Does MDwise Cover Lantus

Explore Lantus coverage with MDwise, reasons for denial, cost without insurance, and FAQs. Get insights on securing coverage for your diabetes treatment.
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Does MDwise Cover Lantus?

 

  • MDwise generally covers Lantus as part of its prescription drug benefits for members. However, coverage is subject to the specific health plan options that members have selected and their associated formularies.
  •  

  • To have Lantus covered, it is essential that the prescription is deemed medically necessary by a healthcare provider.
  •  

  • Patients may need to obtain prior authorization before the coverage applies, which involves the provider justifying the necessity of Lantus over other insulin alternatives.
  •  

  • Members should ensure that they fill their prescriptions at network pharmacies to receive coverage benefits.
  •  

  • Co-payments or co-insurance may apply, and these rates depend on the member's specific health plan details and tier pricing for medications.
  •  

  • It is advisable for members to consult MDwise's formulary or contact customer service to confirm specific plan details regarding Lantus coverage.

 

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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.

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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 Lantus Coverage with MDwise

 

Understanding MDwise and Lantus Coverage

 

  • MDwise is a managed health care plan serving individuals who qualify for governmental programs. It's crucial to understand whether Lantus, a long-acting insulin, is covered under your current MDwise plan.
  •  

  • Check the MDwise formulary, the list of approved medications covered by the plan. The formulary can usually be found on the MDwise website or by contacting customer service.

 

Verify Eligibility and Plan Requirements

 

  • Ensure that you are eligible for medication coverage under MDwise. This might require you to have an active policy that includes prescription drug coverage.
  •  

  • Review your plan documents to understand any co-pays, deductibles, or prior authorizations that might be necessary for Lantus.

 

Consulting with Your Healthcare Provider

 

  • Talk to your healthcare provider about your need for Lantus. They can provide a prescription and any necessary medical justifications that might be required by your insurance plan.
  •  

  • Your provider can also send in a pre-authorization request, if necessary, directly to MDwise to facilitate coverage approval.

 

Navigate MDwise Member Portal

 

  • Log in to the MDwise member portal using your credentials. This portal can provide personalized information regarding your plan specifics and Lantus coverage.
  •  

  • Check if there are any updates or changes related to medication coverage that apply to your plan.

 

Contact MDwise Customer Service

 

  • If you are unsure about any details, contacting MDwise’s customer service department for clarification on your plan and Lantus coverage options is beneficial.
  •  

  • They can guide you on what steps to take if Lantus is not directly covered and whether there are alternative options or required steps like appeals.

 

Pharmacy Coordination

 

  • Once you have approval for Lantus, present your prescription at a pharmacy that accepts MDwise. Ensure the pharmacy verifies the coverage before filling the prescription.
  •  

  • Sometimes pharmacies might need to communicate with MDwise directly for any coverage confirmation or disputes.

 

Continual Monitoring and Updates

 

  • Regularly review your plan and any communications from MDwise in case there are changes to coverage policies or medication lists.
  •  

  • Keep in contact with your healthcare provider to manage your needs effectively and address any complications with insurance coverage promptly.

 

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FAQs

Does MDwise Cover Lantus

Explore Lantus coverage with MDwise, reasons for denial, cost without insurance, and FAQs. Get insights on securing coverage for your diabetes treatment.
Curex allergy drops unboxing

Is Lantus Covered by MDwise

 

Does MDwise Cover Lantus?

 

  • MDwise generally covers Lantus as part of its prescription drug benefits for members. However, coverage is subject to the specific health plan options that members have selected and their associated formularies.
  •  

  • To have Lantus covered, it is essential that the prescription is deemed medically necessary by a healthcare provider.
  •  

  • Patients may need to obtain prior authorization before the coverage applies, which involves the provider justifying the necessity of Lantus over other insulin alternatives.
  •  

  • Members should ensure that they fill their prescriptions at network pharmacies to receive coverage benefits.
  •  

  • Co-payments or co-insurance may apply, and these rates depend on the member's specific health plan details and tier pricing for medications.
  •  

  • It is advisable for members to consult MDwise's formulary or contact customer service to confirm specific plan details regarding Lantus coverage.

