Does Gateway Health Plan Cover Victoza

Explore Victoza coverage by Gateway Health, uncover reasons for denial, coverage steps, costs without insurance, and get answers to common questions.
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Gateway Health Plan Coverage for Victoza

 

  • Gateway Health Plan may cover Victoza, a medication used to treat type 2 diabetes, as part of its prescription drug benefits. Coverage depends on the specific plan and formulary tier placement.
  •  

  • To obtain coverage for Victoza, a prior authorization might be required. This means your healthcare provider must demonstrate medical necessity for using Victoza over other diabetes medications.
  •  

  • Coverage criteria typically include a prescription by a healthcare provider, proven medical need, and possibly a history of inadequate response to other treatments.
  •  

  • It’s essential to review your plan’s formulary and speak with a Gateway Health Plan representative or your healthcare provider to understand specific coverage, co-pays, and any required documentation.

 

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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 Gateway Health Plan

 

Contact Gateway Health Plan Customer Service

 

  • Begin by calling the Gateway Health Plan customer service number found on your insurance card. Inquire about the prescription drug coverage benefits related to Victoza.
  •  

  • Ask for the formulary list and check if Victoza is included in the list of covered medications.

 

Check with Primary Care Provider

 

  • Contact your primary care provider and discuss the need for Victoza, ensuring they agree it is medically necessary for your treatment plan.
  •  

  • Request that your healthcare provider writes a prescription for Victoza and provides any necessary documentation or medical history that may support your case.

 

Understand Prior Authorization Requirements

 

  • Confirm whether Gateway Health Plan requires prior authorization for Victoza. This process ensures that the medication is necessary and that other treatments have been considered.
  •  

  • Request your healthcare provider to initiate the prior authorization process if needed.

 

Gather Necessary Documentation

 

  • Collect all relevant medical records, letters from healthcare providers, and any necessary forms that support the need for Victoza.
  •  

  • Ensure your documentation includes a letter of medical necessity from your doctor.

 

Submit Claims and Documentation

 

  • Upload or mail all collected documents and prescribed forms to Gateway Health Plan as per their instructions.
  •  

  • Follow up with both your healthcare provider and Gateway Health Plan to confirm the receipt of the documentation and inquire about any potential issues.

 

Review Decision and Appeal if Necessary

 

  • Await a decision from Gateway Health Plan regarding the coverage for Victoza. This can take several weeks, so be patient while they process your claim.
  •  

  • If your request is denied, review the reason for denial and discuss it with your healthcare provider. Consider filing an appeal if you believe your case for Victoza coverage is justified.

 

Consider Alternative Assistance Programs

 

  • If Gateway Health Plan ultimately denies coverage, research patient assistance programs provided by the manufacturer of Victoza to help reduce out-of-pocket costs.
  •  

  • Explore other supplementary insurance options or financial aid programs that might be available for prescription medication coverage.

 

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FAQs

Does Gateway Health Plan Cover Victoza

Explore Victoza coverage by Gateway Health, uncover reasons for denial, coverage steps, costs without insurance, and get answers to common questions.
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Is Victoza Covered by Gateway Health Plan

 

Gateway Health Plan Coverage for Victoza

 

  • Gateway Health Plan may cover Victoza, a medication used to treat type 2 diabetes, as part of its prescription drug benefits. Coverage depends on the specific plan and formulary tier placement.
  •  

  • To obtain coverage for Victoza, a prior authorization might be required. This means your healthcare provider must demonstrate medical necessity for using Victoza over other diabetes medications.
  •  

  • Coverage criteria typically include a prescription by a healthcare provider, proven medical need, and possibly a history of inadequate response to other treatments.
  •  

  • It’s essential to review your plan’s formulary and speak with a Gateway Health Plan representative or your healthcare provider to understand specific coverage, co-pays, and any required documentation.

 

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Gateway Health Plan's Approved Criteria for Victoza Coverage

 

Victoza Coverage Criteria Overview

 

  • Victoza is approved for the treatment of patients diagnosed with Type 2 diabetes mellitus.
  •  

  • It is intended for use as an adjunct to diet and exercise to improve glycemic control.
  •  

  • Victoza may be prescribed if the patient has not achieved adequate glycemic control with medications like metformin, sulfonylureas, or thiazolidinediones alone.

