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Does Independence Blue Cross Cover Trelegy

Explore why Independence Blue Cross may deny Trelegy, how to secure coverage, costs without insurance, and find answers to common Trelegy questions.
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Coverage Overview

 

  • Independence Blue Cross (IBC) may cover Trelegy for patients with chronic obstructive pulmonary disease (COPD) or asthma, depending on the specific plan.

    •  

  • Coverage is contingent upon meeting specific medical necessity criteria defined by IBC.

 

Criteria for Coverage

 

  • Patients must have a diagnosis of COPD or asthma and demonstrate a need for a combination inhaler therapy.

    •  

  • Proof of prior trials and failure, or contraindication, with other COPD or asthma medications may be required.

 

Prior Authorization

 

  • Trelegy often requires prior authorization from IBC to ensure that the drug is medically necessary.

    •  

  • Prescribers should submit documentation via the insurer’s portal or through forms provided by Independence Blue Cross.

 

Plan-Specific Details

 

  • Coverage details for Trelegy can vary significantly depending on whether the patient has an HMO, PPO, or another type of plan.

    •  

  • Members should contact Independence Blue Cross directly or check their specific benefits online to confirm their coverage status.

 

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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

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 Independence Blue Cross

 

Check Your Current Coverage

 

  • Log in to the Independence Blue Cross member portal to review your current plan details.

    •  

  • Look for the prescription drug coverage section to see if Trelegy is listed in your formulary.

 

Consult Your Doctor

 

  • Speak with your healthcare provider about needing Trelegy and whether it's the right medication for your condition.

    •  

  • Ask your doctor if any prior authorization is needed from Independence Blue Cross before prescribing Trelegy.

 

Contact Independence Blue Cross

 

  • Call the customer service number on the back of your insurance card to inquire about Trelegy coverage.

    •  

  • Verify if Trelegy requires prior authorization, and if so, ask for the steps involved.

 

Submit Prior Authorization Request

 

  • If prior authorization is required, work with your doctor to submit the necessary forms and documentation.

    •  

  • Ensure that all required information, such as medical history and necessity reason, is included.

 

Review Formulary Alternatives

 

  • If Trelegy is not covered or too costly, consider asking your doctor about alternative medications that are preferred by Independence Blue Cross.

    •  

  • Check the formulary for other similar medications that might not need prior authorization.

 

Appeal a Denial

 

  • If your request for coverage is denied, review the denial letter carefully for the reason and follow the appeals process outlined in the letter.

    •  

  • Prepare any additional documentation or support letters from your physician needed for the appeal.

 

Utilize Pharmacy Benefits

 

  • Ensure that you are using an in-network pharmacy to avoid unnecessary costs.

    •  

  • Ask if there's a mail-order pharmacy option through Independence Blue Cross which may offer cost savings on long-term prescriptions.

 

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FAQs

Does Independence Blue Cross Cover Trelegy

Explore why Independence Blue Cross may deny Trelegy, how to secure coverage, costs without insurance, and find answers to common Trelegy questions.
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Is Trelegy Covered by Independence Blue Cross

 

Coverage Overview

 

  • Independence Blue Cross (IBC) may cover Trelegy for patients with chronic obstructive pulmonary disease (COPD) or asthma, depending on the specific plan.

    •  

  • Coverage is contingent upon meeting specific medical necessity criteria defined by IBC.

 

Criteria for Coverage

 

  • Patients must have a diagnosis of COPD or asthma and demonstrate a need for a combination inhaler therapy.

    •  

  • Proof of prior trials and failure, or contraindication, with other COPD or asthma medications may be required.

 

Prior Authorization

 

  • Trelegy often requires prior authorization from IBC to ensure that the drug is medically necessary.

    •  

  • Prescribers should submit documentation via the insurer’s portal or through forms provided by Independence Blue Cross.

 

Plan-Specific Details

 

  • Coverage details for Trelegy can vary significantly depending on whether the patient has an HMO, PPO, or another type of plan.

    •  

  • Members should contact Independence Blue Cross directly or check their specific benefits online to confirm their coverage status.

