Does Geisinger Health Plan Cover Trelegy

Explore Geisinger Health Plan's Trelegy coverage, reasons for denial, steps to get coverage, costs without insurance, and FAQs in this comprehensive guide.
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Does Geisinger Health Plan Cover Trelegy?

 

  • Geisinger Health Plan generally covers Trelegy Ellipta, a medication prescribed for COPD and other respiratory conditions, as per the plan's formulary.
  •  

  • Coverage is typically provided when the medication is deemed medically necessary by a healthcare provider.
  •  

  • Patients may need to demonstrate a history of using other treatments with inadequate results before Trelegy can be covered.
  •  

  • Prior authorization might be required to confirm the necessity and appropriateness of the drug for the patient's condition.
  •  

  • Members should consult their specific plan details or contact customer service to confirm coverage limits, out-of-pocket costs, and any additional criteria.

 

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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.

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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.

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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 Trelegy Coverage with Geisinger Health Plan

 

Verify Trelegy Coverage in Your Plan

 

  • Login to your Geisinger Health Plan member portal to review your prescription drug coverage.
  • Look for the specific tier placement of Trelegy on the formulary. This will help you understand your copayment or coinsurance responsibility.
  • If Trelegy isn't listed, contact member services for confirmation regarding its coverage status.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Trelegy with your healthcare provider to determine if it is medically necessary for your condition.
  • Inquire if there are alternative medications covered by Geisinger Health Plan that could be effective for you.
  • Request your healthcare provider to prepare necessary documentation justifying the use of Trelegy if required by your plan.

 

Submit Prior Authorization, if Required

 

  • Check if Trelegy requires prior authorization. You can obtain this information through member services or your healthcare provider.
  • If required, have your healthcare provider complete the prior authorization form, providing details about your medical necessity for Trelegy.
  • Submit the completed authorization form to Geisinger Health Plan as per their instructions for processing.

 

Contact Geisinger Health Plan for Assistance

 

  • Reach out to Geisinger Health Plan member services for guidance on obtaining Trelegy coverage if you encounter any issues.
  • Ask about any preferred pharmacy networks or specific instructions to benefit from reduced copays for Trelegy.
  • Inquire about financial assistance programs or patient assistance services that might subsidize medication costs.

 

Appeal a Denial, if Necessary

 

  • If your request for coverage is denied, review the reason for denial provided by Geisinger Health Plan.
  • Consult your healthcare provider for support in submitting an appeal, highlighting your medical need for Trelegy.
  • File the appeal following the process outlined by Geisinger Health Plan. Ensure all additional documentation is clear and submitted on time.

 

Monitor Your Coverage Status

 

  • Keep track of communication from Geisinger Health Plan regarding your coverage status for Trelegy.
  • Stay vigilant for any changes in coverage status, formulary, or plan policy that might affect your access to Trelegy.
  • Regularly communicate with member services if you have ongoing questions or concerns regarding your medication coverage.

 

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FAQs

Does Geisinger Health Plan Cover Trelegy

Explore Geisinger Health Plan's Trelegy coverage, reasons for denial, steps to get coverage, costs without insurance, and FAQs in this comprehensive guide.
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Is Trelegy Covered by Geisinger Health Plan

 

Does Geisinger Health Plan Cover Trelegy?

 

  • Geisinger Health Plan generally covers Trelegy Ellipta, a medication prescribed for COPD and other respiratory conditions, as per the plan's formulary.
  •  

  • Coverage is typically provided when the medication is deemed medically necessary by a healthcare provider.
  •  

  • Patients may need to demonstrate a history of using other treatments with inadequate results before Trelegy can be covered.
  •  

  • Prior authorization might be required to confirm the necessity and appropriateness of the drug for the patient's condition.
  •  

  • Members should consult their specific plan details or contact customer service to confirm coverage limits, out-of-pocket costs, and any additional criteria.

 

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Geisinger Health Plan's Approved Criteria for Trelegy Coverage

 

Criteria for Coverage of Trelegy under Geisinger Health Plan

 

  • Trelegy is covered for patients diagnosed with COPD (Chronic Obstructive Pulmonary Disease) who require a combination of inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA), and long-acting beta2-adrenergic agonist (LABA) therapy.
  • The patient must have a documented inadequacy of single or dual therapy, showing that symptoms are not adequately controlled with other medications.
  • Trelegy is appropriate for adults with moderate to severe COPD who continue to have frequent exacerbations despite a combination therapy regimen.
  • Coverage is also extended to patients with asthma who require treatment with Trelegy for additional respiratory control under the guidance of a healthcare professional.
  • Prior authorization may be required, and the treatment must be prescribed by or in consultation with a pulmonologist or a healthcare provider specializing in respiratory conditions.
  • Continuous eligibility for coverage may depend on documented therapeutic benefit from Trelegy, as evidenced by improvement in lung function tests or reduction in COPD or asthma-related exacerbations.

