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Does Priority Health Cover Trelegy

Explore Trelegy coverage with Priority Health, reasons for denial, steps to get coverage, cost without insurance, and answers to common questions.
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Coverage for Trelegy

 

  • Priority Health may cover Trelegy for patients diagnosed with certain chronic respiratory conditions, such as COPD or asthma.

    •  

  • Trelegy coverage generally requires prior authorization. The healthcare provider must submit necessary documentation to justify its use.

    •  

  • Medical necessity criteria often include evidence of previous treatment options being ineffective or not tolerated.

 

Basic Rules and Criteria

 

  • Members should have health insurance plans that include prescription drug coverage.

    •  

  • The prescriber must be in-network, or a special exception should be requested for out-of-network providers.

    •  

  • Regular review of formulary updates is essential, as coverage terms may change periodically.

    •  

  • Co-pays and deductibles may apply based on individual health plans and coverage tiers.

 

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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

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 Priority Health

 

Identify Your Plan and Coverage

 

  • Start by reviewing your current plan documents provided by Priority Health. Understanding your specific policy details can help you anticipate coverage and any necessary steps.

    •  

  • Contact Priority Health Customer Service to confirm if Trelegy is included within your current plan’s formulary and covered prescriptions.

 

Consult with Your Healthcare Provider

 

  • Make an appointment with your healthcare provider to discuss your need for Trelegy. Your healthcare provider can provide medical documentation and justification which can be crucial for obtaining coverage.

    •  

  • Ensure that your healthcare provider is willing to write a detailed letter of medical necessity if required by Priority Health.

 

Review Prior Authorization Requirements

 

  • Check if Priority Health requires prior authorization for Trelegy. This step is crucial as it involves getting approval from Priority Health before your prescription coverage can be guaranteed.

    •  

  • Your healthcare provider will typically initiate the prior authorization process by submitting the necessary forms and documentation to Priority Health.

 

Submit a Claim or Request Coverage

 

  • If your prescription is not automatically covered, submit a claim directly to Priority Health. Make sure to include all necessary documentation such as the prescription, your healthcare provider’s letter, and any prior authorization forms.

    •  

  • Use Priority Health's online portal for tracking claims and coverage requests which can provide real-time updates and avoid any possible delays.

 

Follow Up

 

  • Contact Priority Health after submitting your claim to confirm receipt and ask about any additional information needed to process your request.

    •  

  • Regularly check the status of your claim through the Priority Health portal or by contacting customer support to ensure that the process is moving forward.

 

Explore Appeals Process If Denied

 

  • If your request for coverage of Trelegy is denied, review the reasons provided by Priority Health in their denial letter.

    •  

  • Work with your healthcare provider to gather any additional information or documentation that might support an appeal to reconsider your coverage request.

 

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FAQs

Does Priority Health Cover Trelegy

Explore Trelegy coverage with Priority Health, reasons for denial, steps to get coverage, cost without insurance, and answers to common questions.
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Is Trelegy Covered by Priority Health

 

Coverage for Trelegy

 

  • Priority Health may cover Trelegy for patients diagnosed with certain chronic respiratory conditions, such as COPD or asthma.

    •  

  • Trelegy coverage generally requires prior authorization. The healthcare provider must submit necessary documentation to justify its use.

    •  

  • Medical necessity criteria often include evidence of previous treatment options being ineffective or not tolerated.

 

Basic Rules and Criteria

 

  • Members should have health insurance plans that include prescription drug coverage.

    •  

  • The prescriber must be in-network, or a special exception should be requested for out-of-network providers.

    •  

  • Regular review of formulary updates is essential, as coverage terms may change periodically.

    •  

  • Co-pays and deductibles may apply based on individual health plans and coverage tiers.

 

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Priority Health's Approved Criteria for Trelegy Coverage

 

Criteria for Trelegy Coverage Under Priority Health

 

  • Member must have a confirmed diagnosis of Chronic Obstructive Pulmonary Disease (COPD) or asthma as determined by a healthcare professional.

    •  

  • Treatment with Trelegy is indicated for members aged 18 years and older.

