Does Medica Cover Jardiance

Explore Jardiance coverage by Medica, reasons for denial, tips to secure approval, costs without insurance, and FAQs in this detailed guide.
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Coverage for Jardiance by Medica

 

  • Medica may cover Jardiance, primarily for treating Type 2 diabetes under their prescription drug plans.
  • Coverage usually depends on the specific Medica plan you have, as coverage can vary significantly.

 

Situations where Jardiance is Covered

 

  • Jardiance is prescribed as part of a comprehensive diabetes management plan, typically after trying first-line medications.
  • Covered when prescribed for heart failure or kidney disease management, if applicable.

 

Basic Rules and Criteria

 

  • Prior authorization might be required, meaning your healthcare provider must request coverage approval from Medica before the prescription is filled.
  • Jardiance should be deemed medically necessary by your healthcare provider for it to be considered for coverage.
  • Consultation with healthcare and plan representatives is advised to understand specific criteria and documentation needed.

 

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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.

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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 Jardiance Coverage with Medica

 

Understand Your Insurance Plan with Medica

 

  • Review your current insurance policy documents to understand what your plan covers regarding prescription medications.
  •  

  • Contact Medica's customer service to verify if Jardiance is included in your current plan's formulary. Formulary lists can change, so ensure you're working with the latest information.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of Jardiance for your treatment.
  •  

  • Ensure they provide a diagnosis that supports the need for Jardiance to help facilitate insurance approval.

 

Verify Prescription Coverage

 

  • Check if Jardiance requires prior authorization or if there are any restrictions for its coverage within your plan.
  •  

  • Make note of any copays, deductibles, or coinsurance that may apply to the prescription to know potential out-of-pocket costs.

 

Request a Prior Authorization

 

  • If prior authorization is needed, work with your healthcare provider to submit the necessary forms to Medica.
  •  

  • Ensure that all details about your medical history and the necessity of Jardiance are thoroughly documented.

 

Follow Up on the Authorization Status

 

  • Regularly check with both Medica and your healthcare provider to ensure the prior authorization is processed in a timely manner.
  •  

  • Be prepared to provide additional information, if requested by Medica, to support the necessity of Jardiance.

 

Appeal Denials if Necessary

 

  • If your request for coverage is denied, review the denial letter for reasons and contact Medica for clarification.
  •  

  • Work with your healthcare provider to gather additional supporting documentation and file an appeal with Medica.

 

Explore Additional Assistance Programs

 

  • Investigate if there are any additional assistance programs available through the pharmaceutical company that offers Jardiance cost-sharing or discount programs.
  •  

  • Look into national or local organizations that might offer financial assistance for medication costs.

 

Stay Informed of Plan Changes

 

  • Regularly review any updates or changes to your Medica insurance plan that may affect prescription coverage.
  •  

  • Check during open enrollment periods if there are other plans that might offer better coverage for Jardiance within Medica.

 

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FAQs

Does Medica Cover Jardiance

Explore Jardiance coverage by Medica, reasons for denial, tips to secure approval, costs without insurance, and FAQs in this detailed guide.
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Is Jardiance Covered by Medica

 

Coverage for Jardiance by Medica

 

  • Medica may cover Jardiance, primarily for treating Type 2 diabetes under their prescription drug plans.
  • Coverage usually depends on the specific Medica plan you have, as coverage can vary significantly.

 

Situations where Jardiance is Covered

 

  • Jardiance is prescribed as part of a comprehensive diabetes management plan, typically after trying first-line medications.
  • Covered when prescribed for heart failure or kidney disease management, if applicable.

 

Basic Rules and Criteria

 

  • Prior authorization might be required, meaning your healthcare provider must request coverage approval from Medica before the prescription is filled.
  • Jardiance should be deemed medically necessary by your healthcare provider for it to be considered for coverage.
  • Consultation with healthcare and plan representatives is advised to understand specific criteria and documentation needed.

 

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Medica's Approved Criteria for Jardiance Coverage

 

Medica's Approved Criteria for Jardiance Coverage

 

  • Diagnosis of type 2 diabetes mellitus, as confirmed by a healthcare professional.
  •  

  • Documented treatment failure or intolerance to metformin, which is typically the first-line treatment for type 2 diabetes.
  •  

  • Comorbid conditions such as cardiovascular disease, which may benefit from the cardiovascular risk reduction associated with Jardiance.
  •  

  • Use in conjunction with diet and exercise improvements to enhance glycemic control in adults.
  •  

  • Appropriate renal function as per Jardiance prescribing information, confirmed by recent lab tests.
  •  

  • Consideration for use in patients with established heart failure, supported by clinical justification from the healthcare provider.
  •  

  • Prescriber documentation supporting the medical necessity of Jardiance based on patient-specific clinical circumstances.
  •  

  • Adherence to Medica's formulary guidelines regarding step therapy or prior authorization procedures, if applicable.

 

Why Medica Might Deny Jardiance Coverage

 

Reasons Medica Might Deny Jardiance Coverage

 

  • Jardiance is not included in the plan's formulary, which is Medica's list of covered medications.
  •  

  • Prescribed usage of Jardiance does not meet Medica's established guidelines, such as specific medical diagnoses or conditions.
  •  

  • Jardiance is classified under a step therapy protocol, and the patient has not tried the preferred alternative medications first.
  •  

  • A lack of prior authorization, where Medica requires detailed justification of the medical necessity for Jardiance before it approves coverage.
  •  

  • The plan coverage does not cover brand-name drugs, and no exceptions are provided for Jardiance.
  •  

  • The prescription does not align with the FDA-approved usage and indications for Jardiance.
  •  

  • Jardiance falls under a plan exclusion, where certain drugs or treatments are not covered at all, regardless of medical necessity.

