Does Horizon Blue Cross Blue Shield of New Jersey Cover Jardiance

Explore if Horizon BCBS New Jersey covers Jardiance, learn the appeal process, cost without insurance, and get answers to common questions.
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Horizon BCBSNJ Coverage for Jardiance

 

  • Jardiance may be covered if prescribed for type 2 diabetes to help improve blood sugar levels along with diet and exercise.
  •  

  • Coverage might extend to certain heart failure conditions, following medical necessity criteria.
  •  

  • Approval often requires prior authorization, where Horizon BCBSNJ reviews necessity based on medical history and current condition.
  •  

  • Patients might need to try other medications before Jardiance, as part of a step therapy protocol.
  •  

  • Check your specific plan details for cost-sharing responsibilities like copayments or coinsurance.
  •  

  • Consult with a healthcare provider and Horizon BCBSNJ to ensure all criteria are met for coverage.

 

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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 Jardiance Coverage with Horizon Blue Cross Blue Shield of New Jersey

 

Verify Your Insurance Plan

 

  • Log into your Horizon Blue Cross Blue Shield of New Jersey account on their official website or app to review your current insurance plan details.
  •  

  • Check your plan's drug coverage section to see if Jardiance is listed as a covered medication.
  •  

  • Contact Horizon Blue Cross Blue Shield customer service if you need assistance confirming whether Jardiance is included in your policy.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about the necessity of Jardiance for your condition and ensure it's the right medication for you.
  •  

  • Request a formal prescription or letter of necessity, if needed, which could support your coverage request with your insurer.

 

Check for Prior Authorization Requirements

 

  • Find out if Jardiance requires prior authorization under your Horizon BCBS plan. This information can typically be found in the drug coverage details of your policy.
  •  

  • Work with your healthcare provider to submit a prior authorization request, if necessary. They may need to provide medical justification for your use of Jardiance.

 

Submit a Coverage Request

 

  • If Jardiance is not covered under your existing plan, request a coverage exception or appeal by contacting Horizon BCBS. This may involve completing specific forms or providing additional documentation from your doctor.
  •  

  • Provide any requested documentation promptly to avoid delays in processing your request.

 

Explore Copay Assistance Options

 

  • Investigate if Jardiance has a copay assistance program that can reduce out-of-pocket costs, even after insurance coverage is determined.
  •  

  • Apply for any manufacturer discounts or third-party assistance programs that may be available for Jardiance users.

 

Monitor and Follow-up

 

  • Once you've followed all steps, continuously monitor your request status through Horizon BCBS's online member portal or by contacting their customer service.
  •  

  • Follow up with both your healthcare provider and Horizon BCBS to ensure all documentation is appropriately submitted and processed.

 

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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Jardiance

Explore if Horizon BCBS New Jersey covers Jardiance, learn the appeal process, cost without insurance, and get answers to common questions.
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Is Jardiance Covered by Horizon Blue Cross Blue Shield of New Jersey

 

Horizon BCBSNJ Coverage for Jardiance

 

  • Jardiance may be covered if prescribed for type 2 diabetes to help improve blood sugar levels along with diet and exercise.
  •  

  • Coverage might extend to certain heart failure conditions, following medical necessity criteria.
  •  

  • Approval often requires prior authorization, where Horizon BCBSNJ reviews necessity based on medical history and current condition.
  •  

  • Patients might need to try other medications before Jardiance, as part of a step therapy protocol.
  •  

  • Check your specific plan details for cost-sharing responsibilities like copayments or coinsurance.
  •  

  • Consult with a healthcare provider and Horizon BCBSNJ to ensure all criteria are met for coverage.

