Does Humana Cover Januvia

Find out if Humana covers Januvia, reasons for denial, steps to secure coverage, costs without insurance, and get answers to common questions in this detailed guide.
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Coverage of Januvia by Humana

 

  • Humana covers Januvia as part of its prescription drug plans, depending on the specific policy held. Coverage may vary by plan tier and formulary listing.
  •  

  • To be eligible for coverage, Januvia must be prescribed by a healthcare provider for its FDA-approved use, which primarily includes managing Type 2 diabetes.
  •  

  • Most Humana plans require a prior authorization to determine medical necessity, ensuring that Januvia is appropriate for the patient's condition.
  •  

  • Patients might have to try a less expensive medication first, as part of step therapy protocols, before Humana approves Januvia coverage.
  •  

  • Co-payments or co-insurance fees typically apply, varying based on the patient's specific plan and its terms regarding tiered drugs.

 

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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 Januvia Coverage with Humana

 

Verify Coverage Options

 

  • Contact Humana Customer Service by calling the number on the back of your insurance card to confirm if Januvia is covered under your current plan.
  •  

  • Visit the Humana website and log into your member account to review your prescription drug list, also known as a formulary.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of Januvia as part of your treatment plan.
  •  

  • Request a detailed prescription plan from your healthcare provider, documenting why Januvia is required over other medications.

 

Check Humana's Formularies

 

  • Access Humana’s online formulary search to check if Januvia is listed and under what tier it falls.
  •  

  • Identify if there are any restrictions, prior authorizations, or step therapy requirements for Januvia.

 

Manage Prior Authorization (if required)

 

  • Have your healthcare provider submit a prior authorization request to Humana if necessary. This includes providing clinical documentation supporting the need for Januvia.
  •  

  • Follow up with Humana to ensure the prior authorization request is processed and confirmed.

 

Compare Plan Options

 

  • Evaluate other Humana health plans during annual enrollment if your current plan does not cover Januvia or has unfavorable terms.
  •  

  • Consider Humana plans with better prescription coverage benefits if you need ongoing access to Januvia.

 

Utilize Humana Pharmacy Services

 

  • Check if Humana offers any specific pharmacy services or discounts for Januvia.
  •  

  • Use mail-order services offered by Humana to possibly reduce the cost of Januvia and ensure convenient delivery.

 

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FAQs

Does Humana Cover Januvia

Find out if Humana covers Januvia, reasons for denial, steps to secure coverage, costs without insurance, and get answers to common questions in this detailed guide.
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Is Januvia Covered by Humana

 

Coverage of Januvia by Humana

 

  • Humana covers Januvia as part of its prescription drug plans, depending on the specific policy held. Coverage may vary by plan tier and formulary listing.
  •  

  • To be eligible for coverage, Januvia must be prescribed by a healthcare provider for its FDA-approved use, which primarily includes managing Type 2 diabetes.
  •  

  • Most Humana plans require a prior authorization to determine medical necessity, ensuring that Januvia is appropriate for the patient's condition.
  •  

  • Patients might have to try a less expensive medication first, as part of step therapy protocols, before Humana approves Januvia coverage.
  •  

  • Co-payments or co-insurance fees typically apply, varying based on the patient's specific plan and its terms regarding tiered drugs.

 

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Humana's Approved Criteria for Januvia Coverage

 

Initial Criteria for Coverage

 

  • The patient must have a diagnosis of type 2 diabetes mellitus.
  •  

  • The patient should be 18 years of age or older.
  •  

  • Documentation confirming that Januvia (sitagliptin) is being prescribed as part of a comprehensive diabetes management plan, including diet and exercise interventions, is required.
  •  

  • The prescription must be for an FDA-approved dosage and administration schedule.

 

Prior Medication Use

 

  • The patient must have tried and failed metformin therapy or demonstrate an intolerance or contraindication to metformin.
  •  

  • In cases where combination therapy is indicated, the patient may need to have tried and not achieved adequate glycemic control with a sulfonylurea, a thiazolidinedione, or other oral anti-diabetic medications, unless contraindicated or not tolerated.

 

Medical and Laboratory Documentation

 

  • Current HbA1c (hemoglobin A1c) levels must be provided to justify the need for Januvia as a component of the treatment regimen.
  •  

  • Additional laboratory tests and documentation may be required to establish baseline renal function, given that dose adjustments may be necessary for patients with moderate to severe renal impairment.

 

Continuation of Therapy

 

  • The patient must show evidence of continuing clinical benefit from Januvia therapy, typically demonstrated by improvement in HbA1c levels.
  •  

  • Regular follow-ups and monitoring should show adherence to the prescribed medication regimen, as well as ongoing lifestyle modifications such as dietary changes and regular physical activity.

 

Insurance Specific Requests

 

  • Additional insurance pre-authorizations or exception requests may be necessary, particularly if other less expensive formulary alternatives are available and covered by the plan.
  •  

  • Supporting documentation, including notes from the healthcare provider, may be needed for submission when requesting pre-authorization.

