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Does Humana Cover Stelara

Discover if Humana covers Stelara, reasons for denial, steps to secure coverage, costs without insurance, and answers to your Stelara-related questions.

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Does Humana Cover Stelara?

Coverage for Stelara may vary by individual insurance plans under Humana. It's essential to review your specific policy or consult directly with Humana to confirm details.

Stelara is generally covered for treating conditions like moderate to severe plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis.

Typically, coverage requires a prior authorization process. This process involves verifying that Stelara is medically necessary, often evidenced by a doctor’s recommendation and supporting clinical documentation.

Patients usually need to have tried and failed other treatments or medications before Stelara is approved for coverage as part of step therapy protocols.

Co-pays or co-insurance for Stelara can differ, so checking with Humana on the specifics of the financial responsibility is advisable.

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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 Stelara Coverage with Humana

Check Your Insurance Policy

Review your current Humana insurance plan documents to ensure that Stelara is listed under covered medications or treatments.

Look for any specific requirements, such as prior authorization or step therapy, which might be needed before coverage is effective.

Contact Humana Member Services

Call the Humana Member Services number found on your insurance card to discuss coverage details for Stelara.

Ask about any specific steps or additional documentation required to secure coverage for your prescription.

Consult with Your Healthcare Provider

Speak with your healthcare provider about prescribing Stelara and discuss any necessary documentation, such as medical necessity or clinical notes, needed for insurance processing.

Ensure your doctor provides detailed information that supports the necessity of Stelara for your treatment plan.

Prepare Necessary Documentation

Gather all required documents, including your prescription for Stelara, letters of medical necessity, and any past treatment records that can support the need for Stelara.

Make copies of all documents to keep for your records and to submit to Humana if needed.

Submit a Prior Authorization Request

If required, have your healthcare provider submit a prior authorization request with the necessary documentation provided by Humana.

Follow up to ensure that the request is received and processed by the insurance company promptly.

Verify Coverage and Approval

Once the prior authorization is submitted, contact Humana to verify that the request has been approved and Stelara is covered under your plan.

Request an official confirmation of coverage or approval letter for your records and future reference.

Understand Co-Payments and Costs

Review your Humana plan to understand your co-payment obligations or any out-of-pocket costs associated with receiving Stelara.

Contact Humana if you have questions regarding financial assistance or patient support programs that may help with medication costs.

Fill Your Prescription

Once coverage is confirmed, proceed with filling your Stelara prescription through a pharmacy or specialty pharmacy recommended by Humana.

Provide any necessary insurance information to ensure that your coverage is applied correctly at the point of sale.

Follow Up Regularly

Regularly follow up with Humana and your healthcare provider to ensure ongoing coverage and address any changes in policy or medical needs.

Keep track of your treatment and any billing issues, contacting Humana promptly if discrepancies occur.

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Does Humana Cover Stelara

Discover if Humana covers Stelara, reasons for denial, steps to secure coverage, costs without insurance, and answers to your Stelara-related questions.

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Is Stelara Covered by Humana

Does Humana Cover Stelara?

Coverage for Stelara may vary by individual insurance plans under Humana. It's essential to review your specific policy or consult directly with Humana to confirm details.

Stelara is generally covered for treating conditions like moderate to severe plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis.

Typically, coverage requires a prior authorization process. This process involves verifying that Stelara is medically necessary, often evidenced by a doctor’s recommendation and supporting clinical documentation.

Patients usually need to have tried and failed other treatments or medications before Stelara is approved for coverage as part of step therapy protocols.

Co-pays or co-insurance for Stelara can differ, so checking with Humana on the specifics of the financial responsibility is advisable.

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Humana's Approved Criteria for Stelara Coverage

Criteria for Coverage under Crohn's Disease

Patient must be 18 years or older.
A confirmed diagnosis of moderate to severe active Crohn's disease.
Documented failure or intolerance to at least one conventional therapy or tumor necrosis factor (TNF) inhibitor.
Prescribing authority by a gastroenterologist or a healthcare professional specializing in gastroenterology.

Criteria for Coverage under Ulcerative Colitis

Patient must be diagnosed with moderate to severe active ulcerative colitis.
Inadequate response or intolerance to at least one conventional therapy, which may include corticosteroids, azathioprine, or mesalamine.
Initiation of therapy should be overseen by a gastroenterologist or appropriate specialist.

Criteria for Coverage under Plaque Psoriasis

Indicated for adults diagnosed with moderate to severe plaque psoriasis.
Inadequate response or contraindication to traditional systemic therapies such as methotrexate or cyclosporine.
Prescribed by a dermatologist or a healthcare professional with experience in dermatological treatments.

Criteria for Coverage under Psoriatic Arthritis

Stelara is indicated in adult patients with active psoriatic arthritis.
Previous treatment failure or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs).
Recommendation and monitoring by a rheumatologist or specialist in managing arthritis.

General Conditions for Stelara Coverage

Verification of patient's age and diagnosis must be provided.
Comprehensive documentation of previous treatment attempts and outcomes is required.
First course of treatment to be prescribed and followed by a specialist with experience in managing the indicated condition.
Continued therapy contingent on demonstration of improvement or stabilization of the disease symptomatology.

Why Humana Might Deny Stelara Coverage

Reasons for Stelara Coverage Denial by Humana

Stelara may not be covered if it is prescribed for a condition that is not FDA-approved or lacks sufficient clinical evidence for efficacy and safety according to Humana's guidelines.

Coverage might be denied if the patient does not meet the necessary medical necessity criteria established by Humana, such as specific diagnostic requirements or failed previous treatments.

