Does Group Health Cooperative (GHC) Cover Lantus

Discover if Group Health Cooperative covers Lantus, reasons for denial, coverage tips, Lantus costs without insurance, and answers to common questions.
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Coverage for Lantus by Group Health Cooperative (GHC)

 

  • Lantus, a long-acting insulin, is covered by GHC under prescription drug benefits. However, coverage specifics may vary based on the particular health plan.
  •  

  • To qualify for coverage, a valid prescription from a healthcare provider is necessary. Medical necessity must be demonstrated as part of the coverage criteria.
  •  

  • Prior authorization may be required for coverage approval, depending on the health plan specifics. Patients should check with GHC or their healthcare provider for plan-specific requirements.
  •  

  • Out-of-pocket costs, such as copayments or coinsurance, depend on the member's health plan tier for prescription medications.
  •  

  • GHC covers Lantus for situations involving diabetes management, but patients may need to adhere to step therapy protocols, trying less expensive medications first unless exempt.

 

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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 Lantus Coverage with Group Health Cooperative (GHC)

 

Check Your GHC Membership Plan

 

  • Log in to your Group Health Cooperative (GHC) member portal to review your current health insurance plan details.
  •  

  • Look for information on prescription drug coverage and identify the drug formulary associated with your plan.
  •  

  • If you're unsure, contact GHC member services for clarity on your current plan's prescription benefits.

 

Verify Lantus Coverage

 

  • Access the GHC drug formulary list online or request a physical copy. Search for "Lantus" to confirm its inclusion and any tiers it may fall under.
  •  

  • If Lantus is included, check if there are any restrictions, such as prior authorization, quantity limits, or step therapy requirements.
  •  

  • Note any specific requirements or exclusions that may apply to your coverage for Lantus.

 

Consult with Your Healthcare Provider

 

  • Schedule a meeting or call with your primary care physician or endocrinologist to discuss your medical necessity for Lantus.
  •  

  • Ask your healthcare provider to write a prescription and, if necessary, provide supporting documentation for the medical necessity of Lantus.
  •  

  • Your provider may need to submit a prior authorization form on your behalf if required by GHC.

 

Submit Required Documentation

 

  • If prior authorization is required, ensure your healthcare provider submits all necessary forms and documentation to GHC promptly.
  •  

  • Gather any additional documentation such as medical records or a letter of medical necessity from your healthcare provider to support your case.
  •  

  • Ensure that all submissions are complete and sent through the appropriate channels (fax, mail, or online submission) as specified by GHC.

 

Follow-Up on Authorization

 

  • Contact GHC's member services to confirm receipt of your prior authorization request and documentation.
  •  

  • Keep track of any reference numbers or correspondence related to your request for future follow-ups.
  •  

  • Inquire about the expected timeline for decision-making regarding your authorization request.

 

Appeal If Necessary

 

  • If your request for Lantus coverage is denied, review the denial letter carefully to understand the reasons for denial.
  •  

  • Gather any additional supporting documents or new information that may strengthen your case for coverage.
  •  

  • Submit an appeal within the timeline specified by GHC, including a detailed explanation and any new evidence.
  •  

  • Consider seeking assistance from your healthcare provider or a patient advocacy organization if you need additional help during the appeal process.

 

Utilize Member Resources

 

  • Explore any available GHC member resources or assistance programs that may help with medication costs or insurance challenges.
  •  

  • Consider reaching out to a GHC case manager or social worker if your situation requires personalized assistance or coordination.

