Does Geisinger Health Plan Cover Novolog

Learn why Geisinger Health Plan may deny Novolog, steps to gain coverage, cost insights without insurance, and explore common Novolog FAQs.
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Coverage of Novolog

 

  • Geisinger Health Plan generally covers Novolog, a rapid-acting insulin used for diabetes management, under its formulary of approved medications.
  •  

  • Coverage typically applies to situations where Novolog is prescribed by a healthcare provider for managing blood glucose levels in individuals with diabetes.

 

Basic Criteria for Coverage

 

  • A valid prescription from a licensed healthcare provider is required for coverage.
  •  

  • Authorization might be needed, especially if alternatives are available, to ensure that Novolog is the most suitable option.
  •  

  • Patients may be required to try alternative medications first, depending on the plan's step therapy protocols.

 

Rules and Limitations

 

  • Coverage can vary based on the specific health plan tier or policy.
  •  

  • Copayments, coinsurance, or deductibles may apply based on the individual’s plan specifics.
  •  

  • It's crucial to review the specific plan details or contact Geisinger Health Plan directly to confirm coverage and potential out-of-pocket costs.

 

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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 Novolog Coverage with Geisinger Health Plan

 

Check Plan Benefits

 

  • Log in to your Geisinger Health Plan member portal to review your insurance benefits and confirm that Novolog is covered under your current plan.
  •  

  • Refer to your plan's drug formulary list, which details all medications covered. Make sure Novolog is included and note any restrictions or requirements.
  •  

  • Contact Geisinger Health Plan's customer service for clarification on benefits related to Novolog, including out-of-pocket costs and any preferred pharmacies.

 

Confirm Prescription Requirements

 

  • Consult with your healthcare provider to ensure Novolog is the appropriate medication for your condition. Discuss your insurance coverage and any documentation needed to support your prescription.
  •  

  • Request your healthcare provider to provide any necessary paperwork or justification that your insurance might require to cover Novolog.

 

Locate In-Network Pharmacies

 

  • Use the Geisinger Health Plan member portal to find in-network pharmacies that will accept your insurance for Novolog without additional out-of-network costs.
  •  

  • Contact these pharmacies to confirm Novolog availability and to inquire about any specific steps needed to process your insurance coverage.

 

Submit Prescription

 

  • Have your healthcare provider send your Novolog prescription directly to an in-network pharmacy electronically, or take a physical copy to the pharmacy yourself.
  •  

  • Verify with the pharmacy that your prescription has been received and processed with your Geisinger Health Plan details correctly.

 

Follow-Up

 

  • Pick up your Novolog once the pharmacy informs you that it is ready. Ensure that your prescription has been processed under your insurance benefits and review any copayment amounts before payment.
  •  

  • If there are any issues with coverage or payment, reach out to Geisinger Health Plan customer service for assistance in resolving the issue.
  •  

  • Maintain open communication with both your healthcare provider and Geisinger Health Plan to manage any future refills or changes in coverage.

 

Appeal if Necessary

 

  • If initially denied coverage, utilize the appeals process provided by Geisinger Health Plan to challenge the decision. Gather any supportive documentation from your healthcare provider to strengthen your case.
  •  

  • Follow up diligently with Geisinger's appeal department to ensure the appeal is processed in a timely manner.

 

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FAQs

Does Geisinger Health Plan Cover Novolog

Learn why Geisinger Health Plan may deny Novolog, steps to gain coverage, cost insights without insurance, and explore common Novolog FAQs.
Curex allergy drops unboxing

Is Novolog Covered by Geisinger Health Plan

 

Coverage of Novolog

 

  • Geisinger Health Plan generally covers Novolog, a rapid-acting insulin used for diabetes management, under its formulary of approved medications.
  •  

  • Coverage typically applies to situations where Novolog is prescribed by a healthcare provider for managing blood glucose levels in individuals with diabetes.

 

Basic Criteria for Coverage

 

  • A valid prescription from a licensed healthcare provider is required for coverage.
  •  

  • Authorization might be needed, especially if alternatives are available, to ensure that Novolog is the most suitable option.
  •  

  • Patients may be required to try alternative medications first, depending on the plan's step therapy protocols.

 

Rules and Limitations

 

  • Coverage can vary based on the specific health plan tier or policy.
  •  

  • Copayments, coinsurance, or deductibles may apply based on the individual’s plan specifics.
  •  

  • It's crucial to review the specific plan details or contact Geisinger Health Plan directly to confirm coverage and potential out-of-pocket costs.

