$49$0.99

Does Geisinger Health Plan Cover Enbrel

Explore Geisinger Health Plan's coverage on Enbrel, learn ways to secure it, understand costs without insurance, and find answers to common Enbrel questions.

Treat your allergies with Curex

as seen on

“Curex is changing the landscape of allergies in 2024”

Does Geisinger Health Plan Cover Enbrel?

Geisinger Health Plan generally covers Enbrel for approved conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis.

Candidates typically need a confirmed diagnosis from a specialist and may require prior authorization.

Patients often must demonstrate inadequate response to first-line treatments before Enbrel coverage is approved.

Coverage may be subject to formulary tier and specific plan details. Co-pays and co-insurance may apply.

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49 $9.99

Review your allergy test results with a Curex allergist.

Start Now

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 Enbrel Coverage with Geisinger Health Plan

Verify Your Geisinger Health Plan Benefits

Contact Geisinger Health Plan's customer service to confirm your current coverage for prescription medications, especially regarding specialty drugs like Enbrel.

Check your plan documentation for any specifics about coverage of biologics or specialty drugs, as conditions and criteria can vary.

Consult with Your Healthcare Provider

Discuss your condition and treatment options with your healthcare provider, ensuring Enbrel is prescribed appropriately for your medical needs.

Your healthcare provider may need to provide prior authorization or a letter of medical necessity, depending on your insurance requirements.

Gather Necessary Documentation

Have your healthcare provider supply all relevant medical records, prescription information, and any necessary prior authorizations.

Collect documentation and justification for the medical need of Enbrel, if required by Geisinger Health Plan.

Submit Your Claim or Prior Authorization

If prior authorization is required, ensure your provider submits all necessary paperwork and documentation to Geisinger Health Plan.

It's important to follow up with your healthcare provider's office to confirm that all documentation was submitted correctly and in a timely manner.

Verify Coverage Determination

Await a response from Geisinger Health Plan regarding your prior authorization or claim for Enbrel coverage.

If you receive approval, review the terms of coverage, including co-payments, deductibles, and any manufacturer assistance programs you might be eligible for.

Appeal If Necessary

If your coverage for Enbrel is denied, review the reasons for denial provided by Geisinger Health Plan.

Work with your healthcare provider to gather additional documentation or justification, and submit an appeal to Geisinger Health Plan.

Explore Manufacturer Assistance Programs

Check if Amgen, the manufacturer of Enbrel, offers any patient assistance or co-pay programs that could help lower out-of-pocket costs.

Apply to these programs if eligible, and coordinate with your healthcare provider and pharmacist to utilize these benefits.

Happy Customers

We love helping people!

Allie, Nevada

"I have two cats I can finally cuddle!"
‍

Cat and dog allergies

Zachary, Texas

“I can breathe through my nose for the first time in like 20 years!"

Dust and mold allergies

Erika, New York

“I've noticed less sneezing and shortness of breath.”

Tree and grass allergies

Richard, Texas

I love the convenience!
‍

Tree and cat allergies

We Treat Allergies

Food Allergies

Weed Pollens

Cat Allergies

Dog Allergies

Dust Mites

Molds

Tree Pollens

curex user showing allergy treatment kit

a male patient showing allergy drops vial

50,000+ users have overcome their allergies

Am I eligible?

At-home Immunotherapy

Benefits of Curex

At-home treatment

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

5-30x higher cumulative dose vs allergy shots

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

Excellent safety profile

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

Treatment prescribed
by clinician

Clinicaly made allergen extracts are customized for your allergies

Your immune system gets desensitized to allergens, giving you long-term relief.

FAQs

Does Geisinger Health Plan Cover Enbrel

Explore Geisinger Health Plan's coverage on Enbrel, learn ways to secure it, understand costs without insurance, and find answers to common Enbrel questions.

Achieve Your Goals Faster with Curex

Is Enbrel Covered by Geisinger Health Plan

Does Geisinger Health Plan Cover Enbrel?

