Does Group Health Cooperative (GHC) Cover Jardiance

Explore Jardiance coverage with GHC, reasons for denial, ways to secure approval, costs without insurance, and get answers to common questions.
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Does Group Health Cooperative (GHC) Cover Jardiance?

 

  • GHC likely covers Jardiance, a medication prescribed for type 2 diabetes, under specified conditions. Coverage might be dependent on the drug formulary in place.
  •  

  • Coverage typically requires a prescription from a healthcare provider and might require prior authorization to control costs and ensure appropriate use.
  •  

  • For accessing Jardiance through GHC, patients may need to verify if their plan includes this medication and understand co-pay or coinsurance responsibilities.
  •  

  • Patients should consult with their healthcare provider to ensure that Jardiance is medically necessary and discuss any potential alternatives if coverage is restricted.
  •  

  • It's advisable to review GHC's formulary or contact them directly for the most updated coverage details regarding Jardiance according to policy changes.

 

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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.

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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 Jardiance Coverage with Group Health Cooperative (GHC)

 

Contact Group Health Cooperative (GHC) Member Services

 

  • Call the GHC Member Services number found on your insurance card to inquire about coverage options for Jardiance. Ask specifically about your prescription drug benefits and if Jardiance is included in the formulary.
  •  

  • Visit the GHC website and log into your member account to access detailed information about your prescription benefits and check if Jardiance is listed under covered medications.

 

Consult With Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of Jardiance for your condition. Make sure they understand your insurance situation and any coverage restrictions.
  •  

  • Ask your healthcare provider to provide a detailed prescription with a justification for use if Jardiance is medically necessary, which can help in processing your coverage request.

 

Check the GHC Formulary

 

  • Access the GHC formulary, which is a list of covered medications, on their website or request a copy from Member Services. This will allow you to see if Jardiance is covered under your current plan.
  •  

  • Note any specific conditions or steps you may need to follow for approval, such as prior authorization or step therapy.

 

Initiate a Prior Authorization Request

 

  • If Jardiance is not immediately covered, your healthcare provider can submit a prior authorization request. This may require submitting additional information about your medical history and treatment plan.
  •  

  • Work closely with your healthcare provider and GHC to ensure all necessary information is provided to facilitate the approval process.

 

Explore Alternative Options

 

  • If Jardiance is not covered, discuss alternative medications with your healthcare provider that are covered under GHC's formulary and might be equally effective for your treatment.
  •  

  • Contact GHC Member Services to discuss any possible appeals if you believe Jardiance is necessary and wish to challenge the initial coverage decision.

 

Utilize GHC Pharmacy Services

 

  • Use GHC's network pharmacies or mail-order service for prescriptions to potentially lower your out-of-pocket costs for Jardiance if it is covered.
  •  

  • Ask about any available discounts, promotions, or patient assistance programs that GHC might offer to reduce the cost of Jardiance.

 

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FAQs

Does Group Health Cooperative (GHC) Cover Jardiance

Explore Jardiance coverage with GHC, reasons for denial, ways to secure approval, costs without insurance, and get answers to common questions.
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Is Jardiance Covered by Group Health Cooperative (GHC)

 

Does Group Health Cooperative (GHC) Cover Jardiance?

 

  • GHC likely covers Jardiance, a medication prescribed for type 2 diabetes, under specified conditions. Coverage might be dependent on the drug formulary in place.
  •  

  • Coverage typically requires a prescription from a healthcare provider and might require prior authorization to control costs and ensure appropriate use.
  •  

  • For accessing Jardiance through GHC, patients may need to verify if their plan includes this medication and understand co-pay or coinsurance responsibilities.
  •  

  • Patients should consult with their healthcare provider to ensure that Jardiance is medically necessary and discuss any potential alternatives if coverage is restricted.
  •  

  • It's advisable to review GHC's formulary or contact them directly for the most updated coverage details regarding Jardiance according to policy changes.

