Does Highmark Cover Trelegy

Explore if Highmark covers Trelegy, reasons for denial, ways to secure coverage, costs without insurance, and get key questions answered in our comprehensive guide.
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Does Highmark Cover Trelegy

 

  • Highmark typically covers Trelegy for patients diagnosed with COPD (Chronic Obstructive Pulmonary Disease) and asthma under certain conditions.
  • Coverage often requires prior authorization, confirming that Trelegy is medically necessary.
  • The patient may need to demonstrate an inadequate response to other treatments or meet specific criteria related to lung function tests.
  • Highmark's plan might require patients to try and fail other first-line treatments before Trelegy is covered.
  • Policy specifics can vary; it's important for members to contact Highmark directly or consult their healthcare provider to verify coverage.
  • Patients should ensure that their plan includes prescription drug coverage and confirm any copay or deductible requirements.

 

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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 Highmark

 

Check Highmark Coverage Plans

 

  • Visit the Highmark website to log into your member account. If you don't have one, you'll need to create it using your member ID.
  •  

  • Use the "Find a Plan" tool to review the summary of benefits and coverages. Look for plans that include prescription drug coverage.
  •  

  • Download or view the plan documents to ensure Trelegy is listed in the formulary. The formulary is a complete list of medications covered by the plan.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment or call your healthcare provider to discuss your need for Trelegy.
  •  

  • Ask your provider to confirm that Trelegy is medically necessary for your condition.
  •  

  • Ensure that your provider is aware of your insurance provider and any relevant coverage details, so they can assist in the process.

 

Obtain a Prescription

 

  • Your healthcare provider will need to provide you with a prescription for Trelegy if deemed appropriate.
  •  

  • Ensure the prescription includes all necessary details, such as dosage and number of refills.
  •  

  • Discuss any prior authorization or step therapy requirements that Highmark might have for Trelegy.

 

Contact Highmark Customer Service

 

  • Call the customer service number listed on your insurance card for direct assistance with coverage questions.
  •  

  • Request information on how to proceed if Trelegy requires prior authorization. The representative should guide you through the necessary steps.
  •  

  • Ask about any potential co-payments or out-of-pocket costs you may incur for Trelegy under your plan.

 

Submit Prior Authorization (if required)

 

  • If prior authorization is required, obtain the necessary forms from Highmark's website or the customer service representative.
  •  

  • Coordinate with your healthcare provider to complete and submit the forms. This often includes justifying the medical necessity of Trelegy.
  •  

  • Follow up with Highmark to ensure your prior authorization request is processed in a timely manner.

 

Fill Your Prescription

 

  • Once you have approval, take your prescription to an in-network pharmacy, or opt for mail-order services if available.
  •  

  • Confirm with the pharmacist that your Highmark insurance covers Trelegy and inquire about your cost after insurance is applied.
  •  

  • Keep your Highmark member ID card handy for any verification the pharmacy might require.

 

Appeal if Necessary

 

  • If your request for Trelegy coverage is denied, ask Highmark for a detailed explanation.
  •  

  • Work with your healthcare provider to gather any additional documentation that could support an appeal.
  •  

  • Submit your appeal following Highmark's procedures, and keep records of all correspondence during this process.

 

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FAQs

Does Highmark Cover Trelegy

Explore if Highmark covers Trelegy, reasons for denial, ways to secure coverage, costs without insurance, and get key questions answered in our comprehensive guide.
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Is Trelegy Covered by Highmark

 

Does Highmark Cover Trelegy

 

  • Highmark typically covers Trelegy for patients diagnosed with COPD (Chronic Obstructive Pulmonary Disease) and asthma under certain conditions.
  • Coverage often requires prior authorization, confirming that Trelegy is medically necessary.
  • The patient may need to demonstrate an inadequate response to other treatments or meet specific criteria related to lung function tests.
  • Highmark's plan might require patients to try and fail other first-line treatments before Trelegy is covered.
  • Policy specifics can vary; it's important for members to contact Highmark directly or consult their healthcare provider to verify coverage.
  • Patients should ensure that their plan includes prescription drug coverage and confirm any copay or deductible requirements.

 

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Highmark's Approved Criteria for Trelegy Coverage

 

Coverage Criteria for Trelegy

 

  • Trelegy is covered for members diagnosed with Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and/or emphysema, who require treatment with a combination of inhaled corticosteroid, long-acting muscarinic antagonist, and long-acting beta-agonist.
  •  

  • Eligible members must have a documented history of COPD confirmed by pulmonary function tests such as spirometry demonstrating airflow obstruction.
  •  

  • Patients should have a documented trial and failure, contraindication, or intolerance to appropriate alternative therapies for COPD such as maintenance treatment with inhaled corticosteroids (ICS) and long-acting beta-agonists (LABAs) or long-acting muscarinic antagonists (LAMAs) prior to the initiation of Trelegy.
  •  