Geisinger Health Plan generally covers Enbrel for approved conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis.

Candidates typically need a confirmed diagnosis from a specialist and may require prior authorization.

Patients often must demonstrate inadequate response to first-line treatments before Enbrel coverage is approved.

Coverage may be subject to formulary tier and specific plan details. Co-pays and co-insurance may apply.

A weight management program tailored to you

Start with Curex

Geisinger Health Plan's Approved Criteria for Enbrel Coverage

Criteria for Enbrel Coverage by Geisinger Health Plan

The patient must have a confirmed diagnosis of a condition for which Enbrel is indicated. This includes rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, plaque psoriasis, or juvenile idiopathic arthritis.

For rheumatoid arthritis, the patient should have tried and had an inadequate response, intolerance, or contraindication to at least one disease-modifying antirheumatic drug (DMARD), such as methotrexate, unless contraindicated.

For plaque psoriasis, the patient should have moderate to severe psoriasis affecting at least 3% of body surface area, or areas that significantly impact daily life. Additionally, there should be documentation of prior medication therapy, including at least one systemic treatment like methotrexate or cyclosporine, or phototherapy unless contraindicated.

The medication must be prescribed by, or in consultation with, a dermatologist, rheumatologist, or specialist experienced in the treatment of the condition being managed.

For initial approval, the prescribing healthcare provider must submit documentation of the disease's severity and previous treatments tried, meeting the detailed criteria for the condition specified.

Enbrel approval may be contingent upon participation in a patient support program, if offered, to optimize therapeutic outcomes.

Continuation of therapy requires documentation of medical benefit from Enbrel treatment, such as improvement in symptom severity, reduction in disease flares, or improvement in functional status.

Re-assessment at specified intervals may be required to ensure continued medical necessity and benefit from therapy.

Certain quantity limits and dosing protocols may apply in accordance with FDA guidelines and Geisinger’s standard formulary for Enbrel.

Why Geisinger Health Plan Might Deny Enbrel Coverage

Reasons for Geisinger Health Plan Denying Enbrel Coverage

**Non-FDA Approved Indications**: Geisinger Health Plan does not cover Enbrel for conditions that are not approved by the FDA. If the use of Enbrel does not align with FDA-approved indications, coverage might be denied.

**Lack of Medical Necessity**: If documentation provided by the healthcare provider does not establish the medical necessity of Enbrel for the patient’s condition, the health plan may deny coverage.

**Step Therapy Requirements Not Met**: Enbrel may be denied if the patient has not tried or failed more cost-effective treatments first, as required by the step therapy protocol.

**Non-Compliance with Prior Authorization Procedures**: Without obtaining necessary prior authorization from Geisinger Health Plan, coverage for Enbrel might be refused.

**Out-of-Formulary Drug**: If Enbrel is not included in the patient's specific drug formulary, it may not be covered unless special exceptions are granted.

**Prescription from Non-Network Provider**: Obtaining a prescription from a non-network provider can lead to denial if the health plan requires a network provider for coverage.

Together with our partners we have changed the lives of over 300,000 patients.

Join Curex

How Much Does Enbrel Cost without Insurance?

Approximate Cost of Enbrel Without Insurance

The approximate cost of Enbrel, an injection used to treat autoimmune conditions such as rheumatoid arthritis and psoriasis, is generally around $5,000 to $7,000 per month without insurance.

This monthly cost can vary depending on the dosage prescribed and the specific pharmacy location.

Patients may be able to find some cost reduction through manufacturer discounts or assistance programs, but these are typically separate from traditional insurance coverage.

Comparing pharmacy prices through services or websites that provide drug price comparisons may help in finding the lowest available price.

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 Enbrel Coverage with Geisinger Health Plan

Verify Your Geisinger Health Plan Benefits

Contact Geisinger Health Plan's customer service to confirm your current coverage for prescription medications, especially regarding specialty drugs like Enbrel.

Check your plan documentation for any specifics about coverage of biologics or specialty drugs, as conditions and criteria can vary.

