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Does Regence Cover Cosentyx

Explore Regence's coverage for Cosentyx, understand denial reasons, learn how to secure insurance approval, and discover costs without insurance.

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Does Regence Cover Cosentyx?

Cosentyx Coverage Criteria: Regence may cover Cosentyx for conditions like plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. Approval depends on meeting clinical criteria.

Approval Requirements: Patients typically need a diagnosis from a specialist and may require documentation showing prior treatment failure with first-line therapies.

Step Therapy: Regence might implement step therapy, requiring patients to try and fail other medications before covering Cosentyx.

Pre-authorization: Pre-authorization from Regence could be necessary to ensure the treatment meets coverage criteria.

Specialty Pharmacy: Cosentyx may be dispensed through Regence's preferred specialty pharmacy for coverage.

Consult with Regence: Always confirm with Regence directly or through your healthcare provider for the most accurate and personalized coverage details.

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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 Cosentyx Coverage with Regence

Verify Your Insurance Policy

Log into your Regence member account on their website.

Locate your insurance policy details to understand the coverage specifics related to prescription drugs.

Check if Cosentyx is listed under the covered medications or requires special authorization.

Consult Your Healthcare Provider

Discuss the need for Cosentyx with your healthcare provider to ensure it is the appropriate treatment for your condition.

Request a written prescription for Cosentyx, including any necessary documentation that may support the need for this medication.

Contact Regence Customer Service

Call the customer service number on your insurance card to inquire whether Cosentyx requires prior authorization or any specific procedures for coverage.

Ask for detailed information regarding their specific requirements and forms needed for submission.

Submit a Prior Authorization Request

Obtain any necessary prior authorization forms from your healthcare provider or directly from Regence.

Fill out the required forms, ensuring that all information is accurate and thorough.

Attach your doctor's prescription and any additional documentation that supports the need for Cosentyx.

Submit the completed authorization request through the designated method, either online, by fax, or by mail, as instructed by Regence.

Follow Up on Your Request

Reach out to Regence to confirm the receipt of your prior authorization request.

Track the progress of your request and inquire about estimated processing times.

If necessary, provide any additional information promptly to prevent delays.

Access Copay Assistance Programs

Investigate potential copay assistance programs offered by the manufacturer of Cosentyx or through patient assistance foundations.

Enroll in these programs if eligible to reduce out-of-pocket costs for your medication.

Fill Your Prescription

Once approved, visit your preferred pharmacy to fill your Cosentyx prescription.

Verify the coverage and copayment details with the pharmacist to ensure alignment with what was authorized.

Maintain Regular Communication

Regularly communicate with your healthcare provider to monitor your treatment progress with Cosentyx.

Inform Regence of any changes to your treatment plan or prescription needs as necessary.

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

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FAQs

Does Regence Cover Cosentyx

Explore Regence's coverage for Cosentyx, understand denial reasons, learn how to secure insurance approval, and discover costs without insurance.

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Is Cosentyx Covered by Regence

Does Regence Cover Cosentyx?

Cosentyx Coverage Criteria: Regence may cover Cosentyx for conditions like plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. Approval depends on meeting clinical criteria.

Approval Requirements: Patients typically need a diagnosis from a specialist and may require documentation showing prior treatment failure with first-line therapies.

Step Therapy: Regence might implement step therapy, requiring patients to try and fail other medications before covering Cosentyx.

Pre-authorization: Pre-authorization from Regence could be necessary to ensure the treatment meets coverage criteria.

Specialty Pharmacy: Cosentyx may be dispensed through Regence's preferred specialty pharmacy for coverage.

Consult with Regence: Always confirm with Regence directly or through your healthcare provider for the most accurate and personalized coverage details.

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Regence's Approved Criteria for Cosentyx Coverage

Coverage Criteria for Cosentyx

Regence covers Cosentyx for patients diagnosed with moderate to severe plaque psoriasis who have not responded to or are intolerant of other systemic therapies such as methotrexate, cyclosporine, or phototherapy.

Approval for Cosentyx is granted for patients with active psoriatic arthritis who have had an inadequate response to or are intolerant of disease-modifying antirheumatic drugs (DMARDs).

Cosentyx is covered for individuals with active ankylosing spondylitis who have failed to respond adequately to at least two different non-steroidal anti-inflammatory drugs (NSAIDs) over a period of at least one month.

Patients with active non-radiographic axial spondyloarthritis are eligible for coverage if they have experienced an inadequate response to or are intolerant of NSAIDs.

Regence offers coverage for adults with active enthesitis-related arthritis when there is documented failure or intolerance to DMARDs and other appropriate treatment options.

Why Regence Might Deny Cosentyx Coverage

Regence Denial Criteria for Cosentyx

Cosentyx is not covered if used for non-FDA approved indications, such as conditions not explicitly cleared or researched by the Food and Drug Administration.

Requests for Cosentyx coverage without documented evidence of a moderate to severe diagnosis of conditions like psoriasis, psoriatic arthritis, or ankylosing spondylitis may be denied.

Absence of prior history of treatment failure, contraindication, or intolerance to conventional therapies before prescribing Cosentyx can lead to a denial.