 

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FAQs

Does Group Health Cooperative (GHC) Cover Lantus

Discover if Group Health Cooperative covers Lantus, reasons for denial, coverage tips, Lantus costs without insurance, and answers to common questions.
Curex allergy drops unboxing

Is Lantus Covered by Group Health Cooperative (GHC)

 

Coverage for Lantus by Group Health Cooperative (GHC)

 

  • Lantus, a long-acting insulin, is covered by GHC under prescription drug benefits. However, coverage specifics may vary based on the particular health plan.
  •  

  • To qualify for coverage, a valid prescription from a healthcare provider is necessary. Medical necessity must be demonstrated as part of the coverage criteria.
  •  

  • Prior authorization may be required for coverage approval, depending on the health plan specifics. Patients should check with GHC or their healthcare provider for plan-specific requirements.
  •  

  • Out-of-pocket costs, such as copayments or coinsurance, depend on the member's health plan tier for prescription medications.
  •  

  • GHC covers Lantus for situations involving diabetes management, but patients may need to adhere to step therapy protocols, trying less expensive medications first unless exempt.

 

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

 

Approved Criteria for Lantus Coverage

 

  • Patients diagnosed with Type 1 Diabetes Mellitus requiring insulin therapy for glycemic control.
  •  

  • Patients diagnosed with Type 2 Diabetes Mellitus where blood sugar levels cannot be adequately controlled with oral medications and/or other forms of insulin.
  •  

  • Individuals with a documented history of recurrent episodes of hypoglycemia or hyperglycemia in need of long-acting insulin to stabilize glucose levels.
  •  

  • Patients with a history of severe insulin resistance where alternative insulin therapies have been insufficient to achieve target glucose control.
  •  

  • Individuals transitioning from another form of long-acting insulin and requiring continuity of care to maintain glucose target levels.
  •  

  • Pediatric patients over the age of 6 who meet one of the above criteria and require long-acting insulin therapy as part of their diabetes management plan.
  •  

  • Patients demonstrating allergic reactions or adverse effects to other forms of insulin who require Lantus for effective diabetes management.
  •  

  • Patients prescribed Lantus as part of an integrated management plan developed in collaboration with a specialist endocrinologist or diabetes care team.
  •  

 

Why Group Health Cooperative (GHC) Might Deny Lantus Coverage

 

Reasons for Lantus Coverage Denial by GHC

 

  • **Non-Prescription Use**: If Lantus is being requested for purposes not prescribed by a healthcare provider, GHC may deny coverage.
  •  

  • **Non-Formulary Drug**: When Lantus is classified as a non-formulary drug without any pre-approved exceptions, coverage may be refused.
  •  

  • **Failure to Meet Medical Necessity**: If there is insufficient documentation proving that Lantus is medically necessary for the member's condition, GHC might not cover it.
  •  

  • **Lack of Prior Authorization**: Requests for Lantus that do not go through the necessary prior authorization process may be denied coverage.
  •  

  • **Non-Compliance with Step Therapy**: If there is a requirement for step therapy and the member has not tried other approved drugs first, GHC might deny Lantus.
  •  

  • **Out-of-Network Provider**: Prescriptions from non-network providers may not be covered under GHC's policies.
  •  

  • **Age or Duration Limits**: If Lantus is requested for an age group or for a duration not covered by GHC’s policy guidelines, it may be subject to denial.

 

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

  • The price of Lantus (insulin glargine) without insurance can vary based on factors such as the pharmacy, location, and available discounts. Typically, the retail price ranges between $250 and $350 for a 10ml vial at a retail pharmacy.
  •  

  • For the Lantus SoloStar pen, which is a more convenient option for some, the price is generally similar, ranging from $400 to $500 for a pack of five pens.
  •  

  • Prices can fluctuate slightly, so it is advisable to check with local pharmacies or online services for the most current prices and potential savings options.
  •  

  • Consider exploring patient assistance programs offered by the manufacturer or third-party organizations, which might offer Lantus at reduced prices or even for free if you qualify based on income.

 

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 Lantus Coverage with Group Health Cooperative (GHC)

 

Check Your GHC Membership Plan

 

  • Log in to your Group Health Cooperative (GHC) member portal to review your current health insurance plan details.
  •  

  • Look for information on prescription drug coverage and identify the drug formulary associated with your plan.
  •  

  • If you're unsure, contact GHC member services for clarity on your current plan's prescription benefits.