 

Why Humana Might Deny Januvia Coverage

 

Reasons Humana Might Deny Januvia Coverage

 

  • **Non-Formulary Drug**: Januvia might not be included in Humana's formulary list of covered medications. If a specific medication is not on the formulary list, coverage can be denied.
  •  

  • **Prior Authorization Required**: Coverage might be denied if prior authorization is needed but not obtained. Januvia might require prior approval from Humana before coverage is granted.
  •  

  • **Lack of Medical Necessity**: If Humana determines that the use of Januvia is not medically necessary based on the patient's health condition and treatment history, coverage can be refused.
  •  

  • **Step Therapy Protocols**: Humana might require patients to try other, often less expensive, diabetes medications before approving coverage for Januvia. If these protocols are not followed, coverage could be denied.
  •  

  • **Expiration of Authorization**: If an existing authorization for Januvia expires without renewal, coverage can be declined until reauthorization is completed.
  •  

  • **Incorrect or Incomplete Documentation**: If necessary paperwork or documentation to justify the need for Januvia is incomplete or incorrectly submitted, claims for coverage can be denied.
  •  

  • **Policy Exclusions**: Certain health insurance plans might specifically exclude coverage for specific drugs, including Januvia, as part of their policy terms.
  •  

 

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How Much Does Januvia Cost without Insurance?

 

Cost of Januvia Without Insurance

 

  • The cost of Januvia (sitagliptin) without insurance can vary based on the pharmacy and location but is typically around $500 to $600 for a 30-day supply of 100 mg tablets.
  •  

  • Prices may differ based on various factors, including pharmacy location, any discount programs available, or changes in the drug market.
  •  

  • It's advisable to check different pharmacies or consider discount programs and prescription savings cards, which can sometimes offer reductions on the retail price.
  •  

  • For individuals paying out of pocket, some online tools or pharmacy networks provide price comparison services to find the best possible rate for Januvia.

 

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 Januvia Coverage with Humana

 

Verify Coverage Options

 

  • Contact Humana Customer Service by calling the number on the back of your insurance card to confirm if Januvia is covered under your current plan.
  •  

  • Visit the Humana website and log into your member account to review your prescription drug list, also known as a formulary.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of Januvia as part of your treatment plan.
  •  

  • Request a detailed prescription plan from your healthcare provider, documenting why Januvia is required over other medications.

 

Check Humana's Formularies

 

  • Access Humana’s online formulary search to check if Januvia is listed and under what tier it falls.
  •  

  • Identify if there are any restrictions, prior authorizations, or step therapy requirements for Januvia.

 

Manage Prior Authorization (if required)

 

  • Have your healthcare provider submit a prior authorization request to Humana if necessary. This includes providing clinical documentation supporting the need for Januvia.
  •  

  • Follow up with Humana to ensure the prior authorization request is processed and confirmed.

 

Compare Plan Options

 

  • Evaluate other Humana health plans during annual enrollment if your current plan does not cover Januvia or has unfavorable terms.
  •  

  • Consider Humana plans with better prescription coverage benefits if you need ongoing access to Januvia.

 

Utilize Humana Pharmacy Services

 

  • Check if Humana offers any specific pharmacy services or discounts for Januvia.
  •  

  • Use mail-order services offered by Humana to possibly reduce the cost of Januvia and ensure convenient delivery.

 

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Januvia FAQ

What are the common side effects of Januvia?

 

Common Side Effects of Januvia

 

  • **Headache**: Often reported and can range from mild to moderate.
  •  

  • **Upper respiratory tract infections**: Can include symptoms like nasal congestion, sore throat, and runny nose.
  •  

  • **Sore throat**: May occur alongside other symptoms such as cough.
  •  

  • **Diarrhea**: Typically mild but can be uncomfortable.
  •  

  • **Nausea**: Some patients experience this, usually transient.
  •  

  • **Abdominal pain**: Not very common but can occur.
  •  

  • **Joint pain**: Although less common, can be experienced by some individuals.

How does Januvia work to control blood sugar?

 

How Januvia Works

 

  • Januvia (sitagliptin) is a DPP-4 inhibitor that enhances the body's own ability to control blood sugar levels by increasing incretin levels, hormones that help regulate insulin production.
  •  

  • Incretins like GLP-1 function by promoting insulin secretion from the pancreas when blood sugar levels are high, and they reduce glucose production in the liver.

 

Benefits

 

  • Prevents rapid glucose level increases after meals while maintaining normal insulin activity during fasting states.
  •  

  • Has a low risk of causing hypoglycemia, a common concern with some other diabetes medications.

 

Considerations

 

  • Commonly prescribed for patients with type 2 diabetes as part of a comprehensive health plan, including diet and exercise.
  •  

  • Adjustments may be necessary for those with renal impairment.

 

Can Januvia be taken with other diabetes medications?

 

Can Januvia Be Combined with Other Diabetes Medications?

 

  • Januvia, a DPP-4 inhibitor, is commonly used with other oral diabetes medications like metformin, sulfonylureas, or thiazolidinediones to improve blood sugar control.
  •  

  • When combined, careful monitoring is essential to avoid hypoglycemia, especially when Januvia is used with insulin or sulfonylureas which can lower blood sugar too much.
  •  

  • Consult your healthcare provider before combining januvia with any other medication to tailor treatment to your specific needs and health status.
  •  

  • There generally aren’t major drug-drug interaction concerns with Januvia, but liver and kidney function should be regularly assessed as they might affect treatment.

 

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Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

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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