Requests that do not meet the required dosing regimens or involve unapproved dosing frequencies might not be eligible for coverage.

Cosentyx used concurrently with other biologic drugs, where safety and efficacy are yet to be established, may result in coverage denial.

Coverage requests might be declined if there is insufficient documentation of medical necessity by the healthcare provider.

Denial might occur if the requested quantity exceeds the maximum limit defined by Regence's policy without a valid clinical rationale.

Use of Cosentyx in pediatric patients where safety and effectiveness have not been established can lead to a denial of coverage.

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How Much Does Cosentyx Cost without Insurance?

Cost of Cosentyx Without Insurance

The cost of Cosentyx without insurance can vary depending on the pharmacy and location. However, the average retail price is typically around $5,500 to $6,000 per 150 mg dose.

Patients often need multiple doses, so the total cost can increase significantly depending on treatment duration and dosing requirements prescribed by a healthcare provider.

The pricing may also differ if there are discounts, special pharmacy funding programs, or if a patient qualifies for any manufacturer-sponsored assistance programs.

Generic versions are not available, as Cosentyx is a brand-name biologic medication.

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 Cosentyx Coverage with Regence

Verify Your Insurance Policy

Log into your Regence member account on their website.

Locate your insurance policy details to understand the coverage specifics related to prescription drugs.

Check if Cosentyx is listed under the covered medications or requires special authorization.

Consult Your Healthcare Provider

Discuss the need for Cosentyx with your healthcare provider to ensure it is the appropriate treatment for your condition.

Request a written prescription for Cosentyx, including any necessary documentation that may support the need for this medication.

Contact Regence Customer Service

Call the customer service number on your insurance card to inquire whether Cosentyx requires prior authorization or any specific procedures for coverage.

Ask for detailed information regarding their specific requirements and forms needed for submission.

Submit a Prior Authorization Request

Obtain any necessary prior authorization forms from your healthcare provider or directly from Regence.

Fill out the required forms, ensuring that all information is accurate and thorough.

Attach your doctor's prescription and any additional documentation that supports the need for Cosentyx.

Submit the completed authorization request through the designated method, either online, by fax, or by mail, as instructed by Regence.

Follow Up on Your Request

Reach out to Regence to confirm the receipt of your prior authorization request.

Track the progress of your request and inquire about estimated processing times.

If necessary, provide any additional information promptly to prevent delays.

Access Copay Assistance Programs

Investigate potential copay assistance programs offered by the manufacturer of Cosentyx or through patient assistance foundations.

Enroll in these programs if eligible to reduce out-of-pocket costs for your medication.

Fill Your Prescription

Once approved, visit your preferred pharmacy to fill your Cosentyx prescription.

Verify the coverage and copayment details with the pharmacist to ensure alignment with what was authorized.

Maintain Regular Communication

Regularly communicate with your healthcare provider to monitor your treatment progress with Cosentyx.

Inform Regence of any changes to your treatment plan or prescription needs as necessary.

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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.

Cosentyx FAQ

1. What are the side effects of Cosentyx?

Potential Side Effects of Cosentyx

Common Side Effects: These include upper respiratory tract infections, headache, and diarrhea. Users might also experience cold-like symptoms.

Serious Side Effects: Serious infections can occur due to immune suppression. Patients should monitor for signs of infections, such as persistent fever or cough.

Allergic Reactions: Watch for signs like difficulty breathing, swelling, or rash; these may indicate a severe allergic reaction.

Laboratory Abnormalities: Changes in white blood cell counts and liver enzymes may surface, necessitating monitoring.

2. How does Cosentyx work for psoriasis?

How Cosentyx Works

Cosentyx is a biologic medication specifically targeting the immune system by inhibiting interleukin-17A (IL-17A), a protein that plays a key role in inflammation.

By blocking IL-17A, Cosentyx reduces inflammation, thus decreasing the symptoms and plaques associated with psoriasis.

It helps control the abnormal skin cell growth and can lead to significant skin clearance in many patients.

Usage and Administration

Cosentyx is administered via subcutaneous injection, typically beginning with a loading dose followed by a maintenance dose.

It is crucial for the success of the treatment to follow the prescribed dosing schedule closely.

Potential Side Effects

Common side effects include respiratory infections, headache, and injection site reactions.

Patients should consult their healthcare provider for any severe or unusual symptoms.

3. Is Cosentyx a biologic medication?

Is Cosentyx a Biologic Medication?

Yes, Cosentyx is a biologic medication. It is a human monoclonal antibody that selectively binds to the interleukin-17A (IL-17A) cytokine, which plays a major role in inflammatory conditions.

Biologics are typically derived from living cells and are used in the treatment of various autoimmune diseases. Cosentyx is specifically used for conditions such as plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis.

Unlike traditional small-molecule drugs, biologics like Cosentyx target specific components of the immune system.

Cosentyx is administered through subcutaneous injections, typically prescribed after other treatments have not provided adequate symptom control.

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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 Regence Cover Cosentyx

Explore Regence's coverage for Cosentyx, understand denial reasons, learn how to secure insurance approval, and discover costs without insurance.

Achieve Your Goals Faster with Curex