Does Quartz Health Solutions Cover Lyrica

Explore Lyrica coverage with Quartz Health Solutions. Learn reasons for denial, ways to secure coverage, costs without insurance, and get answers in Lyrica FAQ.
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Coverage for Lyrica

 

  • Quartz Health Solutions generally covers Lyrica for FDA-approved indications such as neuropathic pain, fibromyalgia, and epilepsy.
  •  

  • Coverage may depend on the specific health plan you have with Quartz. Always check your member portal or contact customer service for detailed coverage information.

 

Criteria for Coverage

 

  • A prescription from a licensed healthcare provider is necessary to qualify for Lyrica coverage.
  •  

  • Prior authorization might be required. This means your doctor will need to justify the necessity of Lyrica for your treatment.
  •  

  • If Lyrica is not a first-line therapy, evidence of trying alternative medications might be needed to qualify for coverage.

 

General Rules

 

  • Ensure that the pharmacy you use is included in the Quartz network to receive the full benefit.
  •  

  • Review any copayments or coinsurance that apply to your plan to understand your financial responsibility when obtaining Lyrica.

 

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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 Lyrica Coverage with Quartz Health Solutions

 

Initial Steps to Start with Quartz Health Solutions

 

  • Visit the Quartz Health Solutions website to gather information on their health plans and services.
  •  

  • Contact Quartz Health Solutions customer support through their official contact numbers or email for inquiries about coverage options for Lyrica.
  •  

  • Review your current health insurance plan policy documents to understand if Lyrica is already covered or if special conditions apply.

 

Verify Prescription Drug Coverage

 

  • Check the Quartz Health Solutions formulary list on their website to see if Lyrica is included as a covered medication.
  •  

  • If Lyrica is not listed, inquire about any alternative medications covered by the insurance that serve similar purposes.

 

Consult with a Healthcare Provider

 

  • Schedule a meeting with your healthcare provider to discuss your medical need for Lyrica and gather any necessary documentation to support your case.
  •  

  • Request a formal prescription and possibly a letter of necessity from your doctor to substantiate the need for Lyrica when communicating with Quartz Health Solutions.

 

Submit a Prior Authorization Request

 

  • If required, obtain and fill out a prior authorization form from the Quartz Health Solutions website or request it directly from their customer service.
  •  

  • Attach all necessary documentation, including your prescription and any letters of necessity from your healthcare provider.
  •  

  • Submit the completed prior authorization form and accompanying documents to Quartz Health Solutions via mail, fax, or any other specified method.

 

Follow-Up and Communication

 

  • Regularly check the status of your authorization request through the customer service contact points provided by Quartz Health Solutions.
  •  

  • Prepare to supply any additional information or documentation if requested by Quartz Health Solutions for the approval process.

 

Appeal a Denied Coverage

 

  • If your request for coverage is denied, review the denial letter for specific reasons and prepare an appeal.
  •  

  • Gather any additional supporting medical documentation that can strengthen your case.
  •  

  • Submit the appeal in accordance with the specified guidelines and deadlines provided in the denial letter.

 

Consider Financial Assistance Programs

 

  • Explore any available financial assistance programs offered by the manufacturer of Lyrica or third-party organizations to support uncovered costs.
  •  

  • Discuss with your healthcare provider other potential avenues for managing medication costs while awaiting resolution.

 

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FAQs

Does Quartz Health Solutions Cover Lyrica

Explore Lyrica coverage with Quartz Health Solutions. Learn reasons for denial, ways to secure coverage, costs without insurance, and get answers in Lyrica FAQ.
Curex allergy drops unboxing

Is Lyrica Covered by Quartz Health Solutions

 

Coverage for Lyrica

 

  • Quartz Health Solutions generally covers Lyrica for FDA-approved indications such as neuropathic pain, fibromyalgia, and epilepsy.
  •  

  • Coverage may depend on the specific health plan you have with Quartz. Always check your member portal or contact customer service for detailed coverage information.

