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Does Geisinger Health Plan Cover Humira

Explore Humira coverage with Geisinger Health Plan, denial reasons, coverage tips, costs without insurance, and get answers to common questions.
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Coverage for Humira

 

  • Geisinger Health Plan may cover Humira for conditions like rheumatoid arthritis, Crohn's disease, ulcerative colitis, and psoriasis.

    •  

  • Coverage depends on plan specifications, so reviewing your policy or contacting customer service is essential.

 

Criteria for Coverage

 

  • The medication must be prescribed by a healthcare provider and deemed medically necessary.

    •  

  • Pre-authorization is often required to ensure the treatment aligns with Geisinger's guidelines.

 

Basic Guidelines

 

  • Members may need to demonstrate failure or contraindication with other treatments before starting Humira.

    •  

  • Formulary tier placement can affect out-of-pocket costs, so verify if Humira is on a preferred tier within your plan.

 

Steps to Take

 

  • Consult with a healthcare provider to discuss potential benefits and alternatives.

    •  

  • Contact Geisinger Health Plan to confirm coverage specifics and any prerequisites.

 

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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 Humira Coverage with Geisinger Health Plan

 

Contact Geisinger Health Plan

 

  • Reach out to Geisinger Health Plan (GHP) member services using the contact information provided on your insurance card. This will help you verify your eligibility for Humira coverage and understand specific plan requirements.

    •  

  • Request information about the prescription drug coverage under your specific health plan, including formularies, coverage policies, and any associated costs for Humira.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Humira with your healthcare provider. Your provider can help determine if Humira is medically necessary for your condition and provide a prescription.

    •  

  • Ask your provider to supply any required documentation or medical records that may support your coverage request for Humira. This might include prior authorization requests or proof of medical necessity.

 

Review the GHP Prescription Drug Formulary

 

  • Access the Geisinger Health Plan's drug formulary on their website to check the status of Humira. The formulary will indicate whether Humira is covered, any potential alternatives, and under what circumstances.

    •  

  • Observe any specific requirements or restrictions, such as step therapy or prior authorizations, needed to access Humira coverage.

 

Submit a Prior Authorization Request

 

  • If required, work with your healthcare provider to submit a prior authorization request to Geisinger Health Plan. This process involves verifying the medical necessity of Humira for your treatment.

    •  

  • Ensure all necessary medical documentation is included in the request to prevent delays or denials. This may include past treatment records and a statement from your provider supporting your need for Humira.

 

Utilize Patient Support Programs

 

  • Explore patient assistance programs offered by AbbVie, the manufacturer of Humira, which may provide financial aid or support for copays and other expenses.

    •  

  • Contact AbbVie to inquire about the terms and eligibility for their assistance programs, which can help bridge the gap of coverage not provided by your Geisinger Health Plan.

 

Follow Up and Monitor Your Coverage

 

  • Stay in regular contact with Geisinger Health Plan to track the status of your authorization request and confirm coverage details once approved.

    •  

  • Review any letters or communications from GHP regarding your coverage, including any actions you need to take for continued access to Humira.

 

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FAQs

Does Geisinger Health Plan Cover Humira

Explore Humira coverage with Geisinger Health Plan, denial reasons, coverage tips, costs without insurance, and get answers to common questions.
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Is Humira Covered by Geisinger Health Plan

 

Coverage for Humira

 

  • Geisinger Health Plan may cover Humira for conditions like rheumatoid arthritis, Crohn's disease, ulcerative colitis, and psoriasis.

    •  

  • Coverage depends on plan specifications, so reviewing your policy or contacting customer service is essential.

 

Criteria for Coverage

 

  • The medication must be prescribed by a healthcare provider and deemed medically necessary.

    •  

  • Pre-authorization is often required to ensure the treatment aligns with Geisinger's guidelines.

 

Basic Guidelines

 

  • Members may need to demonstrate failure or contraindication with other treatments before starting Humira.

