Does Network Health Cover Lyrica

Explore why Network Health may deny Lyrica coverage, steps to secure it, Lyrica's cost without insurance, and FAQs in this insightful article.
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Lyrica Coverage by Network Health

 

  • **Eligibility Requirements**: Coverage for Lyrica under Network Health generally requires a prior authorization based on the member's specific medical needs. It's often covered for conditions such as neuropathic pain, fibromyalgia, and partial onset seizures.
  •  

  • **Prescription Criteria**: A healthcare provider must submit evidence that Lyrica is medically necessary and that other less expensive alternatives have been ineffective or unsuitable for the patient.
  •  

  • **Formulary Status**: Ensure that Lyrica is listed in your specific plan's formulary, as availability and coverage may vary. Check Network Health's formulary information for your plan.
  •  

  • **Policy Details**: Contact Network Health directly for detailed coverage information and confirmation, as policies, covered conditions, and requirements may change annually based on plan updates.

 

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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 Lyrica Coverage with Network Health

 

Understand Lyrica Coverage Under Network Health

 

  • Determine whether Lyrica is included in your Network Health plan's formulary or drug list, which details medications covered under your policy.
  •  

  • Check the tier level of Lyrica in the formulary to understand potential prescription costs and any required co-payments or coinsurance.

 

Consult Your Health Care Provider

 

  • Discuss with your health care provider about the necessity of Lyrica for your treatment plan. They can provide documentation or reasoning for the medication, which can aid in securing coverage.
  •  

  • Your provider may suggest alternative medications that are more likely to be covered, which could be beneficial if Lyrica is not initially included in your plan.

 

Contact Network Health Customer Service

 

  • Reach out to Network Health's customer service for specific details about your plan’s prescription coverage, including Lyrica.
  •  

  • Inquire about the process for getting Lyrica covered if it is not listed in your current plan's formulary.

 

Apply for Prior Authorization

 

  • If Lyrica requires prior authorization, start the application process as directed by Network Health. This typically involves submitting a request with supporting documentation, often provided by your doctor.
  •  

  • Undergo any required evaluations or provide additional information as requested to complete the prior authorization process.

 

Submit an Exception Request

 

  • If Lyrica is not covered, submit an exception request to Network Health to review the case for potential approval based on medical necessity.
  •  

  • Provide any required medical records or a letter of medical necessity from your doctor to support the request.

 

Consider Alternatives or Assistance Programs

 

  • Investigate if there are any pharmaceutical assistance programs provided by the manufacturer of Lyrica for financial support or discounts.
  •  

  • Explore alternative medications with your doctor that may be covered by Network Health to ensure you still receive necessary treatment.

 

Monitor and Appeal Decisions

 

  • Keep track of all communications with Network Health and maintain records of your applications, authorizations, or exception requests.
  •  

  • If your request for Lyrica coverage is denied, discuss next steps with your provider and consider appealing the decision following Network Health’s appeals process.

 

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FAQs

Does Network Health Cover Lyrica

Explore why Network Health may deny Lyrica coverage, steps to secure it, Lyrica's cost without insurance, and FAQs in this insightful article.
Curex allergy drops unboxing

Is Lyrica Covered by Network Health

 

Lyrica Coverage by Network Health

 

  • **Eligibility Requirements**: Coverage for Lyrica under Network Health generally requires a prior authorization based on the member's specific medical needs. It's often covered for conditions such as neuropathic pain, fibromyalgia, and partial onset seizures.
  •  

  • **Prescription Criteria**: A healthcare provider must submit evidence that Lyrica is medically necessary and that other less expensive alternatives have been ineffective or unsuitable for the patient.
  •  

  • **Formulary Status**: Ensure that Lyrica is listed in your specific plan's formulary, as availability and coverage may vary. Check Network Health's formulary information for your plan.
  •  

  • **Policy Details**: Contact Network Health directly for detailed coverage information and confirmation, as policies, covered conditions, and requirements may change annually based on plan updates.

