Does Kaiser Permanente Cover Trelegy

Discover if Kaiser Permanente covers Trelegy, explore coverage options, learn costs without insurance, and find answers to common Trelegy questions.
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Does Kaiser Permanente Cover Trelegy?

 

  • Kaiser Permanente may cover Trelegy Ellipta, primarily used for the treatment of COPD and asthma. Coverage typically depends on the patient's specific health plan and the medical necessity as determined by the attending physician.
  •  

  • To get Trelegy covered, members might need a prescription after an evaluation by a healthcare provider. The patient may also be required to try other medications before Trelegy is approved, a process known as step therapy.
  •  

  • Members should confirm coverage details by checking their benefits document, as these are subject to change. If approved, prescription drug copayments or coinsurance will apply as per plan details.
  •  

  • Pre-authorization or a physician’s request might be necessary to ensure the medication is covered, based on the patient’s condition and treatment history.

 

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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 Kaiser Permanente

 

Check Your Eligibility

 

  • Log into your Kaiser Permanente member account online or contact their customer service to verify your plan's coverage for prescription medications, specifically for the Trelegy inhaler.
  •  

  • Ensure that your plan includes prescription drug coverage. Some plans might have different levels of pharmacy benefits.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your Kaiser Permanente primary care doctor or specialist to discuss your need for Trelegy.
  •  

  • Your doctor will evaluate your condition and decide if Trelegy is the appropriate medication for you.
  •  

  • If Trelegy is necessary, your doctor will write a prescription and possibly note it in your medical records on the Kaiser Permanente system.

 

Verify Prescription Coverage

 

  • With your Trelegy prescription, contact the Kaiser Permanente pharmacy department either online or by phone to confirm if the medication is covered under your specific plan tier.
  •  

  • Check if there are any restrictions such as prior authorization or step therapy, which might require trying a different medication first.

 

Obtain Prior Authorization if Needed

 

  • If Trelegy requires prior authorization, request your healthcare provider to submit the necessary documentation to Kaiser Permanente.
  •  

  • Ensure your doctor provides comprehensive information about your medical necessity for Trelegy, possibly including your treatment history and outcomes with other medications.

 

Explore Financial Assistance

 

  • Inquire if Kaiser Permanente offers any financial assistance programs to help cover the cost of Trelegy not covered by your insurance plan.
  •  

  • Look into any manufacturer coupons or patient assistance programs that Trelegy might offer, which can occasionally be combined with your insurance benefits.

 

Fill Your Prescription

 

  • Once you receive confirmation that Trelegy is covered and any authorizations are approved, fill your prescription at a Kaiser Permanente pharmacy or a partnered pharmacy.
  •  

  • Use your Kaiser Permanente member ID card at the pharmacy to ensure accurate billing of your benefits.

 

Monitor and Follow Up

 

  • Continue to monitor your health and ensure the medication is working effectively for you under the guidance of your doctor.
  •  

  • Stay in communication with your doctor for regular check-ups and to make any necessary adjustments to your treatment plan.

 

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FAQs

Does Kaiser Permanente Cover Trelegy

Discover if Kaiser Permanente covers Trelegy, explore coverage options, learn costs without insurance, and find answers to common Trelegy questions.
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Is Trelegy Covered by Kaiser Permanente

 

Does Kaiser Permanente Cover Trelegy?

 

  • Kaiser Permanente may cover Trelegy Ellipta, primarily used for the treatment of COPD and asthma. Coverage typically depends on the patient's specific health plan and the medical necessity as determined by the attending physician.
  •  

  • To get Trelegy covered, members might need a prescription after an evaluation by a healthcare provider. The patient may also be required to try other medications before Trelegy is approved, a process known as step therapy.
  •  

  • Members should confirm coverage details by checking their benefits document, as these are subject to change. If approved, prescription drug copayments or coinsurance will apply as per plan details.
  •  

  • Pre-authorization or a physician’s request might be necessary to ensure the medication is covered, based on the patient’s condition and treatment history.

