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Does Molina Healthcare Cover Jardiance

Explore Jardiance coverage with Molina Healthcare, reasons for coverage denial, cost insights without insurance, and FAQs for informed healthcare decisions.

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Coverage for Jardiance

Molina Healthcare may cover Jardiance if it is deemed medically necessary for managing type 2 diabetes.

Coverage usually requires prior authorization from a healthcare provider, ensuring that Jardiance is appropriate for the patient's condition.

Criteria for Coverage

Patient must be diagnosed with type 2 diabetes and Jardiance should be part of a comprehensive treatment plan.

Documentation of previous treatments and their outcomes may be necessary to qualify for coverage.

Prescribing physician may need to provide evidence that alternative medications are inappropriate or less effective.

Basic Rules

Patients should consult with their healthcare provider to navigate the specific Molina Healthcare formulary and requirements.

Check plan specifics as coverage can vary based on geographic location and plan type.

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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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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 Molina Healthcare

Check Your Coverage

Review your Molina Healthcare member handbook or benefits guide to see if Jardiance is covered under your current plan. This documentation typically outlines the medications included in your prescription drug benefits.

Log into your Molina Healthcare member account online. Here, you can find more specific information about your prescription coverage and any criteria or prerequisites for including new medications.

Consult with Your Doctor

Discuss your need for Jardiance with your healthcare provider. They might need to document a medical necessity for the drug, which can aid in insurance approval.

Ensure your doctor is aware of the specifics of your Molina Healthcare plan, as they might need to adjust their prescription or provide additional information directly to Molina.

Request Prior Authorization

Many insurance providers, including Molina Healthcare, may require prior authorization for certain medications, including Jardiance.

Work with your healthcare provider to submit the necessary prior authorization forms. They can properly fill out and submit these to Molina Healthcare to evaluate your request.

Contact Molina Customer Service

If you have questions or need assistance, contact Molina Healthcare’s customer service. They can provide guidance on the coverage process and address any specific concerns you might have.

Make sure to have your member ID ready when you call, as this will help streamline the process and provide you with accurate information concerning your policy.

Review Your Plan's Formulary

Access Molina Healthcare’s formulary list, which is a directory of all covered medications. This can usually be found on their website or by contacting customer service.

If Jardiance is not listed, speak with your healthcare provider about alternative medications that are covered, or consider discussing a medication exception with Molina Healthcare.

Check for Updates

Prescription drug coverage can change annually. Regularly check for updates to ensure that new medications like Jardiance might be included in the formulary in the future.

Keep an eye on any communication from Molina Healthcare regarding changes to your plan or formulary updates.

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Does Molina Healthcare Cover Jardiance

Explore Jardiance coverage with Molina Healthcare, reasons for coverage denial, cost insights without insurance, and FAQs for informed healthcare decisions.

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Is Jardiance Covered by Molina Healthcare

Coverage for Jardiance

Molina Healthcare may cover Jardiance if it is deemed medically necessary for managing type 2 diabetes.

Coverage usually requires prior authorization from a healthcare provider, ensuring that Jardiance is appropriate for the patient's condition.

Criteria for Coverage

Patient must be diagnosed with type 2 diabetes and Jardiance should be part of a comprehensive treatment plan.

Documentation of previous treatments and their outcomes may be necessary to qualify for coverage.

Prescribing physician may need to provide evidence that alternative medications are inappropriate or less effective.

Basic Rules

Patients should consult with their healthcare provider to navigate the specific Molina Healthcare formulary and requirements.

Check plan specifics as coverage can vary based on geographic location and plan type.

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Molina Healthcare's Approved Criteria for Jardiance Coverage

Molina Healthcare's Criteria for Jardiance Coverage

**Documented Diagnosis:** Jardiance (empagliflozin) is approved for patients with a documented diagnosis of type 2 diabetes mellitus (T2DM) who have not achieved adequate blood sugar control through lifestyle modifications and metformin.

**Age Requirement:** Patients must be adults, aged 18 years or older, as Jardiance is not typically approved for pediatric use.

**Prior Medication Use:** The patient must have attempted and documented inadequate control or intolerance with at least one alternative glucose-lowering agent before consideration of Jardiance.