    •  

  • Formulary tier placement can affect out-of-pocket costs, so verify if Humira is on a preferred tier within your plan.

 

Steps to Take

 

  • Consult with a healthcare provider to discuss potential benefits and alternatives.

    •  

  • Contact Geisinger Health Plan to confirm coverage specifics and any prerequisites.

 

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Geisinger Health Plan's Approved Criteria for Humira Coverage

 

Criteria for Humira Coverage

 

  • The member must have an established diagnosis that aligns with approved indications for Humira, which may include conditions such as rheumatoid arthritis, psoriatic arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis, or others as specified by the Food and Drug Administration (FDA).

    •  

  • Treatment with Humira is generally considered when standard therapies, such as conventional disease-modifying antirheumatic drugs (DMARDs) or other biologic agents, have been inadequate or not tolerated by the patient.

    •  

  • Documentation from a licensed healthcare provider is required to verify diagnosis, previous treatment trials, and the rationale for prescribing Humira.

    •  

  • The healthcare provider must submit a completed prior authorization request form, ensuring all necessary clinical information and the intended treatment plan are communicated clearly.

    •  

  • Geisinger Health Plan may require documentation showing alignment with clinical guidelines and consensus from professional organizations, such as the American College of Rheumatology or the American Gastroenterological Association.

    •  

  • For ongoing coverage, evidence of positive patient response and evaluation through standardized assessments may be required at specific intervals.

    •  

  • Members must have active coverage under a Geisinger Health Plan, and Humira must be prescribed and administered by authorized and in-network healthcare facilities or providers, unless otherwise approved.

 

Why Geisinger Health Plan Might Deny Humira Coverage

 

Exclusion from FDA-Approved Indications

 

  • Humira is prescribed for conditions that are not part of its FDA-approved indications. Geisinger Health Plan may deny coverage if the use does not align with approved purposes.

 

Lack of Prior Authorization

 

  • The Geisinger Health Plan requires prior authorization for coverage of Humira. If the prescribing healthcare provider fails to obtain this, coverage may be denied.

 

Non-Compliance with Step Therapy

 

  • Patients must demonstrate an inadequate response to preferred therapies before using Humira. Non-compliance with required step therapy protocols may lead to denial of coverage.

 

Use of Non-Preferred Medication

 

  • Geisinger Health Plan may prioritize other medications over Humira. If a patient opts for Humira over a preferred alternative without meeting specific criteria, coverage can be denied.

 

Experimental or Investigational Use

 

  • If Humira is used in experimental or investigational treatments not supported by substantial clinical evidence, the Health Plan may refuse coverage.

 

Lack of Medical Necessity

 

  • In cases where Humira is not deemed medically necessary, based on medical records and professional guidelines, the plan may deny coverage.

 

Absence of Adequate Documentation

 

  • Insufficient or inadequate medical documentation supporting the need for Humira may result in a denial of coverage by the Health Plan.

 

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How Much Does Humira Cost without Insurance?

 

Understanding Humira's Cost

 

  • Humira, a medication used to treat various autoimmune conditions, can be quite expensive without insurance coverage.

    •  

  • The cost for a single 40 mg/0.4 ml pen of Humira is typically priced between $5,000 and $6,000, depending on the pharmacy and location.

    •  

  • Patients often require multiple pens per month, so monthly costs can range from $10,000 to $24,000 or more, depending on dosage and frequency of use.

    •  

  • Pharmaceutical companies may offer financial assistance programs or patient support to help lower these costs for eligible patients.

    •  

  • Discount programs and manufacturer coupons could sometimes reduce the cost for patients who qualify.

 

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 Humira Coverage with Geisinger Health Plan

 

Contact Geisinger Health Plan

 

  • Reach out to Geisinger Health Plan (GHP) member services using the contact information provided on your insurance card. This will help you verify your eligibility for Humira coverage and understand specific plan requirements.