 

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Group Health Cooperative (GHC)'s Approved Criteria for Jardiance Coverage

 

Eligibility Criteria for Jardiance Coverage by GHC

 

  • Patient must be diagnosed with Type 2 Diabetes Mellitus (T2DM) as confirmed by medical records.
  •  

  • Jardiance is prescribed as an adjunct to diet and exercise to improve glycemic control in adults with T2DM.
  •  

  • Candidates for coverage should not achieve adequate glycemic control with metformin or metformin is contraindicated.
  •  

  • Physician documentation must confirm the patient's need for additional blood sugar management beyond current medications.

 

Cardiovascular Indications

 

  • Patient has established cardiovascular disease as documented by the physician.
  •  

  • Jardiance is prescribed to reduce the risk of cardiovascular death in adults with T2DM and cardiovascular disease.
  •  

  • Appropriate laboratory and diagnostic cardiovascular evaluations must support this indication.

 

Renal Benefits Criteria

 

  • Jardiance is indicated to slow the progression of diabetic nephropathy in patients with T2DM.
  •  

  • Documented evidence of renal complications such as albuminuria, confirmed by recent test results, is required.
  •  

  • Patient must have an estimated glomerular filtration rate (eGFR) maintained above the minimum threshold as defined in prescribing information.

 

Documentation and Prior Authorization

 

  • Comprehensive medical records supporting the diagnosis, current treatment plan, and Jardiance necessity are necessary for approval.
  •  

  • Submission of any recent laboratory results and diagnostic tests that justify Jardiance therapy.
  •  

  • Physicians must provide detailed notes outlining the expected benefits of Jardiance for the specific condition being treated.

 

Renewal and Continuous Treatment

 

  • Coverage renewal may require documentation of continued benefit and adherence to the therapy as assessed by the healthcare provider.
  •  

  • Regular follow-ups and updated evaluations confirming Jardiance's ongoing therapeutic effectiveness must be submitted as required.
  •  

  • Review of patient progress and condition is necessary to determine continued eligibility beyond the initial approval period.

 

Why Group Health Cooperative (GHC) Might Deny Jardiance Coverage

 

Reasons for Denial of Jardiance Coverage

 

  • Non-Authorization: Jardiance might be denied if prior authorization has not been obtained when required by GHC for coverage.
  •  

  • Non-Preferred Status: If Jardiance is considered a non-preferred medication within the formulary and there are preferred alternatives that have not been tried, coverage could be denied.
  •  

  • Off-Label Use: Using Jardiance for purposes not approved by the FDA, such as conditions it is not indicated for, may lead to denial of coverage.
  •  

  • Lack of Medical Necessity: If the prescription of Jardiance is not deemed medically necessary according to the criteria set by GHC, it may not be covered.
  •  

  • Duplicate Therapy: Coverage might be denied if Jardiance is prescribed alongside other medications with similar therapeutic effects without proper indication.
  •  

  • Inadequate Documentation: Failure to provide sufficient medical documentation supporting the need for Jardiance can result in denial.
  •  

  • Failed Step Therapy: Jardiance might not be covered if GHC requires step therapy and the patient has not tried and failed other less expensive alternatives.
  •  

  • Excluded from Plan: If Jardiance is explicitly excluded from the specific benefits plan of a member, it won't be covered.

 

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How Much Does Jardiance Cost without Insurance?

 

Estimated Cost of Jardiance Without Insurance

 

  • The cost of Jardiance can vary depending on the pharmacy you visit, but as an oral medication used primarily to treat type 2 diabetes, it is often priced at a premium. Without insurance, the average monthly cost is approximately $550 to $650 for a 30-day supply of 10 mg or 25 mg tablets.
  •  

  • Prices can also vary based on location, pharmacy discounts, and available manufacturer coupons, so it's advisable to shop around or look for any available patient assistance programs to potentially lower the out-of-pocket cost.

 

Ways to Lower the Cost of Jardiance

 

  • **Pharmacy Discount Cards:** Utilizing pharmacy discount cards can sometimes provide substantial savings on your prescription, reducing the price by a notable percentage.
  •  

  • **Manufacturer Coupons and Programs:** Eli Lilly, the manufacturer of Jardiance, may offer savings cards or assistance programs to help eligible patients reduce their costs. It's worth checking through their official website or consulting with your healthcare provider.
  •  

  • **Generic Alternatives:** Although there may not be a generic version of Jardiance available currently, consulting with your healthcare provider about other generic medications for your condition may offer a more budget-friendly option.
  •  

  • **Bulk Purchasing Options:** Some pharmacies might offer discounts for purchasing a 90-day supply instead of a 30-day supply, which can lead to savings in the long term.