Consult with Your Healthcare Provider

Discuss your condition and treatment options with your healthcare provider, ensuring Enbrel is prescribed appropriately for your medical needs.

Your healthcare provider may need to provide prior authorization or a letter of medical necessity, depending on your insurance requirements.

Gather Necessary Documentation

Have your healthcare provider supply all relevant medical records, prescription information, and any necessary prior authorizations.

Collect documentation and justification for the medical need of Enbrel, if required by Geisinger Health Plan.

Submit Your Claim or Prior Authorization

If prior authorization is required, ensure your provider submits all necessary paperwork and documentation to Geisinger Health Plan.

It's important to follow up with your healthcare provider's office to confirm that all documentation was submitted correctly and in a timely manner.

Verify Coverage Determination

Await a response from Geisinger Health Plan regarding your prior authorization or claim for Enbrel coverage.

If you receive approval, review the terms of coverage, including co-payments, deductibles, and any manufacturer assistance programs you might be eligible for.

Appeal If Necessary

If your coverage for Enbrel is denied, review the reasons for denial provided by Geisinger Health Plan.

Work with your healthcare provider to gather additional documentation or justification, and submit an appeal to Geisinger Health Plan.

Explore Manufacturer Assistance Programs

Check if Amgen, the manufacturer of Enbrel, offers any patient assistance or co-pay programs that could help lower out-of-pocket costs.

Apply to these programs if eligible, and coordinate with your healthcare provider and pharmacist to utilize these benefits.

Premium Medication you can trust

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.

Enbrel FAQ

What conditions does Enbrel treat?

Conditions Treated by Enbrel

Rheumatoid Arthritis: Enbrel is commonly used for treating moderate to severe rheumatoid arthritis in adults, helping to reduce joint pain and swelling.
Juvenile Idiopathic Arthritis: Effective for kids aged 2 and older, Enbrel helps manage symptoms of juvenile idiopathic arthritis.
Psoriatic Arthritis: Patients with psoriatic arthritis can benefit from Enbrel, as it alleviates joint and skin symptoms.
Ankylosing Spondylitis: It aids in managing stiffness and inflammation linked to ankylosing spondylitis.
Plaque Psoriasis: Enbrel is used for treating moderate to severe plaque psoriasis in adult patients, reducing skin lesions.

What are common side effects of Enbrel?

Common Side Effects of Enbrel

Injection Site Reactions: Pain, redness, and swelling at the injection site are quite common.

Infections: Users may experience an increased risk of infections, including upper respiratory tract infections.

Headache: Some patients report headaches following administration.

Nausea and Vomiting: These gastrointestinal issues can occur.

Rash: Skin reactions such as rashes are noted in some individuals.

Heartburn: Stomach discomfort and heartburn are possible.

Be sure to consult your healthcare provider for any concerning symptoms or persistent side effects.

How is Enbrel administered?

Administration of Enbrel

Enbrel is administered via subcutaneous injection.
It is typically provided in a prefilled syringe, autoinjector (SureClick), or a vial requiring reconstitution.
Injections are usually administered on the thigh, abdomen, or outer area of the upper arm.
It's crucial to rotate the injection sites to avoid irritation.

Preparation and Injection

Check the solution for particles or discoloration before use.
If needed, allow the solution to reach room temperature for about 15–30 minutes.
Wash your hands thoroughly before handling the medication.
Use an alcohol swab to clean the injection site.
Inject Enbrel by angling the needle at 90 degrees for optimal delivery.

Have questions left?

‍

Get a personalized online consultation with a doctor at Curex

Learn More

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”

Becky D.

"If I could give 6 stars, I would. BEST... BEST… BEST… service.”

Ferdian K.

“The Curex staff has been professional, efficient, and really focused on my individual needs.”

Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

Button Text

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. 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 Geisinger Health Plan Cover Enbrel

Explore Geisinger Health Plan's coverage on Enbrel, learn ways to secure it, understand costs without insurance, and find answers to common Enbrel questions.

Achieve Your Goals Faster with Curex