    •  

  • Request information about the prescription drug coverage under your specific health plan, including formularies, coverage policies, and any associated costs for Humira.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Humira with your healthcare provider. Your provider can help determine if Humira is medically necessary for your condition and provide a prescription.

    •  

  • Ask your provider to supply any required documentation or medical records that may support your coverage request for Humira. This might include prior authorization requests or proof of medical necessity.

 

Review the GHP Prescription Drug Formulary

 

  • Access the Geisinger Health Plan's drug formulary on their website to check the status of Humira. The formulary will indicate whether Humira is covered, any potential alternatives, and under what circumstances.

    •  

  • Observe any specific requirements or restrictions, such as step therapy or prior authorizations, needed to access Humira coverage.

 

Submit a Prior Authorization Request

 

  • If required, work with your healthcare provider to submit a prior authorization request to Geisinger Health Plan. This process involves verifying the medical necessity of Humira for your treatment.

    •  

  • Ensure all necessary medical documentation is included in the request to prevent delays or denials. This may include past treatment records and a statement from your provider supporting your need for Humira.

 

Utilize Patient Support Programs

 

  • Explore patient assistance programs offered by AbbVie, the manufacturer of Humira, which may provide financial aid or support for copays and other expenses.

    •  

  • Contact AbbVie to inquire about the terms and eligibility for their assistance programs, which can help bridge the gap of coverage not provided by your Geisinger Health Plan.

 

Follow Up and Monitor Your Coverage

 

  • Stay in regular contact with Geisinger Health Plan to track the status of your authorization request and confirm coverage details once approved.

    •  

  • Review any letters or communications from GHP regarding your coverage, including any actions you need to take for continued access to Humira.

 

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.

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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.

Humira FAQ

What are the side effects of Humira?

 

Common Side Effects of Humira

 

  • Injection site reactions: redness, itching, or swelling.
  • Upper respiratory infections: sinus congestion and sore throat.
  • Headaches and nausea.

 

Serious Side Effects

 

  • Severe allergic reactions: difficulty breathing, chest pain, or swelling of the face.
  • Risk of infections: tuberculosis, fungal, or viral infections.
  • Blood disorders: unusual bruising or bleeding, pale skin.
  • Heart problems: shortness of breath, swelling of ankles/feet.

 

Long-term Considerations

 

  • Increased risk of certain cancers, particularly lymphomas.
  • Possible liver issues: jaundice or dark urine.

 

How does Humira work for rheumatoid arthritis?

 

How Humira Works

 

  • Humira is a TNF inhibitor. TNF, or tumor necrosis factor, is a substance in the body that causes inflammation.

    •  

  • By blocking TNF, Humira helps reduce inflammation and slow disease progression in rheumatoid arthritis patients.

    •  

  • It targets the underlying cause of inflammation instead of just managing symptoms, providing longer-term relief from discomfort and joint damage.

 

Administration and Effects

 

  • Administered as a subcutaneous injection, typically every two weeks.

    •  

  • Many patients start experiencing relief within a few weeks, though full benefits may take longer.

    •  

  • Consistent use can lead to improved mobility, reduced pain, and decreased swelling, assisting in daily activities.

How often do you take Humira injections?

 

Frequency of Humira Injections

 

  • **Initial Dose**: Typically, patients start with a loading dose. For example, in rheumatoid arthritis, a patient may begin with 160 mg on day 1, followed by 80 mg on day 15.

    •  

  • **Maintenance Dose**: After the initial period, the standard maintenance dose is usually 40 mg every other week. However, some patients may benefit from a weekly dose, depending on the condition and doctor's advice.

    •  

  • **Adjustments**: Dosage frequency may be adjusted based on response and tolerability, making healthcare provider consultation crucial.

 

Consulting Your Physician

 

  • Due to the varying nature of autoimmune conditions, always consult your healthcare professional to determine the appropriate regimen for your specific situation.

 

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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