Does Network Health Cover Lantus

Explore Lantus coverage by Network Health, reasons for denial, ways to secure coverage, costs without insurance, and FAQs in this informative guide.
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Lantus Coverage Overview

 

  • Network Health may cover Lantus under specific insurance plans. Coverage depends on the type of policy a member holds, such as Medicare, Medicaid, or private insurance plans.

 

Situations Covered

 

  • Lantus is typically covered for individuals with diabetes who require long-acting insulin for glucose management.
  • Patients with a doctor's prescription indicating Lantus as medically necessary.

 

Basic Rules and Criteria

 

  • Pre-authorization may be required for coverage, ensuring that Lantus is part of the patient's treatment plan.
  • Healthcare providers may need to demonstrate that Lantus is necessary due to failed treatments with alternative medications.
  • Network Health might have formulary restrictions; members should confirm if Lantus is on the preferred drug list.
  • Co-pays or deductibles may apply depending on the specific plan details.

 

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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 Lantus Coverage with Network Health

 

Contact Network Health Customer Service

 

  • Call the Network Health customer service number found on your insurance card to inquire about your current prescription drug coverage.
  •  

  • Ask specifically if Lantus (insulin glargine) is covered under your pharmacy benefits plan.
  •  

  • Request any necessary forms or documents that may be needed to initiate coverage for Lantus.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the medical need for Lantus.
  •  

  • Ensure that they provide a diagnosis and a prescription for Lantus to submit to Network Health.
  •  

  • Ask if there are any specific forms or prior authorization requests needed by Network Health from your provider.

 

Prepare Necessary Documentation

 

  • Collect all required documents, including your prescription, diagnosis, and any forms or prior authorization requirements from your healthcare provider.
  •  

  • Ensure that all documents are properly filled out and signed by the necessary parties.

 

Submit a Drug Claim

 

  • Submit the claim to Network Health along with all collected documentation.
  •  

  • You can often submit claims online through your Network Health member portal or via mail, depending on preference and available options.
  •  

  • Keep copies of all submitted documents for your own records.

 

Follow Up

 

  • Monitor your claim status through the Network Health member portal or by calling their customer service.
  •  

  • If requested, provide any additional information promptly to avoid any delay in the approval of Lantus coverage.
  •  

  • Contact Network Health if you haven't received a response within the expected processing time, or if any issues arise during the approval process.

 

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Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

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Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
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FAQs

Does Network Health Cover Lantus

Explore Lantus coverage by Network Health, reasons for denial, ways to secure coverage, costs without insurance, and FAQs in this informative guide.
Curex allergy drops unboxing

Is Lantus Covered by Network Health

 

Lantus Coverage Overview

 

  • Network Health may cover Lantus under specific insurance plans. Coverage depends on the type of policy a member holds, such as Medicare, Medicaid, or private insurance plans.

 

Situations Covered

 

  • Lantus is typically covered for individuals with diabetes who require long-acting insulin for glucose management.
  • Patients with a doctor's prescription indicating Lantus as medically necessary.

 

Basic Rules and Criteria

 

  • Pre-authorization may be required for coverage, ensuring that Lantus is part of the patient's treatment plan.
  • Healthcare providers may need to demonstrate that Lantus is necessary due to failed treatments with alternative medications.
  • Network Health might have formulary restrictions; members should confirm if Lantus is on the preferred drug list.
  • Co-pays or deductibles may apply depending on the specific plan details.

 

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Network Health's Approved Criteria for Lantus Coverage

 

Lantus Coverage for Diabetes Management

 

  • Network Health covers Lantus for individuals diagnosed with Type 1 or Type 2 diabetes needing long-acting insulin to control blood glucose levels.
  •  

  • Patients prescribed Lantus must have demonstrated a need for basal insulin therapy not adequately managed with oral medications alone.

