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Does Quartz Health Solutions Cover Stelara

Explore Stelara coverage options with Quartz Health. Learn reasons for potential denials, coverage tips, costs without insurance, and FAQs.

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Does Quartz Health Solutions Cover Stelara?

Quartz Health Solutions may cover Stelara, a prescription medication used primarily for conditions like psoriasis, psoriatic arthritis, and Crohn's disease.

Coverage is often contingent upon the patient meeting specific medical criteria. This can include previous treatments being ineffective or the condition being severe.

Patients generally need prior authorization, which requires documentation from a healthcare provider detailing the medical necessity of Stelara.

Some plans might require trying alternative treatments before approving Stelara.

It is recommended to contact Quartz Health Solutions directly or consult your plan documentation to understand specific coverage details and any potential out-of-pocket costs.

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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.

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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.

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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 Stelara Coverage with Quartz Health Solutions

Initiate Your Quartz Health Solutions Account

Ensure you have an active Quartz Health Solutions insurance plan. If you are not currently enrolled, start by visiting the Quartz Health Solutions website to explore plan options.

Contact Quartz Member Services to confirm your eligibility for coverage and make sure your specific plan includes prescription coverage.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your condition and the necessity of Stelara (ustekinumab) for your treatment. Your doctor will need to determine if Stelara is medically necessary for you.

Request a detailed prescription and any necessary documentation from your healthcare provider, indicating why Stelara is the preferred treatment for your condition.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request to Quartz Health Solutions. This request will typically require medical records, diagnosis, and previous treatments that justify the use of Stelara.

Ensure all necessary forms and documentation are correctly filled out and provided. It may be helpful to consult the Quartz Health Solutions member portal for downloadable forms and submission instructions.

Follow Up on the Authorization Process

Regularly check the status of your prior authorization request. You can do this via the Quartz Health Solutions member portal or by contacting their Member Services.

Be responsive to any additional information requests from Quartz Health Solutions, as prompt responses can expedite the approval process.

Appeal if Necessary

If your prior authorization request for Stelara is denied, review the reason for denial, and work with your healthcare provider to address any issues.

Submit an appeal to Quartz Health Solutions, including additional supportive documentation from your healthcare provider to strengthen your case for needing Stelara.

Explore Financial Assistance Options

If there are still difficulties with coverage or out-of-pocket costs, consider seeking financial assistance. Stelara’s manufacturer, Janssen, may offer patient assistance programs or discounts.

Contact Quartz Health Solutions to inquire about any additional support services or programs that may help with medication costs.

Stay Informed and Communicative

Keep regular communication with both your healthcare provider and Quartz Health Solutions to remain informed about the status of your coverage and any changes in your health insurance benefits.

Periodically review your insurance plan details during open enrollment periods to ensure your coverage meets your healthcare needs.

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FAQs

Does Quartz Health Solutions Cover Stelara

Explore Stelara coverage options with Quartz Health. Learn reasons for potential denials, coverage tips, costs without insurance, and FAQs.

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Is Stelara Covered by Quartz Health Solutions

Does Quartz Health Solutions Cover Stelara?

Quartz Health Solutions may cover Stelara, a prescription medication used primarily for conditions like psoriasis, psoriatic arthritis, and Crohn's disease.

Coverage is often contingent upon the patient meeting specific medical criteria. This can include previous treatments being ineffective or the condition being severe.

Patients generally need prior authorization, which requires documentation from a healthcare provider detailing the medical necessity of Stelara.

Some plans might require trying alternative treatments before approving Stelara.

It is recommended to contact Quartz Health Solutions directly or consult your plan documentation to understand specific coverage details and any potential out-of-pocket costs.

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Quartz Health Solutions's Approved Criteria for Stelara Coverage

Eligibility Criteria for Coverage

Patients must be diagnosed with one of the following conditions for coverage: moderate to severe plaque psoriasis, psoriatic arthritis, Crohn's disease, or ulcerative colitis.

Treatment must be prescribed by, or in consultation with, a dermatologist, rheumatologist, or gastroenterologist, depending on the condition being treated.

Documentation Requirements

Provide medical records documenting the diagnosis and previous treatments that were ineffective, contraindicated, or not tolerated.

A treatment plan with Stelara that includes the dosage and administration schedule as prescribed by the healthcare professional must be submitted.

Trial and Failure of Previous Therapies

For plaque psoriasis, patients should have tried and failed or have contraindications to at least two of the following systemic therapies: methotrexate, cyclosporine, or ultraviolet B phototherapy.

For psoriatic arthritis, patients must have failed or have contraindications to at least one Disease-Modifying Anti-Rheumatic Drug (DMARD).

Crohn’s disease and ulcerative colitis patients should have attempted other conventional treatments such as corticosteroids or immunomodulators without sufficient response or have contraindications to them.

Continued Therapy Requirements

Demonstrated clinical benefit from Stelara treatment must be documented and submitted regularly to maintain coverage.

A reassessment of the condition and treatment efficacy should be conducted at least every 12 months.

Age and Dosing Restrictions

Stelara coverage is typically for adults aged 18 and over, though exceptions may be considered based on documented medical necessity.

The dosing must align with FDA-approved labeling, considering the patient's age and weight for appropriate administration frequency.

Why Quartz Health Solutions Might Deny Stelara Coverage

Criteria for Denial of Stelara Coverage by Quartz Health Solutions

Treatment for Conditions Not Approved by the FDA: Quartz Health Solutions may deny coverage if Stelara is prescribed for conditions not approved by the U.S. Food and Drug Administration (FDA). Off-label use is generally not covered unless specified otherwise in the policy.

Lack of Medical Necessity: Coverage might be refused if Quartz determines that the use of Stelara is not medically necessary for the patient's condition based on their internal guidelines or criteria.