 

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Geisinger Health Plan's Approved Criteria for Novolog Coverage

 

Geisinger Health Plan's Approved Criteria for Novolog Coverage

 

  • **Diagnosis of Diabetes:** Patients must have a documented diagnosis of diabetes mellitus, with evidence of a need for insulin therapy to manage blood glucose levels effectively.
  •  

  • **Prescription from Healthcare Provider:** A valid prescription issued by a licensed healthcare provider is required. The healthcare provider should demonstrate the necessity of Novolog for the patient's diabetes management plan.
  •  

  • **Previous Insulin Use:** Patients should have a history of insulin use, or a new indication should be established by the healthcare provider stipulating Novolog's need due to ineffective glycemic control with other insulins.
  •  

  • **Age Requirements:** Coverage is typically provided for both pediatric and adult patients who meet the medical necessity criteria as determined by their healthcare provider.
  •  

  • **Established Treatment Plan:** Novolog must be part of a comprehensive diabetes treatment plan which may include lifestyle modification, other medications, and regular blood sugar monitoring as prescribed by the healthcare provider.
  •  

  • **Compliance with Treatment:** Patients should follow their healthcare provider's recommendations regarding Novolog usage and have a history of compliance with previous treatments unless contraindicated.
  •  

  • **Clinical Documentation:** Supporting clinical documentation must be submitted to indicate why Novolog is the preferred option, including information on glycemic control goals and any previous treatment outcomes.
  •  

  • **Prior Authorization:** Some plans may require prior authorization to validate medical necessity. This may necessitate submission of clinical records that support the rationale for using Novolog instead of other insulins.

 

Why Geisinger Health Plan Might Deny Novolog Coverage

 

Non-Medically Necessary Use

 

  • Geisinger Health Plan may deny coverage for Novolog if the use of the medication is deemed non-medically necessary by their criteria. This can occur if there is no documentation supporting the medical need for Novolog over other alternatives.

 

Non-Formulary Medications

 

  • Novolog may be excluded from coverage if it is classified as a non-formulary medication. Geisinger Health Plan has a specific list of covered medications, and if Novolog is not on this list, it may not be covered.

 

Lack of Prior Authorization

 

  • In cases where prior authorization is required for Novolog, failure to obtain this authorization from Geisinger Health Plan can lead to a denial of coverage.

 

Experimental or Investigational Use

 

  • Coverage for Novolog might be denied if it is prescribed for an experimental or investigational use that hasn’t been proven effective, according to the criteria set by Geisinger Health Plan.

 

Non-Covered Conditions

 

  • There are specific medical conditions or circumstances under which Geisinger Health Plan will not cover Novolog. If the prescription for Novolog does not align with the covered conditions outlined in their policy, it may be denied.

 

Duplicate Therapy

 

  • If Geisinger Health Plan determines that Novolog is part of a duplicate therapy where the patient is already receiving another medication fulfilling the same purpose, coverage may be denied.

 

Lack of Step Therapy Completion

 

  • Geisinger Health Plan may require a demonstration that alternative, less expensive medications have been tried unsuccessfully before covering Novolog. Failure to complete such step therapy protocols can result in denial of coverage.

 

Failure to Adhere to Plan Guidelines

 

  • If the prescribing physician or patient does not adhere to the guidelines set forth by Geisinger Health Plan for the use of Novolog, the plan might deny coverage.

 

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How Much Does Novolog Cost without Insurance?

 

Novolog Cost Without Insurance

 

  • Novolog, a rapid-acting insulin, is used to help manage blood sugar levels in those with diabetes. It's essential for many patients, but its cost can be significant without insurance coverage.
  •  

  • The approximate cost for a single 10 mL vial of Novolog can range from $290 to $340. This price may vary based on the pharmacy and location.
  •  

  • For a pack of five 3 mL Novolog FlexPen pre-filled pens, the cost typically ranges from $500 to $600.
  •  

  • It's essential to consider that prices fluctuate frequently due to manufacturer pricing, pharmacy-specific pricing, and potential discounts or assistance programs that may be available.
  •  

  • Patients can explore various patient assistance programs or discount cards that may help reduce the cost of Novolog if paying out-of-pocket.
  •  

  • Comparing prices at different pharmacies and checking online pharmacy prices can also result in potential savings.

