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Does Gateway Health Plan Cover Jardiance

Discover if Gateway Health Plan covers Jardiance, reasons for denial, tips for coverage, cost without insurance, and FAQs. Your guide to understanding Jardiance coverage.

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Gateway Health Plan Coverage for Jardiance

**Coverage Situations:** Jardiance, a medication for managing type 2 diabetes, may be covered by Gateway Health Plan based on specific medical necessity and a prior authorization process.

**Basic Criteria:** The coverage often requires documentation from a physician proving the medical necessity of Jardiance. Typically, patients must try other diabetes management medications before coverage for Jardiance is approved.

**Rules:** Patients may need to be part of a diabetes management program and adhere to guidelines established by Gateway Health Plan. Continuous coverage might also require regular prescription renewals and compliance with treatment plans.

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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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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 Jardiance Coverage with Gateway Health Plan

Check Your Eligibility

Visit the Gateway Health Plan website to understand the specifics of your current health coverage and if they cover prescription medications like Jardiance.

Verify if Jardiance is included in the formulary, which is the list of medications covered under Gateway Health Plan. You can usually find this in your member portal or by contacting member services.

Consult with Your Doctor

Schedule a consultation with your healthcare provider to discuss your need for Jardiance and to get a prescription.

Ask your doctor if they have experience working with Gateway Health Plan to ensure the medication is pre-approved if necessary.

Contact Gateway Health Plan Member Services

Call the member services phone number found on your insurance card to get more information about Jardiance coverage.

Inquire about any required pre-authorizations, step therapy protocols, or documentation needed to secure coverage for Jardiance.

Submit a Prior Authorization Request

If a prior authorization is required, work with your healthcare provider to complete and submit this request to Gateway Health Plan. This involves filling out the correct forms and providing any necessary documentation to justify the need for Jardiance.

Follow up with Gateway Health Plan to confirm the receipt of your prior authorization request and check on the processing status.

Understand Your Cost Sharing Responsibilities

Review your Gateway Health Plan policy to understand any copayments, deductibles, or coinsurance responsibilities associated with Jardiance.

Ask member services if there are options for financial assistance or lower-cost alternatives, like generic versions if available.

Fill Your Prescription

Once coverage is confirmed, take your prescription to a network pharmacy that accepts your Gateway Health Plan insurance.

Ensure the pharmacy processes your prescription using your Gateway Health Plan information to reduce out-of-pocket expenses.

Appeal a Denial

If your request for Jardiance coverage is denied, use Gateway Health Plan's appeals process to dispute the decision. Collect any additional supporting documentation from your doctor to strengthen your case.

Stay persistent and follow up regularly with both your healthcare provider and Gateway Health Plan to ensure your appeal is being processed.

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Does Gateway Health Plan Cover Jardiance

Discover if Gateway Health Plan covers Jardiance, reasons for denial, tips for coverage, cost without insurance, and FAQs. Your guide to understanding Jardiance coverage.

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Is Jardiance Covered by Gateway Health Plan

Gateway Health Plan Coverage for Jardiance

**Coverage Situations:** Jardiance, a medication for managing type 2 diabetes, may be covered by Gateway Health Plan based on specific medical necessity and a prior authorization process.

**Basic Criteria:** The coverage often requires documentation from a physician proving the medical necessity of Jardiance. Typically, patients must try other diabetes management medications before coverage for Jardiance is approved.

**Rules:** Patients may need to be part of a diabetes management program and adhere to guidelines established by Gateway Health Plan. Continuous coverage might also require regular prescription renewals and compliance with treatment plans.

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Gateway Health Plan's Approved Criteria for Jardiance Coverage

Eligibility Criteria for Jardiance Coverage

Member must have a documented diagnosis of Type 2 Diabetes Mellitus.

Member should be 18 years of age or older.

Member must demonstrate inadequate glycemic control despite adherence to lifestyle modifications and treatment with metformin unless contraindicated or not tolerated.

Jardiance may be prescribed as part of a comprehensive diabetes treatment plan which includes diet and exercise.

The prescribing physician must be an endocrinologist or a healthcare provider experienced in diabetic treatment management.

Documentation Requirements

Detailed medical records demonstrating the diagnosis of Type 2 Diabetes Mellitus.

History of previous treatments and responses, including documentation of lifestyle interventions and their outcomes.

Documentation of any contraindication or intolerance to metformin.

Current glycemic status and goal, shown through recent HbA1c results.

Reauthorization Criteria

Evidence of Jardiance's efficacy shown by a reduction in HbA1c levels after the initial coverage period.

Ongoing adherence to prescribed diet and exercise regime along with Jardiance therapy.

Updated patient records that demonstrate sustained benefit or continual improvement in glycemic control.

No evidence of adverse effects severe enough to warrant discontinuation of therapy.

Additional Considerations

Jardiance may be used as a combination therapy with other glucose-lowering medications when clinically appropriate.

Special considerations may be given for patients with cardiovascular considerations aligned with appropriate heart failure risk management.

The necessity for continued treatment must be reassessed regularly by the prescribing healthcare provider.

Why Gateway Health Plan Might Deny Jardiance Coverage

Reasons for Jardiance Denial by Gateway Health Plan

Jardiance is not listed as a covered medication on the member's specific plan formulary. Coverage may vary depending on the tier classification of medications.

The prescription for Jardiance does not meet the medical necessity criteria as defined by Gateway Health Plan policies, which might include inadequate documentation or failure to meet condition-specific requirements.

The member has not completed necessary prior authorization requirements. Gateway Health Plan may require submission of clinical documentation or evidence before approving coverage for Jardiance.