If prior authorization protocols are not followed, or if documentation does not adequately justify the need for Stelara, the claim could be denied.

Coverage could be refused if there is non-compliance with Humana's step therapy or fail-first requirements, where alternative therapies should be tried before approving Stelara.

A denial might occur if the pharmacy or healthcare provider is outside of Humana's network, or if the plan does not include out-of-network benefits for this treatment.

If the prescribed dosage or quantity does not align with Humana's approved formulary limits, the insurance might reject the coverage request.

If the patient's specific plan does not include specialty drugs or if Stelara is not included in the formulary covered by the individual's particular benefit package, coverage would likely be denied.

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How Much Does Stelara Cost without Insurance?

Approximate Cost of Stelara without Insurance

The price of Stelara, a medication used primarily for treating conditions such as psoriasis and Crohn's disease, can vary based on the pharmacy and other location-based factors, but without insurance, it typically costs around $20,000 to $40,000 per year.

Individual dosage needs and treatment plans can affect the total cost, as Stelara injections are spaced differently depending on treatment guidelines for specific conditions.

Pricing can also vary depending on the dosage strength; the standard doses are 45 mg and 90 mg, with the 90 mg dose generally being more expensive.

Patients can sometimes find manufacturer coupons or patient assistance programs that help reduce the cost of Stelara. These programs usually require an application process and eligibility criteria.

Additionally, discount pharmacy programs or third-party coupon providers might offer savings, although these are often limited and may vary in percentage or availability.

Clinical Support

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

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

Kayla Mardaga, NP

How to Get Stelara Coverage with Humana

Check Your Insurance Policy

Review your current Humana insurance plan documents to ensure that Stelara is listed under covered medications or treatments.

Look for any specific requirements, such as prior authorization or step therapy, which might be needed before coverage is effective.

Contact Humana Member Services

Call the Humana Member Services number found on your insurance card to discuss coverage details for Stelara.

Ask about any specific steps or additional documentation required to secure coverage for your prescription.

Consult with Your Healthcare Provider

Speak with your healthcare provider about prescribing Stelara and discuss any necessary documentation, such as medical necessity or clinical notes, needed for insurance processing.

Ensure your doctor provides detailed information that supports the necessity of Stelara for your treatment plan.

Prepare Necessary Documentation

Gather all required documents, including your prescription for Stelara, letters of medical necessity, and any past treatment records that can support the need for Stelara.

Make copies of all documents to keep for your records and to submit to Humana if needed.

Submit a Prior Authorization Request

If required, have your healthcare provider submit a prior authorization request with the necessary documentation provided by Humana.

Follow up to ensure that the request is received and processed by the insurance company promptly.

Verify Coverage and Approval

Once the prior authorization is submitted, contact Humana to verify that the request has been approved and Stelara is covered under your plan.

Request an official confirmation of coverage or approval letter for your records and future reference.

Understand Co-Payments and Costs

Review your Humana plan to understand your co-payment obligations or any out-of-pocket costs associated with receiving Stelara.

Contact Humana if you have questions regarding financial assistance or patient support programs that may help with medication costs.

Fill Your Prescription

Once coverage is confirmed, proceed with filling your Stelara prescription through a pharmacy or specialty pharmacy recommended by Humana.

Provide any necessary insurance information to ensure that your coverage is applied correctly at the point of sale.

Follow Up Regularly

Regularly follow up with Humana and your healthcare provider to ensure ongoing coverage and address any changes in policy or medical needs.

Keep track of your treatment and any billing issues, contacting Humana promptly if discrepancies occur.

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Stelara FAQ

What are the common side effects of Stelara?

Common Side Effects of Stelara

**Infections:** Increased susceptibility to infections such as upper respiratory infections and strep throat.
**Headache:** This is a frequently reported side effect among patients who use Stelara.
**Tiredness:** Many individuals may experience fatigue or tiredness while on this medication.
**Redness at Injection Site:** Skin irritation, including redness, itching, or swelling, can occur at the site of injection.
**Nausea:** Some patients report feeling mildly nauseated after taking the medication.

How does Stelara work for psoriasis?

Mechanism of Action

Stelara is a monoclonal antibody that targets interleukin-12 (IL-12) and interleukin-23 (IL-23), which are proteins involved in inflammatory processes associated with psoriasis.

Impact on the Immune System

By inhibiting IL-12 and IL-23, Stelara reduces the activity of specific immune cells (T-cells) that contribute to the inflammation and rapid skin cell production characteristic of psoriasis.

Clinical Efficacy

Many patients experience significant reductions in psoriasis symptoms, including skin clearance, with improvements often visible within weeks after initial treatment.

Administration and Dosage

Stelara is administered via subcutaneous injection, starting with a loading dose followed by maintenance doses every 12 weeks thereafter.

How often do you need Stelara injections?

Stelara Injection Schedule

Initial Doses: After the first dose is administered, a second dose follows four weeks later.

Maintenance Doses: Subsequent injections are given every 12 weeks.

Special Cases: Depending on specific conditions like Crohn's disease, the frequency may vary under a physician's guidance.

Administration: Stelara is typically administered as a subcutaneous injection which can be performed in a healthcare setting or self-administered after proper training.

Consult Your Doctor: Always consult with your healthcare provider to tailor the schedule to your medical needs.

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Initial Dosage

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.

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. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does Humana Cover Stelara

Discover if Humana covers Stelara, reasons for denial, steps to secure coverage, costs without insurance, and answers to your Stelara-related questions.

Achieve Your Goals Faster with Curex