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Does Geisinger Health Plan Cover Metformin

Explore if Geisinger Health Plan covers Metformin, reasons for denial, ways to ensure coverage, pricing without insurance, and comprehensive FAQs.
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Coverage of Metformin

 

  • Geisinger Health Plan generally covers Metformin, commonly prescribed for type 2 diabetes management.
  • Coverage typically includes both the generic version and its branded equivalents.

 

Basic Rules and Criteria for Coverage

 

  • Prescription from a licensed healthcare provider is required.
  • Plan members may need to meet specific criteria, such as a diagnosis of type 2 diabetes or insulin resistance.
  • Coverage may vary depending on the specific plan tier or formulary guidelines.

 

Situations Where Coverage May Be Limited

 

  • Higher costs might apply if a branded version is requested when a generic is available.
  • Prior authorization may be necessary for certain formulations or higher doses.
  • Quantity limits and step therapy requirements may be in place to control costs and ensure effective treatment.

 

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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 Metformin Coverage with Geisinger Health Plan

 

Start by Reviewing Your Geisinger Health Plan Coverage

 

  • Visit the Geisinger Health Plan website or go through your plan's documentation. Check the prescription drug section to see if Metformin is covered and under what terms.
  • Contact Geisinger Health Plan customer service directly for clarifications regarding coverage details for Metformin.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Metformin for your condition.
  • Ensure your provider is in-network with Geisinger Health Plan to get the most coverage benefits.

 

Get a Prescription for Metformin

 

  • Ask your healthcare provider to write a prescription for Metformin, ensuring it includes all necessary details like dosage and frequency.
  • If applicable, request your provider to write a prior authorization if Geisinger Health Plan requires one for Metformin coverage.

 

Submit Your Prescription to a Participating Pharmacy

 

  • Choose a pharmacy that participates in the Geisinger Health Plan network.
  • Present your Geisinger Health Plan card and Metformin prescription at the pharmacy.
  • Check if there are any additional forms or steps needed at the pharmacy to process your prescription under your plan.

 

Confirm the Coverage and Copayment

 

  • Confirm with the pharmacy that Metformin is covered by your Geisinger Health Plan and understand your copayment responsibilities.
  • Inquire about any alternative or generic options available that might be more affordable.

 

Follow Up with Geisinger Health Plan if Needed

 

  • If issues arise with coverage, contact Geisinger Health Plan's customer support to resolve them.
  • Keep documentation from your healthcare provider and pharmacy visits in case Geisinger Health Plan requires additional proof or details.

 

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FAQs

Does Geisinger Health Plan Cover Metformin

Explore if Geisinger Health Plan covers Metformin, reasons for denial, ways to ensure coverage, pricing without insurance, and comprehensive FAQs.
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Is Metformin Covered by Geisinger Health Plan

 

Coverage of Metformin

 

  • Geisinger Health Plan generally covers Metformin, commonly prescribed for type 2 diabetes management.
  • Coverage typically includes both the generic version and its branded equivalents.

 

Basic Rules and Criteria for Coverage

 

  • Prescription from a licensed healthcare provider is required.
  • Plan members may need to meet specific criteria, such as a diagnosis of type 2 diabetes or insulin resistance.
  • Coverage may vary depending on the specific plan tier or formulary guidelines.

 

Situations Where Coverage May Be Limited

 

  • Higher costs might apply if a branded version is requested when a generic is available.
  • Prior authorization may be necessary for certain formulations or higher doses.
  • Quantity limits and step therapy requirements may be in place to control costs and ensure effective treatment.

 

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Geisinger Health Plan's Approved Criteria for Metformin Coverage

 

Geisinger Health Plan's Criteria for Metformin Coverage

 

  • Coverage is provided for individuals diagnosed with Type 2 Diabetes who require assistance in controlling blood glucose levels.

    •  

  • Patients must have a documented inability to control blood glucose levels through diet and exercise alone, necessitating medication.

    •  

  • Primary care or endocrinology specialists must provide a prescription for Metformin, confirming it as part of a comprehensive diabetes management plan.

    •  

  • For patients who are newly diagnosed, Metformin is covered as a first-line treatment option unless contraindicated.

    •  

  • Coverage extends to individuals with prediabetes who have evidence of insulin resistance, particularly when accompanied by other risk factors like obesity or a family history of diabetes.

    •  

  • Prior authorization processes require documentation showing the need for continuous Metformin therapy in managing Type 2 Diabetes or prediabetes effectively.

    •  

  • Coverage includes generic versions of Metformin unless a specific brand is determined medically necessary by the prescribing healthcare provider.

    •  

  • To continue receiving coverage, patients must adhere to outlined follow-up and evaluation requirements to assess ongoing medication effectiveness and safety.

    •  

 

Why Geisinger Health Plan Might Deny Metformin Coverage

 

Geisinger Health Plan Denial Criteria for Metformin Coverage

 

  • Prescription of metformin is not aligned with FDA-approved indications or lacks sufficient clinical evidence for use in the prescribed condition.

    •  

  • The prescribed metformin dosage exceeds the maximum dosage recommendations, leading to potential safety risks.

    •  

  • The patient has not tried and failed on a lower-cost generic version of metformin available within the health plan's formulary tier structure.