 

Criteria for Coverage

 

  • A prescription from a licensed healthcare provider is necessary to qualify for Lyrica coverage.
  •  

  • Prior authorization might be required. This means your doctor will need to justify the necessity of Lyrica for your treatment.
  •  

  • If Lyrica is not a first-line therapy, evidence of trying alternative medications might be needed to qualify for coverage.

 

General Rules

 

  • Ensure that the pharmacy you use is included in the Quartz network to receive the full benefit.
  •  

  • Review any copayments or coinsurance that apply to your plan to understand your financial responsibility when obtaining Lyrica.

 

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Quartz Health Solutions's Approved Criteria for Lyrica Coverage

 

Criteria for Coverage of Lyrica by Quartz Health Solutions

 

  • Lyrica is approved for the treatment of neuropathic pain associated with diabetic peripheral neuropathy, provided the patient has been diagnosed with diabetes and experiences significant neuropathic pain as documented by medical records.
  •  

  • Coverage is available for Lyrica in the management of post-herpetic neuralgia, contingent upon the patient's medical records indicating a prior herpes zoster infection with persistent neuropathic pain.
  •  

  • Lyrica may be prescribed for fibromyalgia if documented evidence shows the patient has chronic, wide-spread pain lasting longer than three months, and other pain causes have been ruled out by the healthcare provider.
  •  

  • In the case of partial onset seizures, supplemental coverage for Lyrica can be obtained when the patient is already on an antiepileptic regimen, but still experiences seizures.
  •  

  • Patients prescribed Lyrica for neuropathic pain associated with spinal cord injury are covered, provided medical documentation supports a significant level of pain following an injury to the spinal cord.
  •  

  • Ensure that Lyrica is prescribed by a healthcare professional experienced in managing the specific condition for which the medication is indicated.
  •  

  • A comprehensive trial and failure of other first-line therapies for the specific condition may be required to establish eligibility for Lyrica coverage.
  •  

  • Detailed documentation or a prior authorization request by the prescribing healthcare provider, outlining the medical necessity and expected benefits of Lyrica, must be obtained.
  •  

  • Adherence to the approved dosage and administration guidelines for Lyrica based on the diagnosis is required for coverage continuation.

 

Why Quartz Health Solutions Might Deny Lyrica Coverage

 

Situations Where Lyrica Is Not Covered by Quartz Health Solutions

 

  • Lyrica is not covered when it is used for conditions not approved by the U.S. Food and Drug Administration (FDA).
  •  

  • If Lyrica is prescribed without meeting the specific medical necessity criteria set by Quartz Health Solutions.
  •  

  • The prescription of Lyrica is outside the clinical guidelines or protocols established by Quartz Health Solutions.
  •  

  • Lyrica is used in experimental or investigational contexts, where there is insufficient evidence of its efficacy and safety according to Quartz Health policies.
  •  

  • When the patient does not satisfy prior authorization requirements or falls outside of the approved demographic or diagnostic criteria.
  •  

  • Lyrica is obtained through unauthorized pharmacies or sources that are not recognized by Quartz Health Solutions.
  •  

  • If alternative therapies or medications deemed more cost-effective and therapeutically equivalent are available and preferred under the Quartz Health Solutions drug formulary.

 

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

How Much Does Lyrica Cost without Insurance?

 

Cost of Lyrica Without Insurance

 

  • The price of Lyrica without insurance can vary significantly depending on the pharmacy, geographic location, dosage, and quantity. On average, the cost can range between $460 to $720 for a 30-day supply when filling a common dosage such as 150 mg capsules.
  •  

  • Generic versions of Lyrica, known as pregabalin, are often significantly cheaper. The average cost for the generic version might be closer to $30 to $70 for a similar quantity and dosage.
  •  

  • Prices may also vary due to manufacturer's discounts, pharmacy membership programs, or coupon usage, which can help reduce the overall cost.
  •  

  • Comparing prices between local pharmacies or using online price comparison tools can help find the most affordable option.

 

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 Lyrica Coverage with Quartz Health Solutions

 

Initial Steps to Start with Quartz Health Solutions

 

  • Visit the Quartz Health Solutions website to gather information on their health plans and services.
  •  

  • Contact Quartz Health Solutions customer support through their official contact numbers or email for inquiries about coverage options for Lyrica.
  •  

  • Review your current health insurance plan policy documents to understand if Lyrica is already covered or if special conditions apply.

