Does Quartz Health Solutions Cover Trelegy

Explore Trelegy coverage with Quartz. Learn reasons for denial, how to secure coverage, costs without insurance, and find answers to common queries.
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Coverage Criteria for Trelegy with Quartz Health Solutions

 

  • Trelegy is typically covered if it is considered medically necessary for treating certain respiratory conditions such as COPD or asthma.
  •  

  • Patients usually need to have tried and failed or shown adverse reactions to other treatments before Trelegy is approved.
  •  

  • A healthcare provider must provide documentation supporting the medical necessity for Trelegy to obtain coverage.

 

Basic Rules for Getting Trelegy Covered

 

  • A prescription from a licensed healthcare provider is required.
  •  

  • Pre-authorization may be necessary; your healthcare provider or pharmacy can initiate this process.
  •  

  • Check with Quartz Health Solutions for any specific formulary requirements or tier-specific copays for Trelegy coverage.

 

Additional Considerations

 

  • Policies can vary, so directly contacting Quartz customer service for the most accurate and tailored information is recommended.
  •  

  • Ensure that your healthcare provider is in-network to potentially reduce out-of-pocket costs.

 

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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 Trelegy Coverage with Quartz Health Solutions

 

Research Your Plan Options

 

  • Visit the Quartz Health Solutions website to explore different plans they offer. Make sure to find ones that include adequate prescription drug coverage.
  •  

  • Review plan documents to verify that Trelegy is listed on the formulary, which is the list of covered medications.

 

Contact Customer Service

 

  • Call or email Quartz Health Solutions customer service for clarification regarding Trelegy coverage if you're uncertain after reviewing plan documents.
  •  

  • Ask specific questions about your coverage level, copayments, and any prior authorization requirements related to Trelegy.

 

Enroll in a Suitable Plan

 

  • Once you identify the plan that covers Trelegy, proceed with the enrollment process either online or via paper application.
  •  

  • Ensure you have all necessary personal information and documentation ready before starting your application.

 

Verify Your Enrollment and Coverage

 

  • After enrolling, wait to receive confirmation from Quartz Health Solutions to ensure your plan is active and includes the desired drug coverage.
  •  

  • Double-check that Trelegy is still listed on your plan’s formulary and understand any utilization management restrictions.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your prescription needs and let them know of your new insurance coverage.
  •  

  • Your provider may need to complete any necessary paperwork if prior authorization from Quartz Health Solutions is required for Trelegy.

 

Submit Prior Authorization, if Required

 

  • If prior authorization is needed, work with your healthcare provider to submit the necessary forms to Quartz Health Solutions as soon as possible.
  •  

  • Ensure that the submission includes all required documentation and that your provider clearly states the medical necessity for Trelegy.

 

Fill Your Prescription

 

  • Once you receive approval, visit a participating pharmacy and provide your Quartz Health Solutions member ID to fill your Trelegy prescription.
  •  

  • Pay any applicable copay or coinsurance amount as indicated by your Quartz Health plan.

 

Regularly Review Coverage Updates

 

  • Periodically check your plan’s formulary updates and any communications from Quartz Health Solutions to stay informed about any changes in Trelegy coverage.
  •  

  • Reach out to customer service if you have questions or need assistance understanding any coverage changes.

 

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FAQs

Does Quartz Health Solutions Cover Trelegy

Explore Trelegy coverage with Quartz. Learn reasons for denial, how to secure coverage, costs without insurance, and find answers to common queries.
Curex allergy drops unboxing

Is Trelegy Covered by Quartz Health Solutions

 

Coverage Criteria for Trelegy with Quartz Health Solutions

 

  • Trelegy is typically covered if it is considered medically necessary for treating certain respiratory conditions such as COPD or asthma.
  •  

  • Patients usually need to have tried and failed or shown adverse reactions to other treatments before Trelegy is approved.
  •  

  • A healthcare provider must provide documentation supporting the medical necessity for Trelegy to obtain coverage.

 

Basic Rules for Getting Trelegy Covered

 

  • A prescription from a licensed healthcare provider is required.
  •  

  • Pre-authorization may be necessary; your healthcare provider or pharmacy can initiate this process.
  •  

  • Check with Quartz Health Solutions for any specific formulary requirements or tier-specific copays for Trelegy coverage.

 

Additional Considerations

 

  • Policies can vary, so directly contacting Quartz customer service for the most accurate and tailored information is recommended.
  •  

  • Ensure that your healthcare provider is in-network to potentially reduce out-of-pocket costs.

 

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Quartz Health Solutions's Approved Criteria for Trelegy Coverage

 

Trelegy Ellipta Coverage Criteria by Quartz Health Solutions

 

  • The patient must have a confirmed diagnosis of Chronic Obstructive Pulmonary Disease (COPD), documented within the patient's medical records.
  •  

  • The patient must have experienced respiratory symptoms not adequately controlled by a combination of inhaled corticosteroids, long-acting beta2-agonists, or long-acting muscarinic antagonists.
  •  

  • Documentation must include the patient's current medication regimen, indicating inadequate control of symptoms or frequent exacerbations despite adherence to previous therapy.
  •  

  • Trelegy use must be prescribed by, or in consultation with, a pulmonologist or a specialist experienced in treating respiratory disorders.
  •  

  • The prescribing healthcare provider must submit a treatment plan showing the rationale for selecting Trelegy over other available therapies.
  •  

  • Patients should have tried and failed treatment with at least one previous combination inhaler therapy unless contraindicated or not tolerated.
  •  

  • The patient must undergo routine follow-up and assessment to evaluate the effectiveness and side effects of the Trelegy treatment.
  •  

  • Continued coverage will require documentation of improved clinical outcomes, such as a reduction in exacerbations, improvements in breathing, or increased quality of life.
  •  

  • Trelegy must be used according to the FDA-approved indications and dosing recommendations, unless otherwise indicated by current, evidence-based guidelines.