 

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 Jardiance Coverage with Group Health Cooperative (GHC)

 

Contact Group Health Cooperative (GHC) Member Services

 

  • Call the GHC Member Services number found on your insurance card to inquire about coverage options for Jardiance. Ask specifically about your prescription drug benefits and if Jardiance is included in the formulary.
  •  

  • Visit the GHC website and log into your member account to access detailed information about your prescription benefits and check if Jardiance is listed under covered medications.

 

Consult With Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of Jardiance for your condition. Make sure they understand your insurance situation and any coverage restrictions.
  •  

  • Ask your healthcare provider to provide a detailed prescription with a justification for use if Jardiance is medically necessary, which can help in processing your coverage request.

 

Check the GHC Formulary

 

  • Access the GHC formulary, which is a list of covered medications, on their website or request a copy from Member Services. This will allow you to see if Jardiance is covered under your current plan.
  •  

  • Note any specific conditions or steps you may need to follow for approval, such as prior authorization or step therapy.

 

Initiate a Prior Authorization Request

 

  • If Jardiance is not immediately covered, your healthcare provider can submit a prior authorization request. This may require submitting additional information about your medical history and treatment plan.
  •  

  • Work closely with your healthcare provider and GHC to ensure all necessary information is provided to facilitate the approval process.

 

Explore Alternative Options

 

  • If Jardiance is not covered, discuss alternative medications with your healthcare provider that are covered under GHC's formulary and might be equally effective for your treatment.
  •  

  • Contact GHC Member Services to discuss any possible appeals if you believe Jardiance is necessary and wish to challenge the initial coverage decision.

 

Utilize GHC Pharmacy Services

 

  • Use GHC's network pharmacies or mail-order service for prescriptions to potentially lower your out-of-pocket costs for Jardiance if it is covered.
  •  

  • Ask about any available discounts, promotions, or patient assistance programs that GHC might offer to reduce the cost of Jardiance.

 

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Jardiance FAQ

What is Jardiance used for?

 

What is Jardiance Used For?

 

  • Jardiance is primarily used to manage type 2 diabetes by helping to lower blood sugar levels in adults.
  •  

  • It works by promoting the excretion of excess glucose through urine, thus reducing the amount of sugar the body absorbs.
  •  

  • In addition to blood sugar management, Jardiance is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.
  •  

  • Patients with heart failure may benefit from Jardiance as it helps in reducing the risk of hospitalization due to heart failure.

 

What are the side effects of Jardiance?

 

Common Side Effects of Jardiance

 

  • Urinary tract infections: Symptoms may include burning sensation while urinating and frequent urges.
  • Increased urination: This is due to Jardiance's mechanism of removing excess glucose via urine.

 

Serious Side Effects

 

  • Ketoacidosis: This rare condition might present as difficulty breathing, nausea, or confusion.
  • Dehydration: Symptoms can be dizziness or light-headedness, especially upon standing.

 

Allergic Reactions

 

  • Rash or hives can occur, requiring immediate medical attention.

 

Precautions

 

  • Consult your healthcare provider before starting if you have kidney issues or are on diuretics.

 

Can Jardiance cause weight loss?

 

Can Jardiance Cause Weight Loss?

 

  • Yes, Jardiance (empagliflozin) can lead to weight loss. This medication is primarily used to treat type 2 diabetes.
  •  

  • It works by preventing glucose reabsorption in the kidneys, leading to glucose excretion through urine, which may also result in calorie loss.
  •  

  • Clinical trials have shown weight reduction as a common side effect, often averaging 2-3 kg.
  •  

  • This loss can differ among individuals; factors like diet and exercise may influence the extent of weight change.
  •  

  • Always consult with healthcare professionals to understand the benefits and risks associated with your specific health condition.

 

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Titration

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

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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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