 

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Independence Blue Cross's Approved Criteria for Trelegy Coverage

 

Coverage Criteria for Trelegy by Independence Blue Cross

 

  • Trelegy is covered for patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and/or emphysema, who require treatment with a combination inhaler for optimal management of their symptoms.

    •  

  • Patients must have a documented history of exacerbations despite receiving a combination of a long-acting beta-agonist (LABA) and inhaled corticosteroid (ICS), necessitating the need for a comprehensive therapy such as Trelegy.

    •  

  • Individuals over the age of 18 are eligible for coverage if they have experienced inadequate symptom control with their current COPD or asthma treatments and require the addition of a long-acting muscarinic antagonist (LAMA).

    •  

  • Demonstration of pulmonary function tests indicating moderate to severe airflow limitation is necessary, which establishes the need for triple therapy inhalation treatment.

    •  

  • For patients with asthma, Trelegy is approved for those who are not adequately controlled on a maintenance regimen of ICS/LABA and require the third component, a LAMA, to help achieve control of asthma symptoms.

    •  

  • Requirement of prior authorization demonstrating that the patient meets the diagnostic criteria and has a clinical necessity for triple inhaler therapy.

    •  

  • Patients are eligible if alternative treatments were insufficient at managing symptoms and the healthcare provider has determined the necessity of Trelegy for their treatment plan.

 

Why Independence Blue Cross Might Deny Trelegy Coverage

 

Situations Where Independence Blue Cross Might Deny Trelegy Coverage

 

  • **Non-Medical Reasons**: The prescription may not be covered if it’s for conditions not approved by the FDA for Trelegy usage, such as unverified off-label uses.

    •  

  • **Lack of Prior Authorization**: Independence Blue Cross may require prior authorization for Trelegy. Failure to obtain this authorization can result in a denial of coverage.

    •  

  • **Failure to Meet Clinical Criteria**: If the patient does not meet the specific clinical criteria outlined by the insurance company, such as severity of condition or prerequisite trials of other medications, coverage may be denied.

    •  

  • **Exceeding Quantity Limits**: There could be a limit on the number of inhalers covered within a certain time frame. Exceeding this amount may lead to denial.

    •  

  • **Policy Exclusions**: If the patient's insurance policy includes exclusions specific to Trelegy or inhaled corticosteroids, the medication may not be covered.

    •  

  • **Generic Alternatives Requirement**: Coverage may be denied if there is a requirement to try a generic alternative before approval for Trelegy is granted.

 

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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.

 

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

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 Independence Blue Cross

 

Check Your Current Coverage

 

  • Log in to the Independence Blue Cross member portal to review your current plan details.

    •  

  • Look for the prescription drug coverage section to see if Trelegy is listed in your formulary.

 

Consult Your Doctor

 

  • Speak with your healthcare provider about needing Trelegy and whether it's the right medication for your condition.

    •  

  • Ask your doctor if any prior authorization is needed from Independence Blue Cross before prescribing Trelegy.

 

Contact Independence Blue Cross

 

  • Call the customer service number on the back of your insurance card to inquire about Trelegy coverage.

    •  

  • Verify if Trelegy requires prior authorization, and if so, ask for the steps involved.

 

Submit Prior Authorization Request

 

  • If prior authorization is required, work with your doctor to submit the necessary forms and documentation.

    •  

  • Ensure that all required information, such as medical history and necessity reason, is included.

 

Review Formulary Alternatives

 

  • If Trelegy is not covered or too costly, consider asking your doctor about alternative medications that are preferred by Independence Blue Cross.

    •  

  • Check the formulary for other similar medications that might not need prior authorization.

 

Appeal a Denial

 

  • If your request for coverage is denied, review the denial letter carefully for the reason and follow the appeals process outlined in the letter.

    •  

  • Prepare any additional documentation or support letters from your physician needed for the appeal.

 

Utilize Pharmacy Benefits

 

  • Ensure that you are using an in-network pharmacy to avoid unnecessary costs.

    •  

  • Ask if there's a mail-order pharmacy option through Independence Blue Cross which may offer cost savings on long-term prescriptions.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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.

 

Have questions left?

‍

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A weight management program tailored to you

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 (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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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