  • Candidates for Trelegy should be adults aged 18 years and older.
  •  

  • Members who have experienced one or more COPD exacerbations requiring hospitalization or oral corticosteroids in the previous year may qualify for treatment with Trelegy.
  •  

  • An assessment and recommendation for Trelegy therapy by a healthcare provider specializing in respiratory diseases may support coverage determination.
  •  

 

Reauthorization Criteria for Continued Coverage

 

  • Improvement or stabilization of symptoms should be assessed to continue coverage for Trelegy. Documentation by a healthcare provider indicating that the patient's symptoms remain stable or have improved since the initiation of Trelegy is required.
  •  

  • Adherence to prescribed Trelegy treatment regimen over the approval period should be confirmed for authorization renewal.
  •  

  • No evidence of significant adverse effects or complications arising from the use of Trelegy, requiring regular monitoring and evaluation to ensure continued benefit.
  •  

  • Annual re-evaluation of the diagnosis and treatment plan by the prescribing healthcare provider to ascertain the necessity of continuing Trelegy.

 

Initiation and Dosing Details

 

  • Initial treatment should align with the prescribed dosage of Trelegy as indicated by the prescribing physician according to clinical guidelines for COPD management.
  •  

  • Adjustments to dosing should be made based on patient response and clinical judgment, with documentation provided for any changes in the treatment regimen.

 

Why Highmark Might Deny Trelegy Coverage

 

Reasons for Highmark Denying Trelegy Coverage

 

  • **Non-Formulary Medication:** Highmark might deny coverage if Trelegy is not listed in their specific formulary plan. Each insurance plan has a list of covered medications, and if Trelegy is not included, it might not be covered.
  •  

  • **Lack of Prior Authorization:** Highmark may require prior authorization for Trelegy. Failure to obtain this approval before filling a prescription can result in denial of coverage.
  •  

  • **Off-Label Use:** If Trelegy is prescribed for a condition not approved by the FDA or not listed in Highmark’s policy for covered uses, coverage may be denied.
  •  

  • **Non-Compliance with Step Therapy:** Highmark might implement step therapy requirements, meaning a patient must try and fail other preferred medications before Trelegy is covered. If these steps are not followed, coverage might be denied.
  •  

  • **Incomplete or Incorrect Documentation:** Highmark may deny coverage if the required documentation for Trelegy's prescription lacks necessary medical information or is incorrectly filled out by the healthcare provider.
  •  

  • **Plan Exclusions:** Some plans might exclude certain medications like Trelegy altogether for cost-saving reasons or due to the availability of alternative treatments within the plan.

 

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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 Highmark

 

Check Highmark Coverage Plans

 

  • Visit the Highmark website to log into your member account. If you don't have one, you'll need to create it using your member ID.
  •  

  • Use the "Find a Plan" tool to review the summary of benefits and coverages. Look for plans that include prescription drug coverage.
  •  

  • Download or view the plan documents to ensure Trelegy is listed in the formulary. The formulary is a complete list of medications covered by the plan.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment or call your healthcare provider to discuss your need for Trelegy.
  •  

  • Ask your provider to confirm that Trelegy is medically necessary for your condition.
  •  

  • Ensure that your provider is aware of your insurance provider and any relevant coverage details, so they can assist in the process.

 

Obtain a Prescription

 

  • Your healthcare provider will need to provide you with a prescription for Trelegy if deemed appropriate.
  •  

  • Ensure the prescription includes all necessary details, such as dosage and number of refills.
  •  

  • Discuss any prior authorization or step therapy requirements that Highmark might have for Trelegy.

 

Contact Highmark Customer Service

 

  • Call the customer service number listed on your insurance card for direct assistance with coverage questions.
  •  

  • Request information on how to proceed if Trelegy requires prior authorization. The representative should guide you through the necessary steps.
  •  

  • Ask about any potential co-payments or out-of-pocket costs you may incur for Trelegy under your plan.

 

Submit Prior Authorization (if required)

 

  • If prior authorization is required, obtain the necessary forms from Highmark's website or the customer service representative.
  •  

  • Coordinate with your healthcare provider to complete and submit the forms. This often includes justifying the medical necessity of Trelegy.
  •  

  • Follow up with Highmark to ensure your prior authorization request is processed in a timely manner.

 

Fill Your Prescription

 

  • Once you have approval, take your prescription to an in-network pharmacy, or opt for mail-order services if available.
  •  

  • Confirm with the pharmacist that your Highmark insurance covers Trelegy and inquire about your cost after insurance is applied.
  •  

  • Keep your Highmark member ID card handy for any verification the pharmacy might require.

 

Appeal if Necessary

 

  • If your request for Trelegy coverage is denied, ask Highmark for a detailed explanation.
  •  

  • Work with your healthcare provider to gather any additional documentation that could support an appeal.
  •  

  • Submit your appeal following Highmark's procedures, and keep records of all correspondence during this process.

 

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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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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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