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

Explore Florida Blue's Lantus coverage, reasons for denial, tips to secure it, cost without insurance, and FAQs for informed decisions.
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Coverage Overview

 

  • Florida Blue generally covers Lantus, a long-acting insulin, for individuals diagnosed with diabetes, as long as it is deemed medically necessary by a healthcare provider.

 

Eligibility Criteria

 

  • Patients must have a prescription from a licensed healthcare provider to qualify for coverage.
  • The coverage often requires prior authorization to ensure the treatment is necessary and aligns with the patient's medical needs.

 

Plan Variations

 

  • Coverage specifics can vary based on the individual’s health plan. It's crucial to check with Florida Blue for the terms applicable to your specific policy.
  • Some plans may require a copayment or coinsurance, affecting the out-of-pocket cost for patients.

 

Steps to Confirm Coverage

 

  • Contact Florida Blue customer service or review the policy details via the member portal to confirm the benefits and requirements for Lantus.
  • Consult with your healthcare provider to ensure all necessary documentation and authorizations are in place.

 

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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 Florida Blue (Blue Cross Blue Shield of Florida)

 

Verify Your Plan Details

 

  • Log into your Florida Blue member account online or review your policy documents to check if Lantus (insulin glargine) is included in your prescription drug coverage.
  • Reach out to Florida Blue’s customer service for clarification on whether Lantus is covered under your specific health plan.
  • If Lantus is not covered, inquire about policy adjustments or alternative plans that include this coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Lantus for your treatment. Having a legitimate medical reason for this prescription can aid in securing coverage.
  • Request your healthcare provider’s assistance in submitting any necessary paperwork that Florida Blue might require for medical justification.

 

Prior Authorization Process

 

  • Understand if Florida Blue requires prior authorization for Lantus. This step is often necessary to confirm the necessity of the medication.
  • Work with your doctor to provide any required clinical documentation or patient history that Florida Blue needs for the prior authorization process.
  • Follow up with Florida Blue to ensure that the prior authorization request has been received and is being processed.

 

Review Cost and Possible Out-of-Pocket Expenses

 

  • After receiving coverage confirmation, ascertain any associated costs or co-pays required for Lantus within your plan.
  • Study how these costs fit into your overall out-of-pocket maximums and deductible limits for the year.

 

Utilize Florida Blue Pharmacy Network

 

  • Use Florida Blue’s pharmacy network to fill your Lantus prescription. They might have preferred pharmacies that offer lower co-pays.
  • Consider options like mail-order pharmacies if offered, which can sometimes provide medications at a reduced cost.

 

Appeal If Necessary

 

  • If your request for Lantus coverage is denied, review the denial letter thoroughly to understand the reasons.
  • Prepare an appeal by gathering supporting documentation from your healthcare provider to address the reasons for denial.
  • Submit the appeal to Florida Blue’s appeals department and follow up on the status of your appeal regularly.

 

Keep Track of Your Coverage

 

  • Regularly review your coverage details, especially during policy renewals, to ensure Lantus remains covered.
  • Stay informed about any changes in Florida Blue’s policies that might affect your prescription drug coverage.

 

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Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

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Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

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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Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
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FAQs

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

Explore Florida Blue's Lantus coverage, reasons for denial, tips to secure it, cost without insurance, and FAQs for informed decisions.
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Is Lantus Covered by Florida Blue (Blue Cross Blue Shield of Florida)

 

Coverage Overview

 

  • Florida Blue generally covers Lantus, a long-acting insulin, for individuals diagnosed with diabetes, as long as it is deemed medically necessary by a healthcare provider.

 

Eligibility Criteria

 

  • Patients must have a prescription from a licensed healthcare provider to qualify for coverage.
  • The coverage often requires prior authorization to ensure the treatment is necessary and aligns with the patient's medical needs.

 

Plan Variations

 

  • Coverage specifics can vary based on the individual’s health plan. It's crucial to check with Florida Blue for the terms applicable to your specific policy.
  • Some plans may require a copayment or coinsurance, affecting the out-of-pocket cost for patients.

 

Steps to Confirm Coverage

 

  • Contact Florida Blue customer service or review the policy details via the member portal to confirm the benefits and requirements for Lantus.
  • Consult with your healthcare provider to ensure all necessary documentation and authorizations are in place.