    •  

  • Member must exhibit symptoms that significantly impact their daily living activities, with documented records of exacerbations requiring corticosteroids or hospitalization.

    •  

  • Previous treatments with at least two other classes of inhaler medications (such as long-acting beta-agonists, inhaled corticosteroids, or long-acting muscarinic antagonists) have been unsuccessful in managing the condition.

    •  

  • For asthma, member should have been on a medium- to high-dose inhaled corticosteroid therapy with suboptimal control or require hospital/ER visits.

    •  

  • Physician documentation should show the expected benefit of Trelegy over currently administered treatments, with a clear rationale for starting Trelegy therapy.

    •  

  • Continued coverage is contingent upon a review of the member’s adherence to the prescribed treatment plan with improvements in symptom management.

    •  

  • Member must have a non-smoking or smoking cessation status for improved treatment efficacy, supported by physician notes.

    •  

  • Healthcare provider must confirm that Trelegy is dispensed in the correct dose and format suitable for the member's condition.

Why Priority Health Might Deny Trelegy Coverage

 

Reasons Priority Health Might Deny Trelegy Coverage

 

  • **Non-Formulary Status:** Trelegy may not be on Priority Health's formulary list. If a medication isn't listed, coverage might be denied.

    •  

  • **Non-Approved Condition:** Trelegy is approved for specific respiratory conditions. If prescribed for conditions outside of its approved use, coverage may be denied.

    •  

  • **Lack of Prior Authorization:** Some medications require prior authorization before coverage approval. If Trelegy is prescribed without obtaining this pre-approval, it may result in denial.

    •  

  • **Insufficient Medical Necessity:** Coverage can be denied if it's determined that Trelegy is not medically necessary based on the patient's medical history and records.

    •  

  • **Failure to Try Alternative Therapies:** If there are other preferred medications or therapies that should be tried first, and Trelegy is prescribed without attempting those, coverage might be denied.

    •  

  • **Out-of-Network Provider:** If Trelegy is prescribed by an out-of-network provider without proper authorization, it could lead to a coverage denial.

    •  

  • **Policy Exclusions:** Certain insurance plans might have exclusions or specific terms that do not cover Trelegy, leading to denial of coverage.

 

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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.

 

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

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 Priority Health

 

Identify Your Plan and Coverage

 

  • Start by reviewing your current plan documents provided by Priority Health. Understanding your specific policy details can help you anticipate coverage and any necessary steps.

    •  

  • Contact Priority Health Customer Service to confirm if Trelegy is included within your current plan’s formulary and covered prescriptions.

 

Consult with Your Healthcare Provider

 

  • Make an appointment with your healthcare provider to discuss your need for Trelegy. Your healthcare provider can provide medical documentation and justification which can be crucial for obtaining coverage.

    •  

  • Ensure that your healthcare provider is willing to write a detailed letter of medical necessity if required by Priority Health.

 

Review Prior Authorization Requirements

 

  • Check if Priority Health requires prior authorization for Trelegy. This step is crucial as it involves getting approval from Priority Health before your prescription coverage can be guaranteed.

    •  

  • Your healthcare provider will typically initiate the prior authorization process by submitting the necessary forms and documentation to Priority Health.

 

Submit a Claim or Request Coverage

 

  • If your prescription is not automatically covered, submit a claim directly to Priority Health. Make sure to include all necessary documentation such as the prescription, your healthcare provider’s letter, and any prior authorization forms.

    •  

  • Use Priority Health's online portal for tracking claims and coverage requests which can provide real-time updates and avoid any possible delays.

 

Follow Up

 

  • Contact Priority Health after submitting your claim to confirm receipt and ask about any additional information needed to process your request.

    •  

  • Regularly check the status of your claim through the Priority Health portal or by contacting customer support to ensure that the process is moving forward.

 

Explore Appeals Process If Denied

 

  • If your request for coverage of Trelegy is denied, review the reasons provided by Priority Health in their denial letter.

    •  

  • Work with your healthcare provider to gather any additional information or documentation that might support an appeal to reconsider your coverage request.

 

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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.

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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.

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.

 

Have questions left?

‍

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A weight management program tailored to you

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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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