    •  

  • The prescription is lacking necessary documentation, such as proof of previous unsuccessful treatment attempts or detailed medical necessity justifications.

    •  

  • The prescribing provider is not within the plan's network, and there is no prior authorization or referral arrangement approved by Geisinger Health Plan.

    •  

  • Presence of contraindications or previous documented adverse reactions in the patient’s medical history that would preclude the safe use of metformin.

    •  

  • The medication is intended for off-label use without sufficient evidence presented to support its efficacy and safety for the specific condition.

    •  

  • Patient enrollment is under a plan that lists metformin as a non-covered benefit due to specific plan design choices or exclusions.

    •  

  • Failure to comply with required pre-authorization steps which necessitate additional information or criteria review before coverage approval.

    •  

 

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How Much Does Metformin Cost without Insurance?

 

Approximate Cost of Metformin Without Insurance

 

  • The cost of Metformin without insurance can vary based on the dosage and quantity of the tablets. Generally, a 30-day supply of the generic version of Metformin (500 mg) might cost around $4 to $15 at major retail pharmacies in the United States.

    •  

  • Prices can differ significantly between pharmacies, so it is advisable to check multiple sources for pricing. Some discount programs or pharmacy discount cards may offer lower prices.

    •  

  • It’s important to note that prices for the branded versions, such as Glucophage, can be higher, typically ranging from $50 to $100, depending on the pharmacy and dosage.

    •  

  • For individuals looking for potential savings, generic versions of Metformin are usually the most economical option.

 

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 Metformin Coverage with Geisinger Health Plan

 

Start by Reviewing Your Geisinger Health Plan Coverage

 

  • Visit the Geisinger Health Plan website or go through your plan's documentation. Check the prescription drug section to see if Metformin is covered and under what terms.
  • Contact Geisinger Health Plan customer service directly for clarifications regarding coverage details for Metformin.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Metformin for your condition.
  • Ensure your provider is in-network with Geisinger Health Plan to get the most coverage benefits.

 

Get a Prescription for Metformin

 

  • Ask your healthcare provider to write a prescription for Metformin, ensuring it includes all necessary details like dosage and frequency.
  • If applicable, request your provider to write a prior authorization if Geisinger Health Plan requires one for Metformin coverage.

 

Submit Your Prescription to a Participating Pharmacy

 

  • Choose a pharmacy that participates in the Geisinger Health Plan network.
  • Present your Geisinger Health Plan card and Metformin prescription at the pharmacy.
  • Check if there are any additional forms or steps needed at the pharmacy to process your prescription under your plan.

 

Confirm the Coverage and Copayment

 

  • Confirm with the pharmacy that Metformin is covered by your Geisinger Health Plan and understand your copayment responsibilities.
  • Inquire about any alternative or generic options available that might be more affordable.

 

Follow Up with Geisinger Health Plan if Needed

 

  • If issues arise with coverage, contact Geisinger Health Plan's customer support to resolve them.
  • Keep documentation from your healthcare provider and pharmacy visits in case Geisinger Health Plan requires additional proof or details.

 

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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.

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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.

Metformin FAQ

What are common side effects of Metformin?

 

Common Side Effects of Metformin

 

  • Nausea  and  vomiting:  Initial  use  often  leads  to  gastrointestinal  discomfort.

    •  

  • Diarrhea: Can occur as the body adjusts to the medication.

    •  

  • Stomach pain: Abdominal discomfort may occur, especially in the beginning.

    •  

  • Loss of appetite: A reduction in appetite is sometimes reported.

    •  

  • Metallic taste: Some users experience an unusual taste in the mouth.

    •  

  • Fatigue: Occasionally, tiredness or weakness may develop.

    •  

  • Lactic acidosis: Rare yet serious; symptoms include muscle pain, trouble breathing, or slow heart rate. Seek immediate medical attention if suspected.

 

Can Metformin help with weight loss?

 

Metformin and Weight Loss

 

  • Metformin is primarily a medication for type 2 diabetes, but it can lead to modest weight loss. This effect is due mainly to its impact on insulin sensitivity and appetite regulation.

    •  

  • It lowers insulin levels and can reduce hunger, leading some patients to eat fewer calories unintentionally.

    •  

  • Metformin is not FDA-approved for weight loss. It should not be used solely for this purpose unless prescribed by a healthcare provider.

    •  

  • While some people may experience weight loss, results can vary. Lifestyle changes, such as diet and exercise, are essential for substantial weight management.

    •  

 

Is Metformin used for treating prediabetes?

 

Metformin for Prediabetes

 

  • Metformin is a first-line medication primarily used to treat type 2 diabetes, but it also plays a role in managing prediabetes.

    •  

  • Studies suggest that Metformin can reduce the progression from prediabetes to diabetes, especially in individuals with a BMI over 35, those under 60, and women with a history of gestational diabetes.

    •  

  • Metformin works by improving insulin sensitivity and decreasing liver glucose production, which helps in controlling blood sugar levels effectively.

    •  

  • While lifestyle changes remain the cornerstone of prediabetes management, Metformin can be an adjunct therapy under a doctor's supervision.

    •  

  • It's important for patients to discuss potential benefits and side effects with their healthcare provider, as individual needs may vary.

 

Have questions left?

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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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