 

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

 

Coverage Criteria for Lantus

 

  • Patient must have a documented diagnosis of diabetes mellitus, either Type 1 or Type 2, requiring control of blood glucose levels.

    •  

  • Appropriate for patients who require long-acting basal insulin for blood sugar management, typically once daily.

    •  

  • Patient must be 18 years or older, unless medically necessary for patients under 18, with validated pediatric diabetic care recommendations.

    •  

  • Lantus is considered when oral antidiabetic agents and diet and lifestyle modifications have not adequately controlled blood glucose levels.

    •  

  • Approval may require evidence that the patient has tried and failed or had an inadequate response to other insulin formulations.

    •  

  • Documentation of ongoing monitoring of blood glucose levels and regular consultations with a healthcare provider.

    •  

  • Coverage may be dependent on prior authorization, which involves the submission of medical records or physician notes confirming the necessity of Lantus for the individual's treatment plan.

 

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

 

Reasons Why Florida Blue Might Deny Lantus Coverage

 

  • Lantus may not be covered if it is prescribed for non-FDA approved indications that do not fulfill Florida Blue's utilization management criteria.

    •  

  • The medication might be excluded if the member's plan specifically lists Lantus as a non-formulary drug, indicating it is not included in the plan’s drug coverage list.

    •  

  • A prior authorization requirement may not be met, such as failing to provide necessary documentation or rationale from the healthcare provider to justify the need for Lantus.

    •  

  • Lantus might be denied if lower-cost alternatives are available and recommended by Florida Blue’s step therapy policy, requiring patients to try these alternatives first unless medically contraindicated.

    •  

  • Coverage may be refused if the prescribing physician is not in the Florida Blue network and the plan requires prescriptions from network providers for coverage.

    •  

  • The patient may have exceeded quantity limits set by Florida Blue for Lantus, leading to denial unless an exception is approved based on medical necessity.

    •  

  • If the patient's plan has a specific exclusion for insulin medications not administered via a pump, Lantus might be denied coverage under this policy.

 

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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 Florida Blue (Blue Cross Blue Shield of Florida)

 

Verify Your Plan Details

 

  • Log into your Florida Blue member account online or review your policy documents to check if Lantus (insulin glargine) is included in your prescription drug coverage.
  • Reach out to Florida Blue’s customer service for clarification on whether Lantus is covered under your specific health plan.
  • If Lantus is not covered, inquire about policy adjustments or alternative plans that include this coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Lantus for your treatment. Having a legitimate medical reason for this prescription can aid in securing coverage.
  • Request your healthcare provider’s assistance in submitting any necessary paperwork that Florida Blue might require for medical justification.

 

Prior Authorization Process

 

  • Understand if Florida Blue requires prior authorization for Lantus. This step is often necessary to confirm the necessity of the medication.
  • Work with your doctor to provide any required clinical documentation or patient history that Florida Blue needs for the prior authorization process.
  • Follow up with Florida Blue to ensure that the prior authorization request has been received and is being processed.

 

Review Cost and Possible Out-of-Pocket Expenses

 

  • After receiving coverage confirmation, ascertain any associated costs or co-pays required for Lantus within your plan.
  • Study how these costs fit into your overall out-of-pocket maximums and deductible limits for the year.

 

Utilize Florida Blue Pharmacy Network

 

  • Use Florida Blue’s pharmacy network to fill your Lantus prescription. They might have preferred pharmacies that offer lower co-pays.
  • Consider options like mail-order pharmacies if offered, which can sometimes provide medications at a reduced cost.

 

Appeal If Necessary

 

  • If your request for Lantus coverage is denied, review the denial letter thoroughly to understand the reasons.
  • Prepare an appeal by gathering supporting documentation from your healthcare provider to address the reasons for denial.
  • Submit the appeal to Florida Blue’s appeals department and follow up on the status of your appeal regularly.

 

Keep Track of Your Coverage

 

  • Regularly review your coverage details, especially during policy renewals, to ensure Lantus remains covered.
  • Stay informed about any changes in Florida Blue’s policies that might affect your prescription drug coverage.

 

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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.

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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.

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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