Does Quartz Health Solutions Cover Humira

Explore Humira coverage with Quartz Health: reasons for denial, coverage options, costs without insurance, and answers to common questions.
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Quartz Health Solutions Coverage for Humira

 

  • Quartz Health Solutions may cover Humira under certain plans. Coverage depends on the specific insurance policy and the medical necessity as determined by Quartz.
  •  

  • Coverage typically requires prior authorization, meaning the provider must verify the necessity for Humira with supporting medical documentation.
  •  

  • Patients may need to try other less costly medications or treatments before Humira is approved, following a step therapy protocol.
  •  

  • The coverage could vary based on whether the medication is administered in a clinical setting or self-injected at home.
  •  

  • Patients should consult their specific Quartz plan details or contact customer service for precise information on coverage limits, co-pays, and any pre-authorization requirements.

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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 Humira Coverage with Quartz Health Solutions

 

Check Your Plan's Formulary

 

  • Log in to the Quartz Health Solutions member portal and access your plan details. Look for the formulary list to verify if Humira is covered under your plan.
  •  

  • If you cannot locate this information online, contact Quartz customer service for assistance in finding whether Humira is included in your pharmacy benefits.

 

Contact Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of Humira for your condition. Having documentation ready can help in case pre-authorization is needed.
  •  

  • Your provider can also assist in providing any required documentation that Quartz may need.

 

Prepare for Pre-Authorization

 

  • Pre-authorization might be required for Humira coverage. Work with your healthcare provider to gather necessary medical records and justification for the medication.
  •  

  • Submit a pre-authorization request through your healthcare provider or directly through Quartz, following their specific submission process and requirements.

 

Understand Costs and Co-Payments

 

  • Determine your out-of-pocket costs for Humira by reviewing your coverage details on the Quartz portal or contacting customer service.
  •  

  • Check for any available financial assistance programs offered by AbbVie, the manufacturer of Humira, if the costs are substantial.

 

Explore Specialty Pharmacy Options

 

  • Quartz may have designated specialty pharmacies for dispensing Humira. Confirm which pharmacy you need to use to maintain coverage and receive your medication.
  •  

  • Your healthcare provider or the Quartz member portal should have detailed information on specialty pharmacy requirements.

 

Refill and Adherence Strategy

 

  • Set up an automatic refill reminder with your pharmacy to ensure no gaps in your medication routine.
  •  

  • Maintain open communication with your healthcare provider to monitor your progress and make any necessary adjustments to your treatment plan.

 

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FAQs

Does Quartz Health Solutions Cover Humira

Explore Humira coverage with Quartz Health: reasons for denial, coverage options, costs without insurance, and answers to common questions.
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Is Humira Covered by Quartz Health Solutions

 

Quartz Health Solutions Coverage for Humira

 

  • Quartz Health Solutions may cover Humira under certain plans. Coverage depends on the specific insurance policy and the medical necessity as determined by Quartz.
  •  

  • Coverage typically requires prior authorization, meaning the provider must verify the necessity for Humira with supporting medical documentation.
  •  

  • Patients may need to try other less costly medications or treatments before Humira is approved, following a step therapy protocol.
  •  

  • The coverage could vary based on whether the medication is administered in a clinical setting or self-injected at home.
  •  

  • Patients should consult their specific Quartz plan details or contact customer service for precise information on coverage limits, co-pays, and any pre-authorization requirements.

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Quartz Health Solutions's Approved Criteria for Humira Coverage

 

Eligibility Criteria for Humira Coverage

 

  • Applicant must have a confirmed diagnosis related to the approved indications for Humira, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, or plaque psoriasis.
  •  

  • For chronic conditions, confirmatory tests must substantiate the diagnosis. Medical records reflecting persistent and severe symptoms are required.
  •  

  • The individual must be over the age threshold suitable for Humira treatment as per FDA guidelines for the specific condition.

 

Step Therapy and Previous Treatments

 

  • Documentation should show that traditional therapies have been tried and found ineffective, contraindicated, or not tolerated prior to the prescription of Humira.
  •  

  • The patient must have gone through at least one or more conventional disease-modifying antirheumatic drugs (DMARDs) for rheumatoid-related conditions.

 

Monitoring and Follow-ups

 

  • Regular monitoring by a healthcare provider is necessary to evaluate treatment effectiveness and adjust dosages if needed, according to healthcare standards and protocols.
  •  

  • Periodic health evaluations and submission of progress reports to ensure ongoing coverage.

 

Supporting Documentation Requirements

 

  • Complete and up-to-date medical records, which may include progress notes, lab results, and any imaging studies relevant to the condition being treated.
  •  

  • A specialist evaluation indicating Humira as an appropriate and necessary treatment.

