Does Oscar Health Cover Trelegy

Explore Oscar Health's Trelegy coverage, reasons for denial, ways to gain approval, Trelegy costs without insurance, and frequently asked questions.
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Oscar Health Coverage for Trelegy

 

  • Trelegy is typically covered under Oscar Health's prescription drug benefits for patients diagnosed with chronic obstructive pulmonary disease (COPD) or asthma.
  •  

  • Coverage may require prior authorization, meaning your healthcare provider must demonstrate that Trelegy is medically necessary for your condition.
  •  

  • Oscar Health adheres to a formulary, a list of covered medications. Trelegy's inclusion may depend on its tier status and other formulary requirements.
  •  

  • Possessing a prescription from a licensed healthcare provider is essential. Refills are managed based on Oscar’s policies and the prescribed treatment plan.
  •  

 

Basic Rules & Criteria

 

  • Verify whether your specific Oscar Health plan supports Trelegy coverage and the required documentation for processing.
  •  

  • Co-pays or co-insurance might apply based on your specific health plan and the tier classification of Trelegy in the formulary.
  •  

  • It is advisable to consult with Oscar Health’s customer support or your healthcare provider to confirm the latest coverage criteria and any potential out-of-pocket costs.

 

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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 Trelegy Coverage with Oscar Health

 

Understanding Trelegy and Coverage Requirements

 

  • Trelegy is a prescription medication used for respiratory issues. Ensure it is a part of Oscar Health's formulary, the list of covered medications.
  •  
  • Check with your healthcare provider if Trelegy is medically necessary for your condition, as this may influence coverage approval.

 

Verify Your Plan's Specific Coverage

 

  • Log into your Oscar Health member portal to review your specific plan details. This will provide insight into prescription coverage specifics.
  •  
  • Check if Trelegy requires pre-authorization or if there are any step therapy protocols, meaning you might need to try other medications first.

 

Consult with an Oscar Health Representative

 

  • Contact Oscar Health's customer service to ask detailed questions about your plan’s specific policies regarding Trelegy.
  •  
  • Prepare your policy ID and any relevant medical documentation to facilitate a more efficient consultation.

 

Get a Prescription from Your Healthcare Provider

 

  • Visit your doctor or specialist to discuss your need for Trelegy and obtain a valid prescription.
  •  
  • Ensure your healthcare provider is an in-network provider with Oscar Health to maximize your benefits and reduce out-of-pocket costs.

 

Submit Any Required Pre-Authorizations

 

  • If pre-authorization is required, work with your healthcare provider to submit necessary forms and documentation to Oscar Health.
  •  
  • Ensure all medical necessity information is clear and detailed to improve the likelihood of coverage approval.

 

Fill Your Prescription at an In-Network Pharmacy

 

  • Locate an in-network pharmacy through your Oscar Health portal to fill your Trelegy prescription.
  •  
  • Present your insurance card when filling the prescription to apply your Oscar Health coverage benefits.

 

Appeal Denials if Necessary

 

  • If Oscar Health denies coverage, review the denial letter for reasons and steps to appeal the decision.
  •  
  • Gather any additional documentation or letters of medical necessity from your healthcare provider to support your appeal.

 

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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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FAQs

Does Oscar Health Cover Trelegy

Explore Oscar Health's Trelegy coverage, reasons for denial, ways to gain approval, Trelegy costs without insurance, and frequently asked questions.
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Is Trelegy Covered by Oscar Health

 

Oscar Health Coverage for Trelegy

 

  • Trelegy is typically covered under Oscar Health's prescription drug benefits for patients diagnosed with chronic obstructive pulmonary disease (COPD) or asthma.
  •  

  • Coverage may require prior authorization, meaning your healthcare provider must demonstrate that Trelegy is medically necessary for your condition.
  •  

  • Oscar Health adheres to a formulary, a list of covered medications. Trelegy's inclusion may depend on its tier status and other formulary requirements.
  •  

  • Possessing a prescription from a licensed healthcare provider is essential. Refills are managed based on Oscar’s policies and the prescribed treatment plan.
  •  

 

Basic Rules & Criteria

 

  • Verify whether your specific Oscar Health plan supports Trelegy coverage and the required documentation for processing.
  •  

  • Co-pays or co-insurance might apply based on your specific health plan and the tier classification of Trelegy in the formulary.
  •  

  • It is advisable to consult with Oscar Health’s customer support or your healthcare provider to confirm the latest coverage criteria and any potential out-of-pocket costs.

 

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Oscar Health's Approved Criteria for Trelegy Coverage

 

Oscar Health's Approved Criteria for Trelegy Coverage

 

  • Patients must be diagnosed with Chronic Obstructive Pulmonary Disease (COPD) or Asthma, as supported by clinical documentation from a healthcare provider.
  •  

  • Patients should have shown inadequate control with alternate maintenance medications, supported by history of prescriptions or treatment plans.
  •  

  • Trelegy must be prescribed by a licensed pulmonologist or a relevant specialist to ensure appropriate diagnosis and treatment plan.
  •  

  • Medical necessity should be demonstrated, preferably by illustrating increased exacerbations or decreased lung function without the use of Trelegy.
  •  

  • Age criteria apply, typically covering patients 18 years or older, unless specific conditions indicate otherwise and are documented by the healthcare provider.
  •  

  • Patients adhere to appropriate follow-up consultations with healthcare providers to monitor effectiveness and side effects, ensuring adherence to the treatment plan.