 

Verify Prescription Drug Coverage

 

  • Check the Quartz Health Solutions formulary list on their website to see if Lyrica is included as a covered medication.
  •  

  • If Lyrica is not listed, inquire about any alternative medications covered by the insurance that serve similar purposes.

 

Consult with a Healthcare Provider

 

  • Schedule a meeting with your healthcare provider to discuss your medical need for Lyrica and gather any necessary documentation to support your case.
  •  

  • Request a formal prescription and possibly a letter of necessity from your doctor to substantiate the need for Lyrica when communicating with Quartz Health Solutions.

 

Submit a Prior Authorization Request

 

  • If required, obtain and fill out a prior authorization form from the Quartz Health Solutions website or request it directly from their customer service.
  •  

  • Attach all necessary documentation, including your prescription and any letters of necessity from your healthcare provider.
  •  

  • Submit the completed prior authorization form and accompanying documents to Quartz Health Solutions via mail, fax, or any other specified method.

 

Follow-Up and Communication

 

  • Regularly check the status of your authorization request through the customer service contact points provided by Quartz Health Solutions.
  •  

  • Prepare to supply any additional information or documentation if requested by Quartz Health Solutions for the approval process.

 

Appeal a Denied Coverage

 

  • If your request for coverage is denied, review the denial letter for specific reasons and prepare an appeal.
  •  

  • Gather any additional supporting medical documentation that can strengthen your case.
  •  

  • Submit the appeal in accordance with the specified guidelines and deadlines provided in the denial letter.

 

Consider Financial Assistance Programs

 

  • Explore any available financial assistance programs offered by the manufacturer of Lyrica or third-party organizations to support uncovered costs.
  •  

  • Discuss with your healthcare provider other potential avenues for managing medication costs while awaiting resolution.

 

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Lyrica FAQ

What are the common side effects of Lyrica?

 

Common Side Effects of Lyrica

 

  • Dizziness: Frequently reported, often occurring shortly after starting treatment.
  • Sleepiness: Commonly affects daily activities due to its sedative effects.
  • Weight Gain: Notable for some, monitoring weight is advised.
  • Swelling: Particularly in hands and feet; may require medical attention if severe.
  • Blurred Vision: Usually temporary but should be reported if persistent.
  • Dry Mouth: Sometimes improved with increased fluid intake.
  • Difficulty concentrating: Can affect mental clarity and focus.

 

Is Lyrica the same as gabapentin?

 

Differences Between Lyrica and Gabapentin

 

  • Classification: Both are anticonvulsants but with different active ingredients. Lyrica contains pregabalin, while gabapentin itself is the active substance in gabapentin medications.
  •  

  • FDA Approval: Lyrica is approved for treating fibromyalgia, neuropathic pain, seizures, and generalized anxiety disorder in certain regions. Gabapentin's primary uses are for seizures and nerve pain.
  •  

  • Potency and Dosing: Lyrica is often considered more potent, requiring lower doses to achieve similar effects compared to gabapentin.
  •  

  • Side Effects: Both can cause dizziness and fatigue, but the severity and other side effects can vary between individuals.

 

Can Lyrica help with anxiety?

 

Understanding Lyrica and Anxiety

 

  • Lyrica (pregabalin) is primarily approved for treating nerve pain, fibromyalgia, and seizures.
  •  

  • Although not FDA-approved for anxiety, it has been used off-label to help some patients manage anxiety symptoms, especially in generalized anxiety disorder (GAD).

 

Mechanism and Effectiveness

 

  • Lyrica works by calming hyper-excited nerves, which may reduce anxiety symptoms by stabilizing neuronal activity.
  •  

  • Clinical studies suggest it can reduce anxiety more effectively than a placebo and comparable to some anxiety medications.

 

Considerations and Side Effects

 

  • Possible side effects include dizziness, sleepiness, and weight gain, which should be considered before off-label use.
  •  

  • Consult your doctor to assess if Lyrica aligns with your specific health needs and to discuss alternate anxiety treatments.

 

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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