 

Verify Lantus Coverage

 

  • Access the GHC drug formulary list online or request a physical copy. Search for "Lantus" to confirm its inclusion and any tiers it may fall under.
  •  

  • If Lantus is included, check if there are any restrictions, such as prior authorization, quantity limits, or step therapy requirements.
  •  

  • Note any specific requirements or exclusions that may apply to your coverage for Lantus.

 

Consult with Your Healthcare Provider

 

  • Schedule a meeting or call with your primary care physician or endocrinologist to discuss your medical necessity for Lantus.
  •  

  • Ask your healthcare provider to write a prescription and, if necessary, provide supporting documentation for the medical necessity of Lantus.
  •  

  • Your provider may need to submit a prior authorization form on your behalf if required by GHC.

 

Submit Required Documentation

 

  • If prior authorization is required, ensure your healthcare provider submits all necessary forms and documentation to GHC promptly.
  •  

  • Gather any additional documentation such as medical records or a letter of medical necessity from your healthcare provider to support your case.
  •  

  • Ensure that all submissions are complete and sent through the appropriate channels (fax, mail, or online submission) as specified by GHC.

 

Follow-Up on Authorization

 

  • Contact GHC's member services to confirm receipt of your prior authorization request and documentation.
  •  

  • Keep track of any reference numbers or correspondence related to your request for future follow-ups.
  •  

  • Inquire about the expected timeline for decision-making regarding your authorization request.

 

Appeal If Necessary

 

  • If your request for Lantus coverage is denied, review the denial letter carefully to understand the reasons for denial.
  •  

  • Gather any additional supporting documents or new information that may strengthen your case for coverage.
  •  

  • Submit an appeal within the timeline specified by GHC, including a detailed explanation and any new evidence.
  •  

  • Consider seeking assistance from your healthcare provider or a patient advocacy organization if you need additional help during the appeal process.

 

Utilize Member Resources

 

  • Explore any available GHC member resources or assistance programs that may help with medication costs or insurance challenges.
  •  

  • Consider reaching out to a GHC case manager or social worker if your situation requires personalized assistance or coordination.

 

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Lantus FAQ

What is Lantus used for?

 

What is Lantus Used For?

 

  • Lantus is primarily used to manage blood sugar levels in individuals with type 1 and type 2 diabetes.
  •  

  • It is a long-acting insulin, providing a steady release of insulin over a 24-hour period with no pronounced peak, mimicking natural insulin secretion.
  •  

  • It's taken once daily, often at the same time each day, helping to maintain consistent blood glucose control.
  •  

  • Beneficial for patients requiring basal insulin to prevent hyperglycemia between meals and overnight.
  •  

  • Alongside diet and exercise, Lantus is vital for comprehensive diabetes management.

 

How does Lantus work in the body?

 

How Lantus Works

 

  • Lantus is a long-acting insulin, also known as insulin glargine. It provides a stable and continuous release of insulin to control blood sugar levels.
  •  

  • The formulation of Lantus enables it to dissolve slowly upon injection, creating a slow and steady insulin level that lasts up to 24 hours.
  •  

  • This minimizes the risk of blood sugar peaks and troughs, providing more consistent blood glucose management.
  •  

  • Lantus mimics the basal level of insulin production in the pancreas, thus helping to maintain glucose balance between meals and overnight.
  •  

  • It binds to insulin receptors, facilitating glucose uptake into muscle and fat tissues, while inhibiting hepatic glucose production.

 

What are the side effects of Lantus?

 

Common Side Effects

 

  • Injection site reactions such as redness, swelling, or itching can occur.
  • Hypoglycemia, or low blood sugar, is a frequent side effect.
  • Weight gain may happen due to improved glucose utilization.

 

Less Common Side Effects

 

  • Allergic reactions like rash or itching may occur but are rare.
  • Systemic reactions such as swelling of hands/feet can occur.
  • Visual changes might be experienced during initial treatment.

 

Serious Side Effects

 

  • Severe hypoglycemia requiring intervention.
  • Signs of allergic reactions like difficulty breathing, require immediate attention.
  • Hypokalemia may develop, leading to muscle weakness or cramps.

 

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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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