Absence of Prior Authorization: If a prior authorization requirement exists and the proper approval process was not completed, Quartz may refuse to cover the medication.

Non-Adherence to Step Therapy Protocols: Stelara coverage can be denied if patients have not tried other less expensive or more conventional therapies and demonstrated that those treatments were ineffective, as per the insurer’s step therapy protocols.

Incomplete Clinical Documentation: Quartz Health Solutions may require specific clinical documentation to justify the use of Stelara. Absence of this documentation can lead to denial of coverage.

Exclusion in the Health Plan: If Stelara is specifically excluded in the member's health plan or formulary, coverage may be denied irrespective of the medical necessity.

Lack of Enrollment in a Quartz Plan: Coverage might be denied if the patient is not actively enrolled in a Quartz Health Solutions insurance plan at the time of the treatment or prescription.

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How Much Does Stelara Cost without Insurance?

Approximate Cost of Stelara without Insurance

The price of Stelara, a medication used primarily for treating conditions such as psoriasis and Crohn's disease, can vary based on the pharmacy and other location-based factors, but without insurance, it typically costs around $20,000 to $40,000 per year.

Individual dosage needs and treatment plans can affect the total cost, as Stelara injections are spaced differently depending on treatment guidelines for specific conditions.

Pricing can also vary depending on the dosage strength; the standard doses are 45 mg and 90 mg, with the 90 mg dose generally being more expensive.

Patients can sometimes find manufacturer coupons or patient assistance programs that help reduce the cost of Stelara. These programs usually require an application process and eligibility criteria.

Additionally, discount pharmacy programs or third-party coupon providers might offer savings, although these are often limited and may vary in percentage or availability.

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

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

Kayla Mardaga, NP

How to Get Stelara Coverage with Quartz Health Solutions

Initiate Your Quartz Health Solutions Account

Ensure you have an active Quartz Health Solutions insurance plan. If you are not currently enrolled, start by visiting the Quartz Health Solutions website to explore plan options.

Contact Quartz Member Services to confirm your eligibility for coverage and make sure your specific plan includes prescription coverage.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your condition and the necessity of Stelara (ustekinumab) for your treatment. Your doctor will need to determine if Stelara is medically necessary for you.

Request a detailed prescription and any necessary documentation from your healthcare provider, indicating why Stelara is the preferred treatment for your condition.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request to Quartz Health Solutions. This request will typically require medical records, diagnosis, and previous treatments that justify the use of Stelara.

Ensure all necessary forms and documentation are correctly filled out and provided. It may be helpful to consult the Quartz Health Solutions member portal for downloadable forms and submission instructions.

Follow Up on the Authorization Process

Regularly check the status of your prior authorization request. You can do this via the Quartz Health Solutions member portal or by contacting their Member Services.

Be responsive to any additional information requests from Quartz Health Solutions, as prompt responses can expedite the approval process.

Appeal if Necessary

If your prior authorization request for Stelara is denied, review the reason for denial, and work with your healthcare provider to address any issues.

Submit an appeal to Quartz Health Solutions, including additional supportive documentation from your healthcare provider to strengthen your case for needing Stelara.

Explore Financial Assistance Options

If there are still difficulties with coverage or out-of-pocket costs, consider seeking financial assistance. Stelara’s manufacturer, Janssen, may offer patient assistance programs or discounts.

Contact Quartz Health Solutions to inquire about any additional support services or programs that may help with medication costs.

Stay Informed and Communicative

Keep regular communication with both your healthcare provider and Quartz Health Solutions to remain informed about the status of your coverage and any changes in your health insurance benefits.

Periodically review your insurance plan details during open enrollment periods to ensure your coverage meets your healthcare needs.

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Stelara FAQ

What are the common side effects of Stelara?

Common Side Effects of Stelara

**Infections:** Increased susceptibility to infections such as upper respiratory infections and strep throat.
**Headache:** This is a frequently reported side effect among patients who use Stelara.
**Tiredness:** Many individuals may experience fatigue or tiredness while on this medication.
**Redness at Injection Site:** Skin irritation, including redness, itching, or swelling, can occur at the site of injection.
**Nausea:** Some patients report feeling mildly nauseated after taking the medication.

How does Stelara work for psoriasis?

Mechanism of Action

Stelara is a monoclonal antibody that targets interleukin-12 (IL-12) and interleukin-23 (IL-23), which are proteins involved in inflammatory processes associated with psoriasis.

Impact on the Immune System

By inhibiting IL-12 and IL-23, Stelara reduces the activity of specific immune cells (T-cells) that contribute to the inflammation and rapid skin cell production characteristic of psoriasis.

Clinical Efficacy

Many patients experience significant reductions in psoriasis symptoms, including skin clearance, with improvements often visible within weeks after initial treatment.

Administration and Dosage

Stelara is administered via subcutaneous injection, starting with a loading dose followed by maintenance doses every 12 weeks thereafter.

How often do you need Stelara injections?

Stelara Injection Schedule

Initial Doses: After the first dose is administered, a second dose follows four weeks later.

Maintenance Doses: Subsequent injections are given every 12 weeks.

Special Cases: Depending on specific conditions like Crohn's disease, the frequency may vary under a physician's guidance.

Administration: Stelara is typically administered as a subcutaneous injection which can be performed in a healthcare setting or self-administered after proper training.

Consult Your Doctor: Always consult with your healthcare provider to tailor the schedule to your medical needs.

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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. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does Quartz Health Solutions Cover Stelara

Explore Stelara coverage options with Quartz Health. Learn reasons for potential denials, coverage tips, costs without insurance, and FAQs.

Achieve Your Goals Faster with Curex