Does Quartz Health Solutions Cover Januvia

Explore if Quartz Health Solutions covers Januvia, reasons for denial, tips for approval, costs without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Januvia

 

  • Quartz Health Solutions typically covers Januvia as part of its prescription drug benefits, contingent upon specific plan guidelines.
  •  

  • To qualify for coverage, patients generally need a confirmed diagnosis of type 2 diabetes, as Januvia is primarily prescribed for managing blood sugar levels in such cases.

 

Eligibility and Criteria

 

  • A prior authorization may be required, where the healthcare provider must substantiate the medical necessity of Januvia.
  •  

  • The patient's medical history and previous treatments might be reviewed to justify the prescription of Januvia over other medications.

 

Plan Variations

 

  • Coverage specifics can vary depending on the individual’s plan type within Quartz. Not all plans have the same drug formularies, so it is important to check the detailed plan documents.
  •  

  • Co-pays or deductibles may apply as per the terms of the chosen Quartz Health insurance plan.

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

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 Januvia Coverage with Quartz Health Solutions

 

Understand Coverage Requirements

 

  • Visit the Quartz Health Solutions website to review coverage policies for prescription medications. Look for information specifically related to diabetes medication or brand name drugs.
  •  

  • Check the formulary list provided by Quartz Health Solutions to see if Januvia is included as a covered medication.

 

Contact Quartz Health Member Services

 

  • Call the member services number on the back of your Quartz Health insurance card to inquire about Januvia coverage, copays, and pre-authorization requirements.
  •  

  • Prepare your member ID and relevant medical history to facilitate the conversation with customer support.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity for Januvia as part of your diabetes treatment plan.
  •  

  • Ask your doctor to provide any necessary documentation or a letter of medical necessity if Quartz Health requires justification for coverage.

 

Submit Necessary Documentation

 

  • If required, submit the letter of medical necessity and any other supporting documentation to Quartz Health Solutions for review.
  •  

  • Follow up with your healthcare provider or Quartz Health to ensure all paperwork has been received and is being processed.

 

Consider Prior Authorization

 

  • Check if prior authorization is needed for Januvia. If so, work with your healthcare provider to submit a prior authorization request.
  •  

  • Regularly check the status of your prior authorization with both your provider and Quartz Health Solutions to expedite the approval process.

 

Review Your Plan's Pharmacy Network

 

  • Verify that your preferred pharmacy is within Quartz Health’s network and that they are authorized to dispense Januvia under your plan.
  •  

  • Ask the pharmacy to process the prescription once the coverage is confirmed to avoid unexpected costs.

 

Appeal Denied Coverage if Necessary

 

  • If coverage for Januvia is denied, request a formal explanation from Quartz Health regarding the decision.
  •  

  • Submit an appeal using the process outlined by Quartz Health Solutions, including any additional documentation needed to support the appeal.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Quartz Health Solutions Cover Januvia

Explore if Quartz Health Solutions covers Januvia, reasons for denial, tips for approval, costs without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

Is Januvia Covered by Quartz Health Solutions

 

Coverage for Januvia

 

  • Quartz Health Solutions typically covers Januvia as part of its prescription drug benefits, contingent upon specific plan guidelines.
  •  

  • To qualify for coverage, patients generally need a confirmed diagnosis of type 2 diabetes, as Januvia is primarily prescribed for managing blood sugar levels in such cases.

 

Eligibility and Criteria

 

  • A prior authorization may be required, where the healthcare provider must substantiate the medical necessity of Januvia.
  •  

  • The patient's medical history and previous treatments might be reviewed to justify the prescription of Januvia over other medications.

 

Plan Variations

 

  • Coverage specifics can vary depending on the individual’s plan type within Quartz. Not all plans have the same drug formularies, so it is important to check the detailed plan documents.
  •  

  • Co-pays or deductibles may apply as per the terms of the chosen Quartz Health insurance plan.

