Does Gateway Health Plan Cover Trelegy

Explore whether Gateway Health Plan covers Trelegy, why coverage might be denied, ways to secure coverage, and Trelegy costs without insurance.
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Coverage of Trelegy under Gateway Health Plan

 

  • Gateway Health Plan generally covers Trelegy, an inhalation therapy used for managing COPD and asthma, depending on your specific plan and prescription requirements.
  •  

  • Coverage may include criteria like prior authorization, which means your healthcare provider must demonstrate that Trelegy is medically necessary for your condition and other treatments have been insufficient.
  •  

  • Ensure the prescribing doctor is in-network with Gateway Health to maximize benefits and reduce out-of-pocket costs.
  •  

  • Check formulary listings as some plan variations may classify Trelegy under different tiers affecting copay amounts.
  •  

  • Appeals or exceptions might be needed if initial coverage decisions are unfavorable; engagement with your healthcare provider can assist in navigating these processes.

 

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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.

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 Trelegy Coverage with Gateway Health Plan

 

Verify Your Eligibility

 

  • Contact Gateway Health Plan customer service to confirm your eligibility for coverage. Use the phone number on your plan ID card.
  • Review your current health insurance policy documents to check for any existing coverage related to prescription medications, specifically Trelegy.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Trelegy and ensure it is medically necessary for your condition.
  • Request a written prescription from your healthcare provider, as it will be required by Gateway Health Plan for processing coverage requests.

 

Check the Formulary

 

  • Visit the Gateway Health Plan website to access their formulary, which lists medications covered under your plan.
  • Search for Trelegy within the formulary to see if it is listed as a covered medication for your specific health plan.

 

Request Prior Authorization

 

  • If Trelegy requires prior authorization, ask your healthcare provider to submit a prior authorization request on your behalf to Gateway Health Plan.
  • Ensure that your provider includes all necessary documentation, such as medical records and a letter of medical necessity, to support the request.

 

Submit a Coverage Request

 

  • If prior authorization is not required or once it is approved, contact Gateway Health Plan to submit a formal coverage request for Trelegy.
  • Provide any additional information requested by Gateway Health Plan to facilitate the processing of your coverage request.

 

Review Coverage Decision

 

  • Wait for Gateway Health Plan to process your coverage request and notify you of their decision.
  • If approved, follow Gateway Health Plan's instructions for obtaining Trelegy from an in-network pharmacy.
  • If denied, contact Gateway Health Plan for more information on their appeal process and consider requesting an appeal.

 

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FAQs

Does Gateway Health Plan Cover Trelegy

Explore whether Gateway Health Plan covers Trelegy, why coverage might be denied, ways to secure coverage, and Trelegy costs without insurance.
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Is Trelegy Covered by Gateway Health Plan

 

Coverage of Trelegy under Gateway Health Plan

 

  • Gateway Health Plan generally covers Trelegy, an inhalation therapy used for managing COPD and asthma, depending on your specific plan and prescription requirements.
  •  

  • Coverage may include criteria like prior authorization, which means your healthcare provider must demonstrate that Trelegy is medically necessary for your condition and other treatments have been insufficient.
  •  

  • Ensure the prescribing doctor is in-network with Gateway Health to maximize benefits and reduce out-of-pocket costs.
  •  

  • Check formulary listings as some plan variations may classify Trelegy under different tiers affecting copay amounts.
  •  

  • Appeals or exceptions might be needed if initial coverage decisions are unfavorable; engagement with your healthcare provider can assist in navigating these processes.

 

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Gateway Health Plan's Approved Criteria for Trelegy Coverage

 

Criteria for Trelegy Coverage

 

  • The patient must have a confirmed diagnosis of Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and emphysema, or asthma.
  •  

  • The patient must be 18 years of age or older for COPD and 12 years or older for asthma coverage.
  •  

  • The patient must have a documented history of moderate to severe COPD or asthma and must require maintenance treatment.
  •  

  • The patient must have demonstrated an inadequate response to an inhaled corticosteroid (ICS) and an inhaled long-acting beta agonist (LABA) or other current COPD or asthma therapies.
  •  

  • The prescribing physician must provide documented evidence that Trelegy is medically necessary for the treatment of the patient's condition.
  •  

  • There must be documented history of improvement in disease symptoms or quality of life with previous COPD or asthma medications to justify the transition to Trelegy.
  •  

  • The patient must not have contraindications to the components of Trelegy or to its use as determined by the prescribing physician.
  •  

  • Documentation of regular follow-up appointments to assess the patient's response to the treatment with Trelegy is required.
  •  

  • The request for Trelegy must be in alignment with FDA-approved indications and dosage guidelines unless otherwise documented by the prescribing physician.