The prescribed dosage or form of Jardiance is not supported by FDA labeling or falls outside the prescribing guidelines recognized by Gateway Health Plan.

Jardiance is intended for a condition not approved by Gateway Health Plan. Off-label uses or experimental treatments may not be covered without sufficient supporting evidence for efficacy.

Jardiance is determined to be not cost-effective when there are equivalent but less expensive therapeutic alternatives available on the plan's formulary.

The member's plan specifically excludes coverage for medications like Jardiance due to benefit limitations or exclusions related to specific conditions or treatment types.

The member has not met or exceeded their plan's specific step therapy requirements, which might mandate trying alternative treatments before covering Jardiance.

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How Much Does Jardiance Cost without Insurance?

Estimated Cost of Jardiance Without Insurance

The cost of Jardiance can vary depending on the pharmacy you visit, but as an oral medication used primarily to treat type 2 diabetes, it is often priced at a premium. Without insurance, the average monthly cost is approximately $550 to $650 for a 30-day supply of 10 mg or 25 mg tablets.

Prices can also vary based on location, pharmacy discounts, and available manufacturer coupons, so it's advisable to shop around or look for any available patient assistance programs to potentially lower the out-of-pocket cost.

Ways to Lower the Cost of Jardiance

**Pharmacy Discount Cards:** Utilizing pharmacy discount cards can sometimes provide substantial savings on your prescription, reducing the price by a notable percentage.

**Manufacturer Coupons and Programs:** Eli Lilly, the manufacturer of Jardiance, may offer savings cards or assistance programs to help eligible patients reduce their costs. It's worth checking through their official website or consulting with your healthcare provider.

**Generic Alternatives:** Although there may not be a generic version of Jardiance available currently, consulting with your healthcare provider about other generic medications for your condition may offer a more budget-friendly option.

**Bulk Purchasing Options:** Some pharmacies might offer discounts for purchasing a 90-day supply instead of a 30-day supply, which can lead to savings in the long term.

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 Jardiance Coverage with Gateway Health Plan

Check Your Eligibility

Visit the Gateway Health Plan website to understand the specifics of your current health coverage and if they cover prescription medications like Jardiance.

Verify if Jardiance is included in the formulary, which is the list of medications covered under Gateway Health Plan. You can usually find this in your member portal or by contacting member services.

Consult with Your Doctor

Schedule a consultation with your healthcare provider to discuss your need for Jardiance and to get a prescription.

Ask your doctor if they have experience working with Gateway Health Plan to ensure the medication is pre-approved if necessary.

Contact Gateway Health Plan Member Services

Call the member services phone number found on your insurance card to get more information about Jardiance coverage.

Inquire about any required pre-authorizations, step therapy protocols, or documentation needed to secure coverage for Jardiance.

Submit a Prior Authorization Request

If a prior authorization is required, work with your healthcare provider to complete and submit this request to Gateway Health Plan. This involves filling out the correct forms and providing any necessary documentation to justify the need for Jardiance.

Follow up with Gateway Health Plan to confirm the receipt of your prior authorization request and check on the processing status.

Understand Your Cost Sharing Responsibilities

Review your Gateway Health Plan policy to understand any copayments, deductibles, or coinsurance responsibilities associated with Jardiance.

Ask member services if there are options for financial assistance or lower-cost alternatives, like generic versions if available.

Fill Your Prescription

Once coverage is confirmed, take your prescription to a network pharmacy that accepts your Gateway Health Plan insurance.

Ensure the pharmacy processes your prescription using your Gateway Health Plan information to reduce out-of-pocket expenses.

Appeal a Denial

If your request for Jardiance coverage is denied, use Gateway Health Plan's appeals process to dispute the decision. Collect any additional supporting documentation from your doctor to strengthen your case.

Stay persistent and follow up regularly with both your healthcare provider and Gateway Health Plan to ensure your appeal is being processed.

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Jardiance FAQ

What is Jardiance used for?

What is Jardiance Used For?

Jardiance is primarily used to manage type 2 diabetes by helping to lower blood sugar levels in adults.

It works by promoting the excretion of excess glucose through urine, thus reducing the amount of sugar the body absorbs.

In addition to blood sugar management, Jardiance is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.

Patients with heart failure may benefit from Jardiance as it helps in reducing the risk of hospitalization due to heart failure.

What are the side effects of Jardiance?

Common Side Effects of Jardiance

Urinary tract infections: Symptoms may include burning sensation while urinating and frequent urges.
Increased urination: This is due to Jardiance's mechanism of removing excess glucose via urine.

Serious Side Effects

Ketoacidosis: This rare condition might present as difficulty breathing, nausea, or confusion.
Dehydration: Symptoms can be dizziness or light-headedness, especially upon standing.

Allergic Reactions

Rash or hives can occur, requiring immediate medical attention.

Precautions

Consult your healthcare provider before starting if you have kidney issues or are on diuretics.

Can Jardiance cause weight loss?

Can Jardiance Cause Weight Loss?

Yes, Jardiance (empagliflozin) can lead to weight loss. This medication is primarily used to treat type 2 diabetes.

It works by preventing glucose reabsorption in the kidneys, leading to glucose excretion through urine, which may also result in calorie loss.

Clinical trials have shown weight reduction as a common side effect, often averaging 2-3 kg.

This loss can differ among individuals; factors like diet and exercise may influence the extent of weight change.

Always consult with healthcare professionals to understand the benefits and risks associated with your specific health condition.

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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 Gateway Health Plan Cover Jardiance

Discover if Gateway Health Plan covers Jardiance, reasons for denial, tips for coverage, cost without insurance, and FAQs. Your guide to understanding Jardiance coverage.

Achieve Your Goals Faster with Curex