A weight management program tailored to you

Start with Curex

Quartz Health Solutions's Approved Criteria for Januvia Coverage

 

Criteria for Coverage of Januvia

 

  • Januvia is covered for individuals diagnosed with Type 2 Diabetes Mellitus. The patient must have confirmed the diagnosis by appropriate clinical tests.
  •  

  • Coverage is applicable for patients who have not achieved desired blood glucose control despite following lifestyle interventions such as diet and exercise.
  •  

  • Januvia can be covered as part of dual therapy when the patient is currently using metformin and requires an additional oral agent to improve glycemic control.
  •  

  • Coverage may be approved if Januvia is prescribed as a monotherapy when metformin is contraindicated or not tolerated by the patient.
  •  

  • Physicians should demonstrate that the patient has tried at least one other oral anti-diabetic agent without adequate blood glucose control before requesting coverage for Januvia.
  •  

  • Januvia is covered when it is being used in conjunction with insulin, provided there is a clear medical necessity to enhance control of blood sugar levels.

 

Continued Coverage Requirements

 

  • Ongoing coverage is contingent upon regular evaluation by the healthcare provider, which shows that Januvia contributes to improved or maintained blood glucose control.
  •  

  • Healthcare providers must provide evidence of continued intolerance or contraindication to other medications if Januvia is continued as a monotherapy.
  •  

  • Patients are required to adhere to appropriate monitoring of diabetes, such as hemoglobin A1c tests as recommended by their healthcare provider.

 

Special Considerations

 

  • Consideration for coverage may be aligned with specific patient-centered factors, such as age, comorbid conditions, and risk of hypoglycemia.
  •  

  • Alternative treatment options should be assessed and documented if the use of Januvia is due to specific advantages it provides over other therapies.

 

Why Quartz Health Solutions Might Deny Januvia Coverage

 

Non-Medically Necessary Uses

 

  • Januvia will not be covered if it is prescribed for conditions not approved by the FDA or not recognized as medically necessary for the patient’s specific type of diabetes.

 

Experimental or Investigational Use

 

  • If Januvia is being used as part of a clinical trial or for experimental treatments not yet sanctioned by recognized health authorities, Quartz Health Solutions may deny coverage.

 

Out-of-Network Providers

 

  • Coverage may be denied if the prescription is filled by an out-of-network pharmacy or provider without prior authorization or agreement within the Quartz Health Solutions network structure.

 

Lack of Prior Authorization

 

  • If there was a requirement for prior authorization to obtain Januvia and this step was not completed, coverage will likely be denied.

 

Non-Adherence to Plan Formularies

 

  • Januvia may not be covered if it is not included in the Quartz Health Solutions formulary list or if there are specific generic substitution policies that were not adhered to by the prescribing physician.

 

Treatment Outside Plan Coverage Limits

 

  • Prescriptions that exceed dosage limits, quantity limits, or duration limits as defined by the Quartz Health Solutions plan may not be covered.

 

Non-Compliance with Step Therapy Requirements

 

  • Coverage may be denied if the patient has not tried or failed to respond to preferred formulary alternatives as required by Quartz Health Solutions' step therapy protocols before moving to Januvia.

 

Non-Payment of Premiums

 

  • In situations where the policyholder has not maintained their premium payments, coverage for Januvia may be denied due to the policy being inactive or ineligible.

 

Absence of Required Documentation

 

  • Claims for Januvia that lack sufficient documentation to justify the medical necessity or the specific need for the medication may result in denial of coverage.

 

Exclusions Based on Policy Terms

 

  • Certain insurance policies have specific exclusions for medications or treatments. If Januvia falls under an exclusion category in a policy’s terms, it will not be covered.

 

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

How Much Does Januvia Cost without Insurance?

 

Cost of Januvia Without Insurance

 

  • The cost of Januvia (sitagliptin) without insurance can vary based on the pharmacy and location but is typically around $500 to $600 for a 30-day supply of 100 mg tablets.
  •  

  • Prices may differ based on various factors, including pharmacy location, any discount programs available, or changes in the drug market.
  •  

  • It's advisable to check different pharmacies or consider discount programs and prescription savings cards, which can sometimes offer reductions on the retail price.
  •  

  • For individuals paying out of pocket, some online tools or pharmacy networks provide price comparison services to find the best possible rate for Januvia.

