initial injection.

Maximum benefits typically observed after 2-3 months of consistent use.

Individual response varies; some might experience quicker relief than others.

Factors Influencing Effectiveness

Variability in individual biology and metabolism affects onset of relief.

Concurrent medications and overall health may also play a role.

Considerations

Consult with your healthcare provider for tailored advice based on your health profile.

Be consistent with your dosing schedule for optimal results.

3. Can Emgality be used for both prevention and treatment of migraines?

Usage of Emgality

Emgality is primarily approved for use as a preventive treatment for migraine. It is designed to reduce the frequency of migraine headaches in adults.

Emgality works by targeting and blocking the calcitonin gene-related peptide (CGRP), a molecule involved in migraine attacks.

Not for Acute Treatment

Emgality is not used for the acute treatment of migraine attacks once they've started. Other medications are typically prescribed for immediate relief.

Consult a healthcare provider for recommendations on acute migraine management options.

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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. Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Emgality

Explore Florida Blue's policy on Emgality coverage, possible denial reasons, ways to secure coverage, costs without insurance, and FAQs.

Achieve Your Goals Faster with Curex