 

Why Geisinger Health Plan Might Deny Trelegy Coverage

 

Reasons for Denial of Trelegy Coverage by Geisinger Health Plan

 

  • Trelegy is prescribed for a condition not officially approved by the FDA. Off-label uses that have not been sufficiently studied or lack credible evidence of efficacy may not be covered.
  •  

  • The prescribed use of Trelegy does not meet the specific eligibility criteria set by the health plan's clinical guidelines, such as failing to meet the severity requirements of the pulmonary condition Trelegy is approved to treat.
  •  

  • The patient fails to provide appropriate documentation of prior unsuccessful treatments with alternative medications, as step therapy protocols may require demonstration of insufficient response or intolerance to other drugs.
  •  

  • A lack of prior authorization or pre-approval from Geisinger Health Plan for the use of Trelegy in the treatment process, which is often a prerequisite before the medication is eligible for coverage.
  •  

  • The prescription falls under the plan’s exclusion list due to formulary restrictions, meaning that Trelegy is either non-formulary or deemed non-essential in comparison to alternative therapeutic options promoted by the plan.
  •  

  • The patient does not fulfill the required insurance policy conditions, such as limitations or caps on drug coverage that apply to Trelegy under specific plans.
  •  

  • Prescription is deemed to exceed the quantity limits set by the plan, which often defines maximum allowable amounts based on safety and clinical treatment protocols.

 

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How Much Does Trelegy Cost without Insurance?

 

Approximate Cost of Trelegy Without Insurance

 

  • The cost of Trelegy Ellipta, without insurance, can vary significantly based on several factors like the pharmacy, geographical location, or available discounts. On average, patients can expect to pay between $550 to $650 for a 30-day supply.
  •  

  • Prices may also fluctuate depending on ongoing promotions or pharmacy memberships that can provide additional savings.
  •  

  • It’s advisable for patients to use discount cards, check for manufacturer coupons, or explore patient assistance programs to lower the out-of-pocket expense.
  •  

  • Shopping around, comparing prices at different pharmacies, or using online price comparison tools can also result in significant cost savings for Trelegy.

 

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 Trelegy Coverage with Geisinger Health Plan

 

Verify Trelegy Coverage in Your Plan

 

  • Login to your Geisinger Health Plan member portal to review your prescription drug coverage.
  • Look for the specific tier placement of Trelegy on the formulary. This will help you understand your copayment or coinsurance responsibility.
  • If Trelegy isn't listed, contact member services for confirmation regarding its coverage status.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Trelegy with your healthcare provider to determine if it is medically necessary for your condition.
  • Inquire if there are alternative medications covered by Geisinger Health Plan that could be effective for you.
  • Request your healthcare provider to prepare necessary documentation justifying the use of Trelegy if required by your plan.

 

Submit Prior Authorization, if Required

 

  • Check if Trelegy requires prior authorization. You can obtain this information through member services or your healthcare provider.
  • If required, have your healthcare provider complete the prior authorization form, providing details about your medical necessity for Trelegy.
  • Submit the completed authorization form to Geisinger Health Plan as per their instructions for processing.

 

Contact Geisinger Health Plan for Assistance

 

  • Reach out to Geisinger Health Plan member services for guidance on obtaining Trelegy coverage if you encounter any issues.
  • Ask about any preferred pharmacy networks or specific instructions to benefit from reduced copays for Trelegy.
  • Inquire about financial assistance programs or patient assistance services that might subsidize medication costs.

 

Appeal a Denial, if Necessary

 

  • If your request for coverage is denied, review the reason for denial provided by Geisinger Health Plan.
  • Consult your healthcare provider for support in submitting an appeal, highlighting your medical need for Trelegy.
  • File the appeal following the process outlined by Geisinger Health Plan. Ensure all additional documentation is clear and submitted on time.

 

Monitor Your Coverage Status

 

  • Keep track of communication from Geisinger Health Plan regarding your coverage status for Trelegy.
  • Stay vigilant for any changes in coverage status, formulary, or plan policy that might affect your access to Trelegy.
  • Regularly communicate with member services if you have ongoing questions or concerns regarding your medication coverage.

 

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Trelegy FAQ

1. What are the side effects of Trelegy?

 

Common Side Effects of Trelegy

 

  • Headaches
  • Back pain
  • Hoarseness
  • Oral thrush

 

Serious Side Effects

 

  • Increased heart rate
  • Chest pain
  • High blood pressure
  • Pneumonia in COPD patients

 

Less Common Side Effects

 

  • Diarrhea
  • Cough
  • Sore throat
  • Gastrointestinal discomfort

 

Precautions

 

  • Monitor for worsening symptoms.
  • Consult a doctor for persistent side effects.

 

2. How does Trelegy compare to Breo?

 

Comparison of Trelegy and Breo

 

  • Trelegy combines three active ingredients: fluticasone furoate (a corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Breo contains only two: fluticasone furoate and vilanterol.
  •  

  • This combination in Trelegy allows for better control of symptoms for COPD patients requiring more comprehensive therapy, whereas Breo is more suitable for those requiring less intensive treatment.
  •  

  • Both medications are administered once daily via inhalation, but Trelegy’s triple therapy provides a broader mechanism of action.
  •  

  • Side effects are generally similar, though patients transitioning from Breo to Trelegy may experience different responses due to the added component.

 

3. Is Trelegy a steroid?

 

Is Trelegy a Steroid?

 

  • Components: Trelegy contains three active ingredients: fluticasone furoate, umeclidinium, and vilanterol. Fluticasone furoate is a corticosteroid.
  •  

  • Steroid Role: The corticosteroid in Trelegy helps reduce inflammation in the airways, which is crucial for treating conditions like COPD and asthma.
  •  

  • Multi-Action: In addition to the steroid, umeclidinium (an anticholinergic) and vilanterol (a long-acting beta-agonist) work to relax and open the airways.
  •  

  • Usage: Trelegy is inhaled, delivering these components directly to the lungs for targeted action, minimizing systemic steroid exposure.

 

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Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

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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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