 

Why Oscar Health Might Deny Trelegy Coverage

 

Situations When Oscar Health Might Deny Trelegy Coverage

 

  • The medication is not deemed medically necessary according to Oscar Health's criteria.
  •  

  • Patient does not meet the severity requirements for asthma or COPD outlined by Oscar Health for Trelegy.
  •  

  • Trelegy is not on the formulary list, and there's no step therapy requirement fulfilled with other preferred medications.
  •  

  • Lack of prior authorization where it is specified as a prerequisite for coverage of Trelegy.
  •  

  • The prescription is being used for an off-label condition or in a manner not approved by the FDA, which Oscar Health does not cover.
  •  

  • The patient has not attempted other treatments that are required to be tried first as per their policy's step therapy protocols.
  •  

  • The coverage request does not comply with their policy's age restrictions or other demographic eligibility criteria for Trelegy.

 

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How Much Does Trelegy Cost without Insurance?

 

Approximate Cost of Trelegy Without Insurance

 

  • The cost of Trelegy Ellipta, without insurance, can vary significantly based on several factors like the pharmacy, geographical location, or available discounts. On average, patients can expect to pay between $550 to $650 for a 30-day supply.
  •  

  • Prices may also fluctuate depending on ongoing promotions or pharmacy memberships that can provide additional savings.
  •  

  • It’s advisable for patients to use discount cards, check for manufacturer coupons, or explore patient assistance programs to lower the out-of-pocket expense.
  •  

  • Shopping around, comparing prices at different pharmacies, or using online price comparison tools can also result in significant cost savings for Trelegy.

 

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 Trelegy Coverage with Oscar Health

 

Understanding Trelegy and Coverage Requirements

 

  • Trelegy is a prescription medication used for respiratory issues. Ensure it is a part of Oscar Health's formulary, the list of covered medications.
  •  
  • Check with your healthcare provider if Trelegy is medically necessary for your condition, as this may influence coverage approval.

 

Verify Your Plan's Specific Coverage

 

  • Log into your Oscar Health member portal to review your specific plan details. This will provide insight into prescription coverage specifics.
  •  
  • Check if Trelegy requires pre-authorization or if there are any step therapy protocols, meaning you might need to try other medications first.

 

Consult with an Oscar Health Representative

 

  • Contact Oscar Health's customer service to ask detailed questions about your plan’s specific policies regarding Trelegy.
  •  
  • Prepare your policy ID and any relevant medical documentation to facilitate a more efficient consultation.

 

Get a Prescription from Your Healthcare Provider

 

  • Visit your doctor or specialist to discuss your need for Trelegy and obtain a valid prescription.
  •  
  • Ensure your healthcare provider is an in-network provider with Oscar Health to maximize your benefits and reduce out-of-pocket costs.

 

Submit Any Required Pre-Authorizations

 

  • If pre-authorization is required, work with your healthcare provider to submit necessary forms and documentation to Oscar Health.
  •  
  • Ensure all medical necessity information is clear and detailed to improve the likelihood of coverage approval.

 

Fill Your Prescription at an In-Network Pharmacy

 

  • Locate an in-network pharmacy through your Oscar Health portal to fill your Trelegy prescription.
  •  
  • Present your insurance card when filling the prescription to apply your Oscar Health coverage benefits.

 

Appeal Denials if Necessary

 

  • If Oscar Health denies coverage, review the denial letter for reasons and steps to appeal the decision.
  •  
  • Gather any additional documentation or letters of medical necessity from your healthcare provider to support your appeal.

 

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Trelegy FAQ

1. What are the side effects of Trelegy?

 

Common Side Effects of Trelegy

 

  • Headaches
  • Back pain
  • Hoarseness
  • Oral thrush

 

Serious Side Effects

 

  • Increased heart rate
  • Chest pain
  • High blood pressure
  • Pneumonia in COPD patients

 

Less Common Side Effects

 

  • Diarrhea
  • Cough
  • Sore throat
  • Gastrointestinal discomfort

 

Precautions

 

  • Monitor for worsening symptoms.
  • Consult a doctor for persistent side effects.

 

2. How does Trelegy compare to Breo?

 

Comparison of Trelegy and Breo

 

  • Trelegy combines three active ingredients: fluticasone furoate (a corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Breo contains only two: fluticasone furoate and vilanterol.
  •  

  • This combination in Trelegy allows for better control of symptoms for COPD patients requiring more comprehensive therapy, whereas Breo is more suitable for those requiring less intensive treatment.
  •  

  • Both medications are administered once daily via inhalation, but Trelegy’s triple therapy provides a broader mechanism of action.
  •  

  • Side effects are generally similar, though patients transitioning from Breo to Trelegy may experience different responses due to the added component.

 

3. Is Trelegy a steroid?

 

Is Trelegy a Steroid?

 

  • Components: Trelegy contains three active ingredients: fluticasone furoate, umeclidinium, and vilanterol. Fluticasone furoate is a corticosteroid.
  •  

  • Steroid Role: The corticosteroid in Trelegy helps reduce inflammation in the airways, which is crucial for treating conditions like COPD and asthma.
  •  

  • Multi-Action: In addition to the steroid, umeclidinium (an anticholinergic) and vilanterol (a long-acting beta-agonist) work to relax and open the airways.
  •  

  • Usage: Trelegy is inhaled, delivering these components directly to the lungs for targeted action, minimizing systemic steroid exposure.

 

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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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