 

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 Januvia Coverage with Quartz Health Solutions

 

Understand Coverage Requirements

 

  • Visit the Quartz Health Solutions website to review coverage policies for prescription medications. Look for information specifically related to diabetes medication or brand name drugs.
  •  

  • Check the formulary list provided by Quartz Health Solutions to see if Januvia is included as a covered medication.

 

Contact Quartz Health Member Services

 

  • Call the member services number on the back of your Quartz Health insurance card to inquire about Januvia coverage, copays, and pre-authorization requirements.
  •  

  • Prepare your member ID and relevant medical history to facilitate the conversation with customer support.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity for Januvia as part of your diabetes treatment plan.
  •  

  • Ask your doctor to provide any necessary documentation or a letter of medical necessity if Quartz Health requires justification for coverage.

 

Submit Necessary Documentation

 

  • If required, submit the letter of medical necessity and any other supporting documentation to Quartz Health Solutions for review.
  •  

  • Follow up with your healthcare provider or Quartz Health to ensure all paperwork has been received and is being processed.

 

Consider Prior Authorization

 

  • Check if prior authorization is needed for Januvia. If so, work with your healthcare provider to submit a prior authorization request.
  •  

  • Regularly check the status of your prior authorization with both your provider and Quartz Health Solutions to expedite the approval process.

 

Review Your Plan's Pharmacy Network

 

  • Verify that your preferred pharmacy is within Quartz Health’s network and that they are authorized to dispense Januvia under your plan.
  •  

  • Ask the pharmacy to process the prescription once the coverage is confirmed to avoid unexpected costs.

 

Appeal Denied Coverage if Necessary

 

  • If coverage for Januvia is denied, request a formal explanation from Quartz Health regarding the decision.
  •  

  • Submit an appeal using the process outlined by Quartz Health Solutions, including any additional documentation needed to support the appeal.

 

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.

Januvia FAQ

What are the common side effects of Januvia?

 

Common Side Effects of Januvia

 

  • **Headache**: Often reported and can range from mild to moderate.
  •  

  • **Upper respiratory tract infections**: Can include symptoms like nasal congestion, sore throat, and runny nose.
  •  

  • **Sore throat**: May occur alongside other symptoms such as cough.
  •  

  • **Diarrhea**: Typically mild but can be uncomfortable.
  •  

  • **Nausea**: Some patients experience this, usually transient.
  •  

  • **Abdominal pain**: Not very common but can occur.
  •  

  • **Joint pain**: Although less common, can be experienced by some individuals.

How does Januvia work to control blood sugar?

 

How Januvia Works

 

  • Januvia (sitagliptin) is a DPP-4 inhibitor that enhances the body's own ability to control blood sugar levels by increasing incretin levels, hormones that help regulate insulin production.
  •  

  • Incretins like GLP-1 function by promoting insulin secretion from the pancreas when blood sugar levels are high, and they reduce glucose production in the liver.

 

Benefits

 

  • Prevents rapid glucose level increases after meals while maintaining normal insulin activity during fasting states.
  •  

  • Has a low risk of causing hypoglycemia, a common concern with some other diabetes medications.

 

Considerations

 

  • Commonly prescribed for patients with type 2 diabetes as part of a comprehensive health plan, including diet and exercise.
  •  

  • Adjustments may be necessary for those with renal impairment.

 

Can Januvia be taken with other diabetes medications?

 

Can Januvia Be Combined with Other Diabetes Medications?

 

  • Januvia, a DPP-4 inhibitor, is commonly used with other oral diabetes medications like metformin, sulfonylureas, or thiazolidinediones to improve blood sugar control.
  •  

  • When combined, careful monitoring is essential to avoid hypoglycemia, especially when Januvia is used with insulin or sulfonylureas which can lower blood sugar too much.
  •  

  • Consult your healthcare provider before combining januvia with any other medication to tailor treatment to your specific needs and health status.
  •  

  • There generally aren’t major drug-drug interaction concerns with Januvia, but liver and kidney function should be regularly assessed as they might affect treatment.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

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.

Made in Webflow