 

Patient Eligibility Criteria

 

  • Patients must be at least 18 years of age.
  •  

  • Diagnosis of Type 2 diabetes must be officially documented by a healthcare provider.
  •  

  • Hemoglobin A1c levels should be above 7.0%, indicating insufficient control with existing diabetes medications.

 

Additional Considerations for Approval

 

  • Prescribing healthcare professional should ensure that the patient does not have a history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.
  •  

  • Patients may be considered if they have established cardiovascular disease and Victoza can be beneficial in reducing cardiovascular events.
  •  

  • An assessment for any known history of pancreatitis should be done before initiating therapy with Victoza.

 

Approval Documentation Requirements

 

  • Clinical notes from the prescribing physician outlining the patient's treatment history and the need for Victoza.
  •  

  • Lab results indicating current levels of HbA1c.
  •  

  • Verification of attempted and failed treatment with at least two other antidiabetic medications.

 

Why Gateway Health Plan Might Deny Victoza Coverage

 

Reasons Gateway Health Plan May Deny Victoza Coverage

 

  • **Non-FDA Approved Use:** Victoza prescribed for purposes or conditions not approved by the FDA may lead to denial of coverage.
  •  

  • **Lack of Medical Necessity:** If the health plan determines that the use of Victoza is not medically necessary based on their criteria, coverage may be denied.
  •  

  • **Non-Compliance with Prior Authorization Requirements:** Failure to obtain prior authorization or not providing sufficient documentation as required by Gateway Health Plan can result in denial of the medication's coverage.
  •  

  • **Exceeding Quantity Limits:** Prescriptions of Victoza exceeding the established quantity limits set by the health plan might not be covered unless an exception is granted.
  •  

  • **Absence of Step Therapy Protocol Adherence:** If the patient has not tried and failed other less costly therapies required in the plan's step therapy protocol, coverage could be denied.
  •  

  • **Member Plan Exclusion:** If the specific insurance plan excludes Victoza from its list of covered drugs or doesn’t include it in the formulary, coverage will be denied.

 

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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 Gateway Health Plan

 

Contact Gateway Health Plan Customer Service

 

  • Begin by calling the Gateway Health Plan customer service number found on your insurance card. Inquire about the prescription drug coverage benefits related to Victoza.
  •  

  • Ask for the formulary list and check if Victoza is included in the list of covered medications.

 

Check with Primary Care Provider

 

  • Contact your primary care provider and discuss the need for Victoza, ensuring they agree it is medically necessary for your treatment plan.
  •  

  • Request that your healthcare provider writes a prescription for Victoza and provides any necessary documentation or medical history that may support your case.

 

Understand Prior Authorization Requirements

 

  • Confirm whether Gateway Health Plan requires prior authorization for Victoza. This process ensures that the medication is necessary and that other treatments have been considered.
  •  

  • Request your healthcare provider to initiate the prior authorization process if needed.

 

Gather Necessary Documentation

 

  • Collect all relevant medical records, letters from healthcare providers, and any necessary forms that support the need for Victoza.
  •  

  • Ensure your documentation includes a letter of medical necessity from your doctor.

 

Submit Claims and Documentation

 

  • Upload or mail all collected documents and prescribed forms to Gateway Health Plan as per their instructions.
  •  

  • Follow up with both your healthcare provider and Gateway Health Plan to confirm the receipt of the documentation and inquire about any potential issues.

 

Review Decision and Appeal if Necessary

 

  • Await a decision from Gateway Health Plan regarding the coverage for Victoza. This can take several weeks, so be patient while they process your claim.
  •  

  • If your request is denied, review the reason for denial and discuss it with your healthcare provider. Consider filing an appeal if you believe your case for Victoza coverage is justified.

 

Consider Alternative Assistance Programs

 

  • If Gateway Health Plan ultimately denies coverage, research patient assistance programs provided by the manufacturer of Victoza to help reduce out-of-pocket costs.
  •  

  • Explore other supplementary insurance options or financial aid programs that might be available for prescription medication 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.

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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