 

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 Novolog Coverage with Geisinger Health Plan

 

Check Plan Benefits

 

  • Log in to your Geisinger Health Plan member portal to review your insurance benefits and confirm that Novolog is covered under your current plan.
  •  

  • Refer to your plan's drug formulary list, which details all medications covered. Make sure Novolog is included and note any restrictions or requirements.
  •  

  • Contact Geisinger Health Plan's customer service for clarification on benefits related to Novolog, including out-of-pocket costs and any preferred pharmacies.

 

Confirm Prescription Requirements

 

  • Consult with your healthcare provider to ensure Novolog is the appropriate medication for your condition. Discuss your insurance coverage and any documentation needed to support your prescription.
  •  

  • Request your healthcare provider to provide any necessary paperwork or justification that your insurance might require to cover Novolog.

 

Locate In-Network Pharmacies

 

  • Use the Geisinger Health Plan member portal to find in-network pharmacies that will accept your insurance for Novolog without additional out-of-network costs.
  •  

  • Contact these pharmacies to confirm Novolog availability and to inquire about any specific steps needed to process your insurance coverage.

 

Submit Prescription

 

  • Have your healthcare provider send your Novolog prescription directly to an in-network pharmacy electronically, or take a physical copy to the pharmacy yourself.
  •  

  • Verify with the pharmacy that your prescription has been received and processed with your Geisinger Health Plan details correctly.

 

Follow-Up

 

  • Pick up your Novolog once the pharmacy informs you that it is ready. Ensure that your prescription has been processed under your insurance benefits and review any copayment amounts before payment.
  •  

  • If there are any issues with coverage or payment, reach out to Geisinger Health Plan customer service for assistance in resolving the issue.
  •  

  • Maintain open communication with both your healthcare provider and Geisinger Health Plan to manage any future refills or changes in coverage.

 

Appeal if Necessary

 

  • If initially denied coverage, utilize the appeals process provided by Geisinger Health Plan to challenge the decision. Gather any supportive documentation from your healthcare provider to strengthen your case.
  •  

  • Follow up diligently with Geisinger's appeal department to ensure the appeal is processed in a timely manner.

 

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Novolog FAQ

What is the difference between Novolog and Humalog?

 

Novolog vs. Humalog

 

  • Insulin Type: Both are rapid-acting insulin analogs used to control blood sugar in people with diabetes. They mimic natural insulin more closely than regular human insulin.
  •  

  • Onset and Duration: Novolog generally starts working within 10-20 minutes, whereas Humalog typically takes effect in 15 minutes. Both peak in about 1-2 hours and last 3-5 hours.
  •  

  • Formulation: Novolog contains insulin aspart, while Humalog consists of insulin lispro. The difference in formulation can affect absorption and performance based on individual reactions.
  •  

  • Usage: Dosage and administration may vary. Always follow healthcare provider guidance for each insulin type, as personal factors may impact the efficacy of each option.

 

How long does Novolog take to start working?

 

Novolog Overview

 

  • Novolog is a rapid-acting insulin analog used to manage blood glucose in individuals with diabetes.

 

Onset of Action

 

  • Novolog typically begins to work within 10 to 20 minutes after administration.
  • The onset can vary based on factors like injection site, dosage, and individual metabolic responses.

 

Peak Activity

 

  • It reaches peak effectiveness approximately 1 to 3 hours post-injection.

 

Duration

 

  • The effects last for about 3 to 5 hours, making it suitable for controlling blood sugar spikes during meals.
    •  

      Usage Tips

       

      • Administer Novolog 5 to 10 minutes before meals to manage postprandial blood glucose efficiently.
      • Monitor blood sugar levels regularly to tailor your insulin regimen effectively.

       

What are the side effects of Novolog insulin?

 

Common Side Effects of Novolog

 

  • Mild allergic reactions such as itching, rash, or redness at the injection site.
  • Weight gain is possible, as insulin promotes glucose storage.
  • There may be swelling in the hands or feet.
  • Symptoms of low blood sugar, such as shakiness, dizziness, or sweating.

 

Serious Side Effects

 

  • Severe allergic reactions include difficulty breathing or swelling of the face, lips, tongue, or throat.
  • Hypoglycemia can become life-threatening if not treated, manifesting as confusion or seizures.
  • Potassium levels may decrease, especially with high insulin doses, leading to muscle cramps and irregular heartbeats.

 

Tips on Managing Side Effects

 

  • Monitor blood sugar levels regularly to prevent hypoglycemia.
  • Keep a source of sugar on hand to address low blood sugar quickly.
  • Consult your healthcare provider for adverse reactions or persistent side effects.

 

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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.

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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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