 

Why Gateway Health Plan Might Deny Trelegy Coverage

 

Reasons for Trelegy Coverage Denial by Gateway Health Plan

 

  • **Lack of Medical Necessity:** If the prescribing physician does not provide sufficient documentation to demonstrate the medical necessity of Trelegy for the patient's condition, coverage may be denied.
  •  

  • **Prior Authorization Not Obtained:** Trelegy requires prior authorization from Gateway Health Plan. If this authorization is not secured before the prescription is filled, the claim may be denied.
  •  

  • **Non-Formulary Medication:** Gateway Health Plan has a list of approved medications, known as a formulary. If Trelegy is not included on this formulary, coverage may be refused unless an exception is granted.
  •  

  • **Step Therapy Requirements:** The plan may require the patient to try one or more alternative medications before covering Trelegy. If these steps are not followed, coverage may be denied.
  •  

  • **Quantity Limits Exceeded:** There might be specific quantity limits for Trelegy. If a prescription exceeds these limits without an approved exception, coverage may be denied.
  •  

  • **Out-of-Network Pharmacy:** If Trelegy is purchased from a pharmacy that is not within the insurance network, the plan may not cover the medication.
  •  

  • **Incomplete Documentation:** Incomplete or incorrect paperwork submitted as part of the claims process can lead to denial of coverage.

 

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How Much Does Trelegy Cost without Insurance?

 

Approximate Cost of Trelegy Without Insurance

 

  • The cost of Trelegy Ellipta, without insurance, can vary significantly based on several factors like the pharmacy, geographical location, or available discounts. On average, patients can expect to pay between $550 to $650 for a 30-day supply.
  •  

  • Prices may also fluctuate depending on ongoing promotions or pharmacy memberships that can provide additional savings.
  •  

  • It’s advisable for patients to use discount cards, check for manufacturer coupons, or explore patient assistance programs to lower the out-of-pocket expense.
  •  

  • Shopping around, comparing prices at different pharmacies, or using online price comparison tools can also result in significant cost savings for Trelegy.

 

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 Trelegy Coverage with Gateway Health Plan

 

Verify Your Eligibility

 

  • Contact Gateway Health Plan customer service to confirm your eligibility for coverage. Use the phone number on your plan ID card.
  • Review your current health insurance policy documents to check for any existing coverage related to prescription medications, specifically Trelegy.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Trelegy and ensure it is medically necessary for your condition.
  • Request a written prescription from your healthcare provider, as it will be required by Gateway Health Plan for processing coverage requests.

 

Check the Formulary

 

  • Visit the Gateway Health Plan website to access their formulary, which lists medications covered under your plan.
  • Search for Trelegy within the formulary to see if it is listed as a covered medication for your specific health plan.

 

Request Prior Authorization

 

  • If Trelegy requires prior authorization, ask your healthcare provider to submit a prior authorization request on your behalf to Gateway Health Plan.
  • Ensure that your provider includes all necessary documentation, such as medical records and a letter of medical necessity, to support the request.

 

Submit a Coverage Request

 

  • If prior authorization is not required or once it is approved, contact Gateway Health Plan to submit a formal coverage request for Trelegy.
  • Provide any additional information requested by Gateway Health Plan to facilitate the processing of your coverage request.

 

Review Coverage Decision

 

  • Wait for Gateway Health Plan to process your coverage request and notify you of their decision.
  • If approved, follow Gateway Health Plan's instructions for obtaining Trelegy from an in-network pharmacy.
  • If denied, contact Gateway Health Plan for more information on their appeal process and consider requesting an appeal.

 

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Trelegy FAQ

1. What are the side effects of Trelegy?

 

Common Side Effects of Trelegy

 

  • Headaches
  • Back pain
  • Hoarseness
  • Oral thrush

 

Serious Side Effects

 

  • Increased heart rate
  • Chest pain
  • High blood pressure
  • Pneumonia in COPD patients

 

Less Common Side Effects

 

  • Diarrhea
  • Cough
  • Sore throat
  • Gastrointestinal discomfort

 

Precautions

 

  • Monitor for worsening symptoms.
  • Consult a doctor for persistent side effects.

 

2. How does Trelegy compare to Breo?

 

Comparison of Trelegy and Breo

 

  • Trelegy combines three active ingredients: fluticasone furoate (a corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Breo contains only two: fluticasone furoate and vilanterol.
  •  

  • This combination in Trelegy allows for better control of symptoms for COPD patients requiring more comprehensive therapy, whereas Breo is more suitable for those requiring less intensive treatment.
  •  

  • Both medications are administered once daily via inhalation, but Trelegy’s triple therapy provides a broader mechanism of action.
  •  

  • Side effects are generally similar, though patients transitioning from Breo to Trelegy may experience different responses due to the added component.

 

3. Is Trelegy a steroid?

 

Is Trelegy a Steroid?

 

  • Components: Trelegy contains three active ingredients: fluticasone furoate, umeclidinium, and vilanterol. Fluticasone furoate is a corticosteroid.
  •  

  • Steroid Role: The corticosteroid in Trelegy helps reduce inflammation in the airways, which is crucial for treating conditions like COPD and asthma.
  •  

  • Multi-Action: In addition to the steroid, umeclidinium (an anticholinergic) and vilanterol (a long-acting beta-agonist) work to relax and open the airways.
  •  

  • Usage: Trelegy is inhaled, delivering these components directly to the lungs for targeted action, minimizing systemic steroid exposure.

 

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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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