 

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How Much Does Jardiance Cost without Insurance?

 

Estimated Cost of Jardiance Without Insurance

 

  • The cost of Jardiance can vary depending on the pharmacy you visit, but as an oral medication used primarily to treat type 2 diabetes, it is often priced at a premium. Without insurance, the average monthly cost is approximately $550 to $650 for a 30-day supply of 10 mg or 25 mg tablets.
  •  

  • Prices can also vary based on location, pharmacy discounts, and available manufacturer coupons, so it's advisable to shop around or look for any available patient assistance programs to potentially lower the out-of-pocket cost.

 

Ways to Lower the Cost of Jardiance

 

  • **Pharmacy Discount Cards:** Utilizing pharmacy discount cards can sometimes provide substantial savings on your prescription, reducing the price by a notable percentage.
  •  

  • **Manufacturer Coupons and Programs:** Eli Lilly, the manufacturer of Jardiance, may offer savings cards or assistance programs to help eligible patients reduce their costs. It's worth checking through their official website or consulting with your healthcare provider.
  •  

  • **Generic Alternatives:** Although there may not be a generic version of Jardiance available currently, consulting with your healthcare provider about other generic medications for your condition may offer a more budget-friendly option.
  •  

  • **Bulk Purchasing Options:** Some pharmacies might offer discounts for purchasing a 90-day supply instead of a 30-day supply, which can lead to savings in the long term.

 

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 Jardiance Coverage with Medica

 

Understand Your Insurance Plan with Medica

 

  • Review your current insurance policy documents to understand what your plan covers regarding prescription medications.
  •  

  • Contact Medica's customer service to verify if Jardiance is included in your current plan's formulary. Formulary lists can change, so ensure you're working with the latest information.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of Jardiance for your treatment.
  •  

  • Ensure they provide a diagnosis that supports the need for Jardiance to help facilitate insurance approval.

 

Verify Prescription Coverage

 

  • Check if Jardiance requires prior authorization or if there are any restrictions for its coverage within your plan.
  •  

  • Make note of any copays, deductibles, or coinsurance that may apply to the prescription to know potential out-of-pocket costs.

 

Request a Prior Authorization

 

  • If prior authorization is needed, work with your healthcare provider to submit the necessary forms to Medica.
  •  

  • Ensure that all details about your medical history and the necessity of Jardiance are thoroughly documented.

 

Follow Up on the Authorization Status

 

  • Regularly check with both Medica and your healthcare provider to ensure the prior authorization is processed in a timely manner.
  •  

  • Be prepared to provide additional information, if requested by Medica, to support the necessity of Jardiance.

 

Appeal Denials if Necessary

 

  • If your request for coverage is denied, review the denial letter for reasons and contact Medica for clarification.
  •  

  • Work with your healthcare provider to gather additional supporting documentation and file an appeal with Medica.

 

Explore Additional Assistance Programs

 

  • Investigate if there are any additional assistance programs available through the pharmaceutical company that offers Jardiance cost-sharing or discount programs.
  •  

  • Look into national or local organizations that might offer financial assistance for medication costs.

 

Stay Informed of Plan Changes

 

  • Regularly review any updates or changes to your Medica insurance plan that may affect prescription coverage.
  •  

  • Check during open enrollment periods if there are other plans that might offer better coverage for Jardiance within Medica.

 

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Jardiance FAQ

What is Jardiance used for?

 

What is Jardiance Used For?

 

  • Jardiance is primarily used to manage type 2 diabetes by helping to lower blood sugar levels in adults.
  •  

  • It works by promoting the excretion of excess glucose through urine, thus reducing the amount of sugar the body absorbs.
  •  

  • In addition to blood sugar management, Jardiance is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.
  •  

  • Patients with heart failure may benefit from Jardiance as it helps in reducing the risk of hospitalization due to heart failure.

 

What are the side effects of Jardiance?

 

Common Side Effects of Jardiance

 

  • Urinary tract infections: Symptoms may include burning sensation while urinating and frequent urges.
  • Increased urination: This is due to Jardiance's mechanism of removing excess glucose via urine.

 

Serious Side Effects

 

  • Ketoacidosis: This rare condition might present as difficulty breathing, nausea, or confusion.
  • Dehydration: Symptoms can be dizziness or light-headedness, especially upon standing.

 

Allergic Reactions

 

  • Rash or hives can occur, requiring immediate medical attention.

 

Precautions

 

  • Consult your healthcare provider before starting if you have kidney issues or are on diuretics.

 

Can Jardiance cause weight loss?

 

Can Jardiance Cause Weight Loss?

 

  • Yes, Jardiance (empagliflozin) can lead to weight loss. This medication is primarily used to treat type 2 diabetes.
  •  

  • It works by preventing glucose reabsorption in the kidneys, leading to glucose excretion through urine, which may also result in calorie loss.
  •  

  • Clinical trials have shown weight reduction as a common side effect, often averaging 2-3 kg.
  •  

  • This loss can differ among individuals; factors like diet and exercise may influence the extent of weight change.
  •  

  • Always consult with healthcare professionals to understand the benefits and risks associated with your specific health condition.

 

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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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