 

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Horizon Blue Cross Blue Shield of New Jersey's Approved Criteria for Jardiance Coverage

 

Jardiance Coverage Criteria

 

  • Jardiance is approved for coverage when used to treat Type 2 Diabetes Mellitus in adults aiming to improve glycemic control when diet and exercise alone do not suffice.
  •  

  • Individuals must demonstrate a failure to achieve adequate glycemic control despite being on appropriate diabetic diet modifications and physical activity.
  •  

  • Coverage is provided for patients with a documented history of trying at least one other oral diabetic medication that was unsuccessful or not tolerated.
  •  

  • Jardiance may be covered when used in combination with other diabetic medications such as metformin, sulfonylurea, or insulin to achieve desired blood sugar levels.
  •  

  • Evidence of cardiovascular benefits, such as reduced risk of major adverse cardiovascular events in patients with established cardiovascular disease, supports coverage.
  •  

  • Documentation supporting the diagnosis, current therapeutic regimen, and history of previous treatments may be required for coverage evaluation.

 

Additional Considerations for Coverage

 

  • Individuals with contraindications to first-line diabetes medications may qualify for Jardiance as an alternative therapy.
  •  

  • Patients exhibiting chronic kidney disease (CKD) stages 1-3 may be eligible when Jardiance is used to address both glycemic control and to slow the progression of CKD.
  •  

  • Special consideration is given to patients who experience intolerable side effects or hypersensitivity to other approved medications for Type 2 Diabetes.

 

Why Horizon Blue Cross Blue Shield of New Jersey Might Deny Jardiance Coverage

 

Reasons for Denial of Jardiance Coverage

 

  • Jardiance might not be covered if it is not included in Horizon Blue Cross Blue Shield of New Jersey's formulary or drug list. The drug formulary outlines which medications are approved for coverage based on therapeutic efficacy and cost considerations.
  •  

  • Prescription of Jardiance for a non-approved use may result in denial. If the medication is prescribed for conditions other than what is recognized by the FDA or other authoritative agencies, coverage might be limited or denied.
  •  

  • Failure to meet prior authorization requirements could lead to refusal of coverage. If the insurance provider deems that the necessary prior approval or documentation is not submitted correctly or timely, it may deny coverage for Jardiance.
  •  

  • The patient has not demonstrated inadequate response to more cost-effective alternative treatments. If a patient fails to try or respond to alternative, less expensive treatments first, their request for Jardiance might be denied.
  •  

  • Exceeding quantity or dosage limits may result in non-coverage. If the prescribed dosage or quantity does not align with the insurance policy's guidelines, the coverage claim can be denied.
  •  

  • Insurance provisions related to lifestyle health condition management might exclude coverage. If Jardiance is used primarily as a lifestyle drug and not primarily for its approved clinical benefits, the plan might not cover it.

 

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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 Horizon Blue Cross Blue Shield of New Jersey

 

Verify Your Insurance Plan

 

  • Log into your Horizon Blue Cross Blue Shield of New Jersey account on their official website or app to review your current insurance plan details.
  •  

  • Check your plan's drug coverage section to see if Jardiance is listed as a covered medication.
  •  

  • Contact Horizon Blue Cross Blue Shield customer service if you need assistance confirming whether Jardiance is included in your policy.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about the necessity of Jardiance for your condition and ensure it's the right medication for you.
  •  

  • Request a formal prescription or letter of necessity, if needed, which could support your coverage request with your insurer.

 

Check for Prior Authorization Requirements

 

  • Find out if Jardiance requires prior authorization under your Horizon BCBS plan. This information can typically be found in the drug coverage details of your policy.
  •  

  • Work with your healthcare provider to submit a prior authorization request, if necessary. They may need to provide medical justification for your use of Jardiance.

 

Submit a Coverage Request

 

  • If Jardiance is not covered under your existing plan, request a coverage exception or appeal by contacting Horizon BCBS. This may involve completing specific forms or providing additional documentation from your doctor.
  •  

  • Provide any requested documentation promptly to avoid delays in processing your request.

 

Explore Copay Assistance Options

 

  • Investigate if Jardiance has a copay assistance program that can reduce out-of-pocket costs, even after insurance coverage is determined.
  •  

  • Apply for any manufacturer discounts or third-party assistance programs that may be available for Jardiance users.

 

Monitor and Follow-up

 

  • Once you've followed all steps, continuously monitor your request status through Horizon BCBS's online member portal or by contacting their customer service.
  •  

  • Follow up with both your healthcare provider and Horizon BCBS to ensure all documentation is appropriately submitted and processed.

 

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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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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.

Got questions? We have answers.

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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