Does Network Health Cover Victoza

Explore why Victoza may not be covered, how to secure coverage, costs without insurance, and answers to common questions in this comprehensive guide.
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Coverage for Victoza

 

  • Network Health may cover Victoza under certain plans for individuals with Type 2 diabetes.
  • Coverage typically requires prior authorization based on medical necessity, as determined by the healthcare provider.

 

Basic Criteria

 

  • Patients usually need a diagnosis of Type 2 diabetes and a demonstrated need for medication beyond lifestyle changes and metformin.
  • Documentation from healthcare providers is necessary to show why Victoza is appropriate, including past treatment history and efficacy.

 

Situations Covered

 

  • Victoza may be covered when used to improve blood sugar control in adults with Type 2 diabetes.
  • It can be considered if there is a need to reduce the risk of major cardiovascular events in patients with heart disease.

 

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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 Victoza Coverage with Network Health

 

Check Your Coverage Plan

 

  • Log in to your Network Health member portal to review your current health plan documents and benefits.
  •  

  • Look for prescription drug coverage information to see if Victoza is listed under the formulary.
  •  

  • If you don't have access online, reach out to Network Health member services for assistance. They can provide details on your plan’s coverage for Victoza.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Victoza and inquire if there are any specific coverage requirements or documentation needed by Network Health.
  •  

  • Ensure your prescriber is aware of any prior authorization or step therapy requirements that might be necessary for coverage.

 

Verify Prior Authorization Requirements

 

  • Contact Network Health’s pharmacy benefits manager, or check the member portal to determine if Victoza requires prior authorization for coverage.
  •  

  • If prior authorization is needed, work with your healthcare provider to submit the necessary paperwork for approval.

 

Submit a Prescription Claim

 

  • Visit an in-network pharmacy to fill your Victoza prescription, ensuring the pharmacy is part of Network Health's network to optimize coverage options.
  •  

  • Provide your Network Health insurance card at the time of prescription pickup for direct billing through your health plan.

 

Appeal Denied Coverage

 

  • If coverage for Victoza is denied, review the denial letter from Network Health for specific reasons and potential areas to address.
  •  

  • Coordinate with your healthcare provider to gather supportive documents or medical justification needed for an appeal and submit it to Network Health.

 

Explore Additional Assistance Programs

 

  • Investigate if the manufacturer of Victoza offers patient assistance programs or discounts that might be applicable even with network insurance limitations.
  •  

  • Look into any state or local government health programs that might offer supplementary assistance for prescription medication if needed.

 

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FAQs

Does Network Health Cover Victoza

Explore why Victoza may not be covered, how to secure coverage, costs without insurance, and answers to common questions in this comprehensive guide.
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Is Victoza Covered by Network Health

 

Coverage for Victoza

 

  • Network Health may cover Victoza under certain plans for individuals with Type 2 diabetes.
  • Coverage typically requires prior authorization based on medical necessity, as determined by the healthcare provider.

 

Basic Criteria

 

  • Patients usually need a diagnosis of Type 2 diabetes and a demonstrated need for medication beyond lifestyle changes and metformin.
  • Documentation from healthcare providers is necessary to show why Victoza is appropriate, including past treatment history and efficacy.

 

Situations Covered

 

  • Victoza may be covered when used to improve blood sugar control in adults with Type 2 diabetes.
  • It can be considered if there is a need to reduce the risk of major cardiovascular events in patients with heart disease.

 

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Network Health's Approved Criteria for Victoza Coverage

 

Victoza Coverage Criteria

 

  • Patient has a confirmed diagnosis of type 2 diabetes mellitus.
  •  

  • Evidence that lifestyle modification and oral hypoglycemic agents have not achieved glycated hemoglobin (HbA1c) targets as specified by their healthcare provider.
  •  

  • Patient is 18 years or older and meets the health guidelines based on professional health assessment.
  •  

  • Documentation of recent lab results demonstrating the need for an additional therapeutic approach beyond existing medications.
  •  

  • Prescription must be written by a healthcare professional specializing in endocrinology or a related field.
  •  

  • Prior authorization completed and submitted by the prescribing provider, including detailed patient history and need for Victoza.
  •  

  • Verification that the patient does not have any contraindications for Victoza, such as medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2.
  •  

  • Patient education, understanding of medication administration, and agreement to follow-up visits to monitor medication efficacy and safety.
  •  

  • Endorsement of Victoza as part of the comprehensive diabetes management plan, which may include diet, exercise, and additional medications if required.