 

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MDwise's Approved Criteria for Lantus Coverage

 

Lantus Coverage Criteria by MDwise

 

  • Medically necessary for the treatment of individuals diagnosed with type 1 diabetes mellitus. Documentation from a healthcare provider confirming the diagnosis is required.
  •  

  • Approved for individuals with type 2 diabetes mellitus who show inadequate glycemic control on oral medications and lifestyle modifications. Evidence of previous treatments and their outcomes should be provided.
  •  

  • Coverage is available for pediatric patients with diabetes who meet the criteria for long-acting insulin therapy. A pediatrician's assessment and reasoning will support the case.
  •  

  • Considered essential for individuals transitioning from NPH insulin or other forms of long-acting insulin due to issues like allergic reactions or instability in blood glucose levels. Medical records evidencing previous complications with alternative insulins should be included.
  •  

  • Eligible for individuals prescribed Lantus as part of a comprehensive diabetes management plan, as directed by an endocrinologist or diabetes specialist. A treatment plan demonstrating Lantus as a necessary component must be noted.
  •  

  • Covered when prescribed alongside short-acting insulins as part of a combined insulin regimen. Documentation must elucidate the intended insulin therapeutic strategy and anticipated benefits.
  •  

  • Recognized for its role in pregnancy-related diabetes management, such as gestational diabetes, where Lantus has been determined safe and effective. Confirmation of pregnancy and rationale for Lantus use should be discussed in submitted documentation.

 

Why MDwise Might Deny Lantus Coverage

 

Reasons for Denial of Lantus Coverage by MDwise

 

  • **Non-Formulary Drug:** If Lantus is not part of the MDwise formulary list, coverage may be denied unless prior authorization is secured.
  • **Lack of Prior Authorization:** MDwise may require prior authorization for Lantus. If this process is not completed, coverage can be denied.
  • **Inappropriate Indication:** Coverage might be denied if Lantus is prescribed for a condition that is not approved by MDwise's guidelines or FDA-approved indications.
  • **Therapeutic Alternatives:** If MDwise prefers alternative treatments or medications for the same indication that are considered more cost-effective, Lantus coverage may be denied.
  • **Exceeded Quantity Limits:** If the prescribed quantity exceeds MDwise's predetermined limits without proper documentation of need, coverage may be denied.
  • **Out-of-Network Provider:** If Lantus is prescribed or dispensed by an out-of-network provider without prior approval, MDwise may deny coverage.
  • **Plan Exclusions:** Certain plans may have specific exclusions which include Lantus, leading to denial of coverage.
  • **Generic Requirement:** If a generic version of Lantus is required by MDwise policy and not utilized, coverage may be denied.

 

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

  • The price of Lantus (insulin glargine) without insurance can vary based on factors such as the pharmacy, location, and available discounts. Typically, the retail price ranges between $250 and $350 for a 10ml vial at a retail pharmacy.
  •  

  • For the Lantus SoloStar pen, which is a more convenient option for some, the price is generally similar, ranging from $400 to $500 for a pack of five pens.
  •  

  • Prices can fluctuate slightly, so it is advisable to check with local pharmacies or online services for the most current prices and potential savings options.
  •  

  • Consider exploring patient assistance programs offered by the manufacturer or third-party organizations, which might offer Lantus at reduced prices or even for free if you qualify based on income.

 

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 Lantus Coverage with MDwise

 

Understanding MDwise and Lantus Coverage

 

  • MDwise is a managed health care plan serving individuals who qualify for governmental programs. It's crucial to understand whether Lantus, a long-acting insulin, is covered under your current MDwise plan.
  •  

  • Check the MDwise formulary, the list of approved medications covered by the plan. The formulary can usually be found on the MDwise website or by contacting customer service.