**Combination Therapy:** Jardiance may be prescribed as part of combination therapy, usually in conjunction with metformin or other antidiabetic medications if required for optimal glycemic control.

**Risk Factors:** Approval may be contingent upon the presence of specific cardiovascular risk factors. Jardiance is often considered for patients with established cardiovascular disease or significant risk due to its cardioprotective benefits.

**Renal Function Criteria:** Jardiance coverage is reviewed based on renal function. Patients must have an estimated glomerular filtration rate (eGFR) that supports the safe use of Jardiance.

**Evidence of Comprehensive Management Plan:** Patients must be enrolled in a comprehensive diabetes management plan, including diet, exercise, and regular monitoring, as Jardiance is part of an overall treatment strategy.

**Prescribing Physician:** Jardiance prescriptions must be initiated by an endocrinologist or a primary care provider experienced in managing diabetes and meeting Molina Healthcare’s credentialing standards.

**Continued Coverage:** For continued coverage approval, documentation such as improved HbA1c levels or patient adherence to therapy may be required during follow-up evaluations.

Why Molina Healthcare Might Deny Jardiance Coverage

Reasons Molina Healthcare Might Deny Jardiance Coverage

Jardiance is not included in the formulary or preferred drug list specified by Molina Healthcare for the patient's specific plan, making it a non-covered medication.

The prescription for Jardiance may be denied if it is not deemed medically necessary according to Molina Healthcare’s medical guidelines or if there is an absence of supporting documentation indicating its necessity for the patient’s condition.

Coverage may be refused if Jardiance is being prescribed for off-label use that is not approved or recognized by Molina Healthcare’s policies.

If the patient has not tried or failed other more cost-effective treatments that are listed in Molina's formulary first, Jardiance may not be covered.

In cases where a specific plan under Molina Healthcare has restrictions or limitations on specialty medications, Jardiance may fall under these categories and hence, not be covered.

Non-compliance with prior authorization requirements set by Molina Healthcare for Jardiance can lead to denial of coverage.

Denial may occur if the patient’s healthcare provider is not within the network associated with the specific Molina Healthcare plan, leading to authorization issues for prescribing Jardiance.

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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.

Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

Jill Hamburg, PA - C

Immunotherapy made simple. We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Kayla Mardaga, NP

How to Get Jardiance Coverage with Molina Healthcare

Check Your Coverage

Review your Molina Healthcare member handbook or benefits guide to see if Jardiance is covered under your current plan. This documentation typically outlines the medications included in your prescription drug benefits.

Log into your Molina Healthcare member account online. Here, you can find more specific information about your prescription coverage and any criteria or prerequisites for including new medications.

Consult with Your Doctor

Discuss your need for Jardiance with your healthcare provider. They might need to document a medical necessity for the drug, which can aid in insurance approval.

Ensure your doctor is aware of the specifics of your Molina Healthcare plan, as they might need to adjust their prescription or provide additional information directly to Molina.

Request Prior Authorization

Many insurance providers, including Molina Healthcare, may require prior authorization for certain medications, including Jardiance.

Work with your healthcare provider to submit the necessary prior authorization forms. They can properly fill out and submit these to Molina Healthcare to evaluate your request.

Contact Molina Customer Service

If you have questions or need assistance, contact Molina Healthcare’s customer service. They can provide guidance on the coverage process and address any specific concerns you might have.

Make sure to have your member ID ready when you call, as this will help streamline the process and provide you with accurate information concerning your policy.

Review Your Plan's Formulary

Access Molina Healthcare’s formulary list, which is a directory of all covered medications. This can usually be found on their website or by contacting customer service.

If Jardiance is not listed, speak with your healthcare provider about alternative medications that are covered, or consider discussing a medication exception with Molina Healthcare.

Check for Updates

Prescription drug coverage can change annually. Regularly check for updates to ensure that new medications like Jardiance might be included in the formulary in the future.

Keep an eye on any communication from Molina Healthcare regarding changes to your plan or formulary updates.

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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. Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Does Molina Healthcare Cover Jardiance

Explore Jardiance coverage with Molina Healthcare, reasons for coverage denial, cost insights without insurance, and FAQs for informed healthcare decisions.

Achieve Your Goals Faster with Curex