 

Why Network Health Might Deny Victoza Coverage

 

Situations where Network Health Might Deny Victoza Coverage

 

  • The medication is not being used for an FDA-approved indication. Victoza is specifically approved for managing type 2 diabetes and must only be prescribed for this condition.
  •  

  • Failure to meet specific medical necessity criteria. Patients must demonstrate a medical necessity for Victoza as determined by Network Health's guidelines.
  •  

  • Absence of prior authorization, if required. Some insurance plans may require prior authorization to verify that Victoza is an appropriate treatment based on medical history and documentation.
  •  

  • Victoza is prescribed without first attempting preferred medications. Network Health may have a formulary list of preferred drugs that need to be tried before covering Victoza.
  •  

  • Non-compliance with prescribed treatment plans. Coverage might be denied if there is evidence of not following the treatment plan laid out by healthcare providers.
  •  

  • Prescriptions written by non-network providers without proper referrals. Prescription coverage might be denied if a network healthcare provider does not write the prescription or if proper referrals aren't in place.
  •  

  • Inadequate documentation provided to support the prescribed use. It's crucial to supply sufficient and accurate documentation from healthcare professionals to justify the need for Victoza.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Victoza Cost without Insurance?

 

Understanding Victoza Costs Without Insurance

 

  • The cost of Victoza without insurance can vary depending on the pharmacy and location, but typically it ranges from $900 to $1,200 for a 30-day supply.
  •  

  • Prices can fluctuate slightly due to different pharmacy pricing policies, geographic location, and available discounts or membership programs.
  •  

  • It's advisable to check with multiple pharmacies for the most accurate and competitive pricing if paying out-of-pocket.
  •  

  • Some pharmacies or pharmaceutical discount programs might offer lower prices or savings cards, so it could be beneficial to explore these options.

 

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 Victoza Coverage with Network Health

 

Check Your Coverage Plan

 

  • Log in to your Network Health member portal to review your current health plan documents and benefits.
  •  

  • Look for prescription drug coverage information to see if Victoza is listed under the formulary.
  •  

  • If you don't have access online, reach out to Network Health member services for assistance. They can provide details on your plan’s coverage for Victoza.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Victoza and inquire if there are any specific coverage requirements or documentation needed by Network Health.
  •  

  • Ensure your prescriber is aware of any prior authorization or step therapy requirements that might be necessary for coverage.

 

Verify Prior Authorization Requirements

 

  • Contact Network Health’s pharmacy benefits manager, or check the member portal to determine if Victoza requires prior authorization for coverage.
  •  

  • If prior authorization is needed, work with your healthcare provider to submit the necessary paperwork for approval.

 

Submit a Prescription Claim

 

  • Visit an in-network pharmacy to fill your Victoza prescription, ensuring the pharmacy is part of Network Health's network to optimize coverage options.
  •  

  • Provide your Network Health insurance card at the time of prescription pickup for direct billing through your health plan.

 

Appeal Denied Coverage

 

  • If coverage for Victoza is denied, review the denial letter from Network Health for specific reasons and potential areas to address.
  •  

  • Coordinate with your healthcare provider to gather supportive documents or medical justification needed for an appeal and submit it to Network Health.

 

Explore Additional Assistance Programs

 

  • Investigate if the manufacturer of Victoza offers patient assistance programs or discounts that might be applicable even with network insurance limitations.
  •  

  • Look into any state or local government health programs that might offer supplementary assistance for prescription medication if needed.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Victoza FAQ

What are the common side effects of Victoza?

 

Common Side Effects of Victoza

 

  • Gastrointestinal Issues: Nausea, vomiting, diarrhea, and constipation are frequent side effects, typically subsiding after a few weeks.
  •  

  • Headaches: Some individuals may experience mild to moderate headaches.
  •  

  • Fatigue: Feeling tired or weak can occur, especially during initial treatment.
  •  

  • Hypoglycemia: Though rarer, low blood sugar may happen, particularly if combined with other diabetes medications.
  •  

  • Injection Site Reactions: Redness, itching, or swelling at the site of injection can arise.

 

Note

 

  • Consult your healthcare provider if side effects persist or worsen.

 

How does Victoza help with weight loss?

 

How Victoza Assists in Weight Reduction

 

  • Appetite Suppression: Victoza (liraglutide), a GLP-1 receptor agonist, influences brain regions that regulate appetite, reducing hunger and food intake.
  •  

  • Delayed Gastric Emptying: It slows stomach emptying, contributing to prolonged feelings of fullness after meals, which helps reduce calorie consumption.
  •  

  • Improved Insulin Sensitivity: Enhances insulin efficiency, promoting better glucose utilization and reduced fat storage, supporting weight loss.
  •  

  • Fat Metabolism: Encourages the breakdown of stored fat for energy usage, facilitating gradual weight reduction.

 

Can Victoza be used for type 1 diabetes?

 

Can Victoza Be Used for Type 1 Diabetes?

 

  • Victoza (liraglutide) is primarily prescribed for Type 2 diabetes management. It works by stimulating insulin secretion and delaying gastric emptying.
  •  

  • For Type 1 diabetes, the body doesn't produce insulin, making Victoza ineffective as a sole treatment. Patients require insulin replacement therapy.
  •  

  • Some studies explore adjunctive use of GLP-1 receptor agonists like Victoza to improve glycemic control and reduce insulin doses in Type 1, but it's not standard.

 

Recommendation

 

  • Consult a healthcare provider before considering Victoza for Type 1 diabetes, focusing on its potential benefits and risks within individual treatment plans.

 

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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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