 

Verify Eligibility and Plan Requirements

 

  • Ensure that you are eligible for medication coverage under MDwise. This might require you to have an active policy that includes prescription drug coverage.
  •  

  • Review your plan documents to understand any co-pays, deductibles, or prior authorizations that might be necessary for Lantus.

 

Consulting with Your Healthcare Provider

 

  • Talk to your healthcare provider about your need for Lantus. They can provide a prescription and any necessary medical justifications that might be required by your insurance plan.
  •  

  • Your provider can also send in a pre-authorization request, if necessary, directly to MDwise to facilitate coverage approval.

 

Navigate MDwise Member Portal

 

  • Log in to the MDwise member portal using your credentials. This portal can provide personalized information regarding your plan specifics and Lantus coverage.
  •  

  • Check if there are any updates or changes related to medication coverage that apply to your plan.

 

Contact MDwise Customer Service

 

  • If you are unsure about any details, contacting MDwise’s customer service department for clarification on your plan and Lantus coverage options is beneficial.
  •  

  • They can guide you on what steps to take if Lantus is not directly covered and whether there are alternative options or required steps like appeals.

 

Pharmacy Coordination

 

  • Once you have approval for Lantus, present your prescription at a pharmacy that accepts MDwise. Ensure the pharmacy verifies the coverage before filling the prescription.
  •  

  • Sometimes pharmacies might need to communicate with MDwise directly for any coverage confirmation or disputes.

 

Continual Monitoring and Updates

 

  • Regularly review your plan and any communications from MDwise in case there are changes to coverage policies or medication lists.
  •  

  • Keep in contact with your healthcare provider to manage your needs effectively and address any complications with insurance coverage promptly.

 

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Lantus FAQ

What is Lantus used for?

 

What is Lantus Used For?

 

  • Lantus is primarily used to manage blood sugar levels in individuals with type 1 and type 2 diabetes.
  •  

  • It is a long-acting insulin, providing a steady release of insulin over a 24-hour period with no pronounced peak, mimicking natural insulin secretion.
  •  

  • It's taken once daily, often at the same time each day, helping to maintain consistent blood glucose control.
  •  

  • Beneficial for patients requiring basal insulin to prevent hyperglycemia between meals and overnight.
  •  

  • Alongside diet and exercise, Lantus is vital for comprehensive diabetes management.

 

How does Lantus work in the body?

 

How Lantus Works

 

  • Lantus is a long-acting insulin, also known as insulin glargine. It provides a stable and continuous release of insulin to control blood sugar levels.
  •  

  • The formulation of Lantus enables it to dissolve slowly upon injection, creating a slow and steady insulin level that lasts up to 24 hours.
  •  

  • This minimizes the risk of blood sugar peaks and troughs, providing more consistent blood glucose management.
  •  

  • Lantus mimics the basal level of insulin production in the pancreas, thus helping to maintain glucose balance between meals and overnight.
  •  

  • It binds to insulin receptors, facilitating glucose uptake into muscle and fat tissues, while inhibiting hepatic glucose production.

 

What are the side effects of Lantus?

 

Common Side Effects

 

  • Injection site reactions such as redness, swelling, or itching can occur.
  • Hypoglycemia, or low blood sugar, is a frequent side effect.
  • Weight gain may happen due to improved glucose utilization.

 

Less Common Side Effects

 

  • Allergic reactions like rash or itching may occur but are rare.
  • Systemic reactions such as swelling of hands/feet can occur.
  • Visual changes might be experienced during initial treatment.

 

Serious Side Effects

 

  • Severe hypoglycemia requiring intervention.
  • Signs of allergic reactions like difficulty breathing, require immediate attention.
  • Hypokalemia may develop, leading to muscle weakness or cramps.

 

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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 (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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