 

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Kaiser Permanente's Approved Criteria for Trelegy Coverage

 

Kaiser Permanente's Approved Criteria for Trelegy Coverage

 

  • **Diagnosis of COPD or Asthma:** Member must have a clinical diagnosis of chronic obstructive pulmonary disease (COPD) or asthma, confirmed through appropriate medical testing and evaluation by a healthcare provider.
  •  

  • **Previous Medication Trials:** Member should have tried and failed, or have contraindications to, alternative therapies such as long-acting beta-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), or inhaled corticosteroids (ICS).
  •  

  • **Documented Symptoms:** There must be documented evidence of symptoms inadequately controlled with current therapy, including frequent exacerbations or significant limitation in lung function.
  •  

  • **Adherence to Current Therapy:** Member should demonstrate adherence to current treatment regimens, as poor compliance might indicate the need to reassess the management plan.
  •  

  • **Specialist Consultation:** Coverage is typically provided after a specialist in pulmonology or a related field has evaluated the patient and suggested Trelegy as a suitable treatment option.
  •  

  • **Age Requirement:** Usually, members must be 18 years or older, though exceptions might be made based on individual case assessments by healthcare providers.
  •  

  • **Physician Authorization:** A prescribing physician must submit a formal request or prior authorization form, detailing the rationale for using Trelegy over existing therapies.
  •  

  • **Review of Medical History:** An in-depth review of the member's medical history, including any cardiovascular or significant comorbid conditions, might be necessary to assess the appropriateness of Trelegy.

 

Why Kaiser Permanente Might Deny Trelegy Coverage

 

Reasons Kaiser Permanente Might Deny Trelegy Coverage

 

  • The patient does not have an appropriate diagnosis that justifies the use of Trelegy according to Kaiser Permanente's clinical guidelines.
  •  

  • The patient has not tried or failed less expensive alternatives before obtaining Trelegy, as Kaiser Permanente might require step therapy.
  •  

  • Trelegy is being prescribed for an off-label use that is not approved by Kaiser's formulary guidelines.
  •  

  • The patient is not enrolled in a plan that includes prescription drug coverage or the specific medication is excluded from their plan's coverage.
  •  

  • The prescription does not meet the established criteria for coverage, such as proper dosing or frequency limitations set by Kaiser Permanente.
  •  

  • Trelegy is not on the formulary list, and there has been no prior authorization or exception request approved for its use.
  •  

  • The patient has exceeded quantity limits that are established by Kaiser Permanente for this medication without an approved exception.
  •  

  • The patient was non-compliant with previous medications, violating the managed care plan's protocol which may affect future coverage decisions.

 

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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 Kaiser Permanente

 

Check Your Eligibility

 

  • Log into your Kaiser Permanente member account online or contact their customer service to verify your plan's coverage for prescription medications, specifically for the Trelegy inhaler.
  •  

  • Ensure that your plan includes prescription drug coverage. Some plans might have different levels of pharmacy benefits.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your Kaiser Permanente primary care doctor or specialist to discuss your need for Trelegy.
  •  

  • Your doctor will evaluate your condition and decide if Trelegy is the appropriate medication for you.
  •  

  • If Trelegy is necessary, your doctor will write a prescription and possibly note it in your medical records on the Kaiser Permanente system.

 

Verify Prescription Coverage

 

  • With your Trelegy prescription, contact the Kaiser Permanente pharmacy department either online or by phone to confirm if the medication is covered under your specific plan tier.
  •  

  • Check if there are any restrictions such as prior authorization or step therapy, which might require trying a different medication first.

 

Obtain Prior Authorization if Needed

 

  • If Trelegy requires prior authorization, request your healthcare provider to submit the necessary documentation to Kaiser Permanente.
  •  

  • Ensure your doctor provides comprehensive information about your medical necessity for Trelegy, possibly including your treatment history and outcomes with other medications.

 

Explore Financial Assistance

 

  • Inquire if Kaiser Permanente offers any financial assistance programs to help cover the cost of Trelegy not covered by your insurance plan.
  •  

  • Look into any manufacturer coupons or patient assistance programs that Trelegy might offer, which can occasionally be combined with your insurance benefits.

 

Fill Your Prescription

 

  • Once you receive confirmation that Trelegy is covered and any authorizations are approved, fill your prescription at a Kaiser Permanente pharmacy or a partnered pharmacy.
  •  

  • Use your Kaiser Permanente member ID card at the pharmacy to ensure accurate billing of your benefits.

 

Monitor and Follow Up

 

  • Continue to monitor your health and ensure the medication is working effectively for you under the guidance of your doctor.
  •  

  • Stay in communication with your doctor for regular check-ups and to make any necessary adjustments to your treatment plan.

 

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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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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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