 

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Network Health's Approved Criteria for Lyrica Coverage

 

Lyrica Prescription Criteria

 

  • Lyrica is covered for the management of neuropathic pain associated with diabetic peripheral neuropathy in individuals for whom other treatments have been unsuccessful.
  •  

  • Coverage is available for patients with post-herpetic neuralgia when alternative therapies have not provided sufficient relief.
  •  

  • To be eligible for Lyrica coverage, patients must have a documented diagnosis of fibromyalgia with an inadequate response or intolerance to at least two other standard pain management therapies.
  •  

  • Lyrica is approved for partial onset seizures as adjunctive therapy in patients already undergoing treatment with at least one other antiepileptic agent.
  •  

  • Approved coverage includes management of neuropathic pain associated with spinal cord injury in patients for whom other therapeutic options are not adequately effective.

 

Documentation Requirements

 

  • Prescribing physician must provide documentation supporting the diagnosis and prior treatment history indicating the necessity of Lyrica therapy.
  •  

  • Clinical notes reflecting the patient's response to previous medications must accompany the coverage request to demonstrate necessity and eligibility.
  •  

  • Submission of medical records must indicate specific symptoms and how they interfere with daily activities, emphasizing the need for Lyrica treatment.

 

Duration and Continuation of Coverage

 

  • Initial coverage is generally approved for a trial period, often requiring follow-up documentation to justify continued therapy.
  •  

  • Subsequent renewals of coverage require evidence of clinical improvement, such as reduced pain levels or improved functionality.
  •  

  • Periodic re-evaluations may be necessary to continue approval of Lyrica, ensuring that the medication remains an appropriate part of the treatment plan.

 

Exclusions Specific to Patient Conditions

 

  • Patients must not have a history of allergic reactions to pregabalin or any components of Lyrica.
  •  

  • Patients with certain underlying health conditions may require physician justification or additional paperwork to secure coverage.

 

Why Network Health Might Deny Lyrica Coverage

 

Exclusion Criteria for Lyrica Coverage

 

  • Lyrica is used for indications not approved by the FDA or not recognized by Network Health as medically necessary.
  •  

  • The prescription is for an off-label use that does not align with accepted medical practice or lacks robust clinical evidence.
  •  

  • The patient does not meet the specific clinical criteria established by Network Health, such as documented failure of alternative therapies or confirmation of certain medical conditions.
  •  

  • Network Health has not received necessary pre-authorization documentation or approvals as per their policy requirements.
  •  

  • The prescription is classified as a duplicate therapy, where Lyrica may overlap in function and therapeutic effect with another medication already provided to the patient.
  •  

  • Coverage limits have been reached or exceeded, according to Network Health's formulary guidelines or annual caps on prescription drug coverage.
  •  

  • Lyrica is prescribed by a provider not recognized within the Network Health system or outside of their network requirements without necessary out-of-network approvals.
  •  

  • The patient is not compliant with stipulated treatment guidelines, follow-up appointments, or other adherence protocols tied to their Lyrica therapy management.

 

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How Much Does Lyrica Cost without Insurance?

 

Cost of Lyrica Without Insurance

 

  • The price of Lyrica without insurance can vary significantly depending on the pharmacy, geographic location, dosage, and quantity. On average, the cost can range between $460 to $720 for a 30-day supply when filling a common dosage such as 150 mg capsules.
  •  

  • Generic versions of Lyrica, known as pregabalin, are often significantly cheaper. The average cost for the generic version might be closer to $30 to $70 for a similar quantity and dosage.
  •  

  • Prices may also vary due to manufacturer's discounts, pharmacy membership programs, or coupon usage, which can help reduce the overall cost.
  •  

  • Comparing prices between local pharmacies or using online price comparison tools can help find the most affordable option.

 

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 Lyrica Coverage with Network Health

 

Understand Lyrica Coverage Under Network Health

 

  • Determine whether Lyrica is included in your Network Health plan's formulary or drug list, which details medications covered under your policy.
  •  

  • Check the tier level of Lyrica in the formulary to understand potential prescription costs and any required co-payments or coinsurance.