 

Why Quartz Health Solutions Might Deny Humira Coverage

 

Exclusions for Humira Coverage by Quartz Health Solutions

 

  • **Non-Formulary Drug**: Humira is not covered if it is classified as a non-formulary drug under Quartz's drug formulary guidelines.
  •  

  • **Off-Label Use**: Coverage is denied if Humira is prescribed for off-label uses that are not FDA-approved or not supported by substantial clinical evidence.
  •  

  • **Lack of Prior Authorization**: If prior authorization is required and not obtained before the medication is dispensed, coverage may be denied.
  •  

  • **Non-Compliant Treatment Protocols**: If the treatment regimen does not align with established clinical guidelines or approved indications outlined by Quartz.
  •  

  • **Failure to Meet Step Therapy Requirements**: Humira may not be covered if the patient has not tried and failed alternative therapies as required by step therapy protocols.
  •  

  • **Ineligible Plan Type**: Certain plan types within Quartz Health Solutions might exclude coverage for specialty drugs like Humira.
  •  

  • **No Supporting Documentation**: Coverage is denied if necessary supporting documentation demonstrating medical necessity is not provided.
  •  

  • **Experimental Use**: The drug is considered experimental or investigational for the condition being treated.
  •  

  • **Non-Covered Benefit**: If the specific health plan does not include benefits for certain biologic therapies.

 

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How Much Does Humira Cost without Insurance?

 

Understanding Humira's Cost

 

  • Humira, a medication used to treat various autoimmune conditions, can be quite expensive without insurance coverage.
  •  

  • The cost for a single 40 mg/0.4 ml pen of Humira is typically priced between $5,000 and $6,000, depending on the pharmacy and location.
  •  

  • Patients often require multiple pens per month, so monthly costs can range from $10,000 to $24,000 or more, depending on dosage and frequency of use.
  •  

  • Pharmaceutical companies may offer financial assistance programs or patient support to help lower these costs for eligible patients.
  •  

  • Discount programs and manufacturer coupons could sometimes reduce the cost for patients who qualify.

 

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 Humira Coverage with Quartz Health Solutions

 

Check Your Plan's Formulary

 

  • Log in to the Quartz Health Solutions member portal and access your plan details. Look for the formulary list to verify if Humira is covered under your plan.
  •  

  • If you cannot locate this information online, contact Quartz customer service for assistance in finding whether Humira is included in your pharmacy benefits.

 

Contact Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of Humira for your condition. Having documentation ready can help in case pre-authorization is needed.
  •  

  • Your provider can also assist in providing any required documentation that Quartz may need.

 

Prepare for Pre-Authorization

 

  • Pre-authorization might be required for Humira coverage. Work with your healthcare provider to gather necessary medical records and justification for the medication.
  •  

  • Submit a pre-authorization request through your healthcare provider or directly through Quartz, following their specific submission process and requirements.

 

Understand Costs and Co-Payments

 

  • Determine your out-of-pocket costs for Humira by reviewing your coverage details on the Quartz portal or contacting customer service.
  •  

  • Check for any available financial assistance programs offered by AbbVie, the manufacturer of Humira, if the costs are substantial.

 

Explore Specialty Pharmacy Options

 

  • Quartz may have designated specialty pharmacies for dispensing Humira. Confirm which pharmacy you need to use to maintain coverage and receive your medication.
  •  

  • Your healthcare provider or the Quartz member portal should have detailed information on specialty pharmacy requirements.

 

Refill and Adherence Strategy

 

  • Set up an automatic refill reminder with your pharmacy to ensure no gaps in your medication routine.
  •  

  • Maintain open communication with your healthcare provider to monitor your progress and make any necessary adjustments to your treatment plan.

 

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Humira FAQ

What are the side effects of Humira?

 

Common Side Effects of Humira

 

  • Injection site reactions: redness, itching, or swelling.
  • Upper respiratory infections: sinus congestion and sore throat.
  • Headaches and nausea.

 

Serious Side Effects

 

  • Severe allergic reactions: difficulty breathing, chest pain, or swelling of the face.
  • Risk of infections: tuberculosis, fungal, or viral infections.
  • Blood disorders: unusual bruising or bleeding, pale skin.
  • Heart problems: shortness of breath, swelling of ankles/feet.

 

Long-term Considerations

 

  • Increased risk of certain cancers, particularly lymphomas.
  • Possible liver issues: jaundice or dark urine.

 

How does Humira work for rheumatoid arthritis?

 

How Humira Works

 

  • Humira is a TNF inhibitor. TNF, or tumor necrosis factor, is a substance in the body that causes inflammation.
  •  

  • By blocking TNF, Humira helps reduce inflammation and slow disease progression in rheumatoid arthritis patients.
  •  

  • It targets the underlying cause of inflammation instead of just managing symptoms, providing longer-term relief from discomfort and joint damage.

 

Administration and Effects

 

  • Administered as a subcutaneous injection, typically every two weeks.
  •  

  • Many patients start experiencing relief within a few weeks, though full benefits may take longer.
  •  

  • Consistent use can lead to improved mobility, reduced pain, and decreased swelling, assisting in daily activities.

How often do you take Humira injections?

 

Frequency of Humira Injections

 

  • **Initial Dose**: Typically, patients start with a loading dose. For example, in rheumatoid arthritis, a patient may begin with 160 mg on day 1, followed by 80 mg on day 15.
  •  

  • **Maintenance Dose**: After the initial period, the standard maintenance dose is usually 40 mg every other week. However, some patients may benefit from a weekly dose, depending on the condition and doctor's advice.
  •  

  • **Adjustments**: Dosage frequency may be adjusted based on response and tolerability, making healthcare provider consultation crucial.

 

Consulting Your Physician

 

  • Due to the varying nature of autoimmune conditions, always consult your healthcare professional to determine the appropriate regimen for your specific situation.

 

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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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