 

Required Documentation

 

  • A healthcare provider must submit a filled pre-authorization form specifying the need for Lantus based on patient history and current treatment plans.
  •  

  • Recent medical records including HbA1c levels, fasting blood glucose levels, and previous insulin therapy responses should be provided.

 

Trial and Failure of Alternatives

 

  • Pain documentation of intolerance or inadequate response to other long-acting insulins, such as Levemir or Basaglar, is required before Lantus coverage approval.
  •  

  • Evidence of at least a 3-month trial with one or more alternative insulins must be presented.

 

Specialist Endorsement

 

  • Coverage may require endorsement or consultation with an endocrinologist or diabetes specialist confirming the necessity of Lantus in the treatment regimen.
  •  

  • Specialist recommendation should include a tailored diabetes management plan, emphasizing the role of Lantus in achieving glycemic targets.

 

Network Health Plan Considerations

 

  • Ensure the plan under which the coverage is being requested includes comprehensive diabetes care benefits allowing Lantus prescriptions.
  •  

  • Confirm that the patient's plan tier categorizes Lantus as a covered medication within its formulary.

 

Why Network Health Might Deny Lantus Coverage

 

Reasons Network Health Might Deny Lantus Coverage

 

  • **Non-Compliance with Formulary Requirements**: Lantus may not be included in Network Health’s formulary list, which comprises drugs that are covered. Insurances often require patients to select alternatives from their approved list unless there is a strong case for exception.
  •  

  • **Lack of Prior Authorization**: Network Health may require prior authorization before covering the cost of Lantus. If this step is not completed or if authorization is denied based on provided information, coverage may be denied.
  •  

  • **Absence of Medical Necessity**: If medical documents do not sufficiently justify the need for Lantus over other covered insulin alternatives, Network Health may deny its coverage on the grounds of medical necessity.
  •  

  • **Step Therapy Failure**: Some insurance plans require patients to try and fail cheaper or preferred alternative treatments before covering Lantus. If such protocols are not followed, coverage can be denied.
  •  

  • **Quantity Limits Exceedance**: Insurance plans often impose quantity limits on medications. If the prescribed amount exceeds these limits and lacks additional authorization, coverage may be refused.
  •  

  • **Plan-Specific Exclusions**: The specific health insurance plan of the patient may have exclusions that apply to Lantus, barring any coverage. These exclusions can vary greatly from plan to plan within Network Health.
  •  

  • **Non-Compliance with Clinical Guidelines**: If the use of Lantus does not align with clinical guidelines set forth by Network Health’s policies or does not reflect standard treatment protocols approved by the insurance provider, it may be denied coverage.

 

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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 Network Health

 

Contact Network Health Customer Service

 

  • Call the Network Health customer service number found on your insurance card to inquire about your current prescription drug coverage.
  •  

  • Ask specifically if Lantus (insulin glargine) is covered under your pharmacy benefits plan.
  •  

  • Request any necessary forms or documents that may be needed to initiate coverage for Lantus.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the medical need for Lantus.
  •  

  • Ensure that they provide a diagnosis and a prescription for Lantus to submit to Network Health.
  •  

  • Ask if there are any specific forms or prior authorization requests needed by Network Health from your provider.

 

Prepare Necessary Documentation

 

  • Collect all required documents, including your prescription, diagnosis, and any forms or prior authorization requirements from your healthcare provider.
  •  

  • Ensure that all documents are properly filled out and signed by the necessary parties.

 

Submit a Drug Claim

 

  • Submit the claim to Network Health along with all collected documentation.
  •  

  • You can often submit claims online through your Network Health member portal or via mail, depending on preference and available options.
  •  

  • Keep copies of all submitted documents for your own records.

 

Follow Up

 

  • Monitor your claim status through the Network Health member portal or by calling their customer service.
  •  

  • If requested, provide any additional information promptly to avoid any delay in the approval of Lantus coverage.
  •  

  • Contact Network Health if you haven't received a response within the expected processing time, or if any issues arise during the approval process.

 

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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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