 

Consult Your Health Care Provider

 

  • Discuss with your health care provider about the necessity of Lyrica for your treatment plan. They can provide documentation or reasoning for the medication, which can aid in securing coverage.
  •  

  • Your provider may suggest alternative medications that are more likely to be covered, which could be beneficial if Lyrica is not initially included in your plan.

 

Contact Network Health Customer Service

 

  • Reach out to Network Health's customer service for specific details about your plan’s prescription coverage, including Lyrica.
  •  

  • Inquire about the process for getting Lyrica covered if it is not listed in your current plan's formulary.

 

Apply for Prior Authorization

 

  • If Lyrica requires prior authorization, start the application process as directed by Network Health. This typically involves submitting a request with supporting documentation, often provided by your doctor.
  •  

  • Undergo any required evaluations or provide additional information as requested to complete the prior authorization process.

 

Submit an Exception Request

 

  • If Lyrica is not covered, submit an exception request to Network Health to review the case for potential approval based on medical necessity.
  •  

  • Provide any required medical records or a letter of medical necessity from your doctor to support the request.

 

Consider Alternatives or Assistance Programs

 

  • Investigate if there are any pharmaceutical assistance programs provided by the manufacturer of Lyrica for financial support or discounts.
  •  

  • Explore alternative medications with your doctor that may be covered by Network Health to ensure you still receive necessary treatment.

 

Monitor and Appeal Decisions

 

  • Keep track of all communications with Network Health and maintain records of your applications, authorizations, or exception requests.
  •  

  • If your request for Lyrica coverage is denied, discuss next steps with your provider and consider appealing the decision following Network Health’s appeals process.

 

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Lyrica FAQ

What are the common side effects of Lyrica?

 

Common Side Effects of Lyrica

 

  • Dizziness: Frequently reported, often occurring shortly after starting treatment.
  • Sleepiness: Commonly affects daily activities due to its sedative effects.
  • Weight Gain: Notable for some, monitoring weight is advised.
  • Swelling: Particularly in hands and feet; may require medical attention if severe.
  • Blurred Vision: Usually temporary but should be reported if persistent.
  • Dry Mouth: Sometimes improved with increased fluid intake.
  • Difficulty concentrating: Can affect mental clarity and focus.

 

Is Lyrica the same as gabapentin?

 

Differences Between Lyrica and Gabapentin

 

  • Classification: Both are anticonvulsants but with different active ingredients. Lyrica contains pregabalin, while gabapentin itself is the active substance in gabapentin medications.
  •  

  • FDA Approval: Lyrica is approved for treating fibromyalgia, neuropathic pain, seizures, and generalized anxiety disorder in certain regions. Gabapentin's primary uses are for seizures and nerve pain.
  •  

  • Potency and Dosing: Lyrica is often considered more potent, requiring lower doses to achieve similar effects compared to gabapentin.
  •  

  • Side Effects: Both can cause dizziness and fatigue, but the severity and other side effects can vary between individuals.

 

Can Lyrica help with anxiety?

 

Understanding Lyrica and Anxiety

 

  • Lyrica (pregabalin) is primarily approved for treating nerve pain, fibromyalgia, and seizures.
  •  

  • Although not FDA-approved for anxiety, it has been used off-label to help some patients manage anxiety symptoms, especially in generalized anxiety disorder (GAD).

 

Mechanism and Effectiveness

 

  • Lyrica works by calming hyper-excited nerves, which may reduce anxiety symptoms by stabilizing neuronal activity.
  •  

  • Clinical studies suggest it can reduce anxiety more effectively than a placebo and comparable to some anxiety medications.

 

Considerations and Side Effects

 

  • Possible side effects include dizziness, sleepiness, and weight gain, which should be considered before off-label use.
  •  

  • Consult your doctor to assess if Lyrica aligns with your specific health needs and to discuss alternate anxiety treatments.

 

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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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