 

Why Quartz Health Solutions Might Deny Trelegy Coverage

 

Reasons for Trelegy Coverage Denial by Quartz Health Solutions

 

  • Trelegy is prescribed for a condition not covered under the member's specific insurance plan.
  •  

  • The prescribed dosage or frequency differs from the FDA-approved guidelines, leading to non-coverage.
  •  

  • The patient does not meet the criteria for prior authorization, such as step therapy or documentation of previous treatment failures.
  •  

  • A generic alternative is available and preferred by the insurance plan, resulting in denial of Trelegy.
  •  

  • Trelegy is used outside its labeled indications, such as for experimental or non-standard treatments.
  •  

  • The member's insurance plan has specific exclusions for certain medications due to formulary restrictions or cost-control measures.
  •  

  • Coverage is restricted to certain age groups, and the patient falls outside the covered demographic.

 

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How Much Does Trelegy Cost without Insurance?

 

Approximate Cost of Trelegy Without Insurance

 

  • The cost of Trelegy Ellipta, without insurance, can vary significantly based on several factors like the pharmacy, geographical location, or available discounts. On average, patients can expect to pay between $550 to $650 for a 30-day supply.
  •  

  • Prices may also fluctuate depending on ongoing promotions or pharmacy memberships that can provide additional savings.
  •  

  • It’s advisable for patients to use discount cards, check for manufacturer coupons, or explore patient assistance programs to lower the out-of-pocket expense.
  •  

  • Shopping around, comparing prices at different pharmacies, or using online price comparison tools can also result in significant cost savings for Trelegy.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Trelegy Coverage with Quartz Health Solutions

 

Research Your Plan Options

 

  • Visit the Quartz Health Solutions website to explore different plans they offer. Make sure to find ones that include adequate prescription drug coverage.
  •  

  • Review plan documents to verify that Trelegy is listed on the formulary, which is the list of covered medications.

 

Contact Customer Service

 

  • Call or email Quartz Health Solutions customer service for clarification regarding Trelegy coverage if you're uncertain after reviewing plan documents.
  •  

  • Ask specific questions about your coverage level, copayments, and any prior authorization requirements related to Trelegy.

 

Enroll in a Suitable Plan

 

  • Once you identify the plan that covers Trelegy, proceed with the enrollment process either online or via paper application.
  •  

  • Ensure you have all necessary personal information and documentation ready before starting your application.

 

Verify Your Enrollment and Coverage

 

  • After enrolling, wait to receive confirmation from Quartz Health Solutions to ensure your plan is active and includes the desired drug coverage.
  •  

  • Double-check that Trelegy is still listed on your plan’s formulary and understand any utilization management restrictions.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your prescription needs and let them know of your new insurance coverage.
  •  

  • Your provider may need to complete any necessary paperwork if prior authorization from Quartz Health Solutions is required for Trelegy.

 

Submit Prior Authorization, if Required

 

  • If prior authorization is needed, work with your healthcare provider to submit the necessary forms to Quartz Health Solutions as soon as possible.
  •  

  • Ensure that the submission includes all required documentation and that your provider clearly states the medical necessity for Trelegy.

 

Fill Your Prescription

 

  • Once you receive approval, visit a participating pharmacy and provide your Quartz Health Solutions member ID to fill your Trelegy prescription.
  •  

  • Pay any applicable copay or coinsurance amount as indicated by your Quartz Health plan.

 

Regularly Review Coverage Updates

 

  • Periodically check your plan’s formulary updates and any communications from Quartz Health Solutions to stay informed about any changes in Trelegy coverage.
  •  

  • Reach out to customer service if you have questions or need assistance understanding any coverage changes.

 

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Trelegy FAQ

1. What are the side effects of Trelegy?

 

Common Side Effects of Trelegy

 

  • Headaches
  • Back pain
  • Hoarseness
  • Oral thrush

 

Serious Side Effects

 

  • Increased heart rate
  • Chest pain
  • High blood pressure
  • Pneumonia in COPD patients

 

Less Common Side Effects

 

  • Diarrhea
  • Cough
  • Sore throat
  • Gastrointestinal discomfort

 

Precautions

 

  • Monitor for worsening symptoms.
  • Consult a doctor for persistent side effects.

 

2. How does Trelegy compare to Breo?

 

Comparison of Trelegy and Breo

 

  • Trelegy combines three active ingredients: fluticasone furoate (a corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Breo contains only two: fluticasone furoate and vilanterol.
  •  

  • This combination in Trelegy allows for better control of symptoms for COPD patients requiring more comprehensive therapy, whereas Breo is more suitable for those requiring less intensive treatment.
  •  

  • Both medications are administered once daily via inhalation, but Trelegy’s triple therapy provides a broader mechanism of action.
  •  

  • Side effects are generally similar, though patients transitioning from Breo to Trelegy may experience different responses due to the added component.

 

3. Is Trelegy a steroid?

 

Is Trelegy a Steroid?

 

  • Components: Trelegy contains three active ingredients: fluticasone furoate, umeclidinium, and vilanterol. Fluticasone furoate is a corticosteroid.
  •  

  • Steroid Role: The corticosteroid in Trelegy helps reduce inflammation in the airways, which is crucial for treating conditions like COPD and asthma.
  •  

  • Multi-Action: In addition to the steroid, umeclidinium (an anticholinergic) and vilanterol (a long-acting beta-agonist) work to relax and open the airways.
  •  

  • Usage: Trelegy is inhaled, delivering these components directly to the lungs for targeted action, minimizing systemic steroid exposure.

 

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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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