Does Regence Cover Januvia

Explore Januvia coverage with Regence. Learn why it might be denied, how to gain approval, costs without insurance, and FAQs in this detailed guide.
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Regence Coverage for Januvia

 

  • Regence generally covers Januvia, a diabetes medication used to manage blood sugar levels in adults with type 2 diabetes, when medically necessary.
  •  

  • Coverage criteria include a diagnosis of type 2 diabetes, and that Januvia is prescribed as part of a comprehensive diabetes management plan.
  •  

  • A healthcare provider must demonstrate that Januvia is appropriate by providing documentation of previous treatments and their outcomes.
  •  

  • Prior authorization is often required to ensure coverage. This involves submitting a request with supporting clinical information to Regence.
  •  

  • Coverage can vary based on individual plans, so it's important to verify specific benefits directly through Regence or the member's policy documents.

 

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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 Januvia Coverage with Regence

 

Verify Your Current Coverage

 

  • Begin by reviewing your current Regence insurance policy documents to understand your existing prescription drug coverage.
  •  

  • Check the formulary provided by Regence, which lists all the medications they cover. Look specifically for Januvia to see if it’s included.

 

Consult with Your Healthcare Provider

 

  • Discuss your medical condition and the necessity of Januvia with your healthcare provider. They might have insights on coverage or potential alternatives.
  •  

  • Request that your healthcare provider prepares any required documentation or prior authorization forms needed by Regence for coverage approval.

 

Contact Regence Customer Service

 

  • Call Regence's customer service to inquire about the coverage process for Januvia specifically. Having your policy number ready can expedite the conversation.
  •  

  • Ask about any specific steps or forms you need to complete to ensure Januvia is covered under your plan.

 

Submit Prior Authorization, if Necessary

 

  • If prior authorization is required, work with your healthcare provider to complete and submit the necessary form to Regence.
  •  

  • Ensure that all supporting medical documentation is included to strengthen your case for coverage.

 

Explore Savings Programs

 

  • Research savings programs provided by the manufacturer of Januvia, as they might offer assistance or copay discounts, which can be combined with your insurance coverage.
  •  

  • Discuss with Regence if they recognize or work with any third-party discount programs to help reduce out-of-pocket costs.

 

Follow Up Regularly

 

  • Keep in touch with Regence to monitor the status of your coverage application or any claims submitted for Januvia.
  •  

  • Document all interactions with Regence for future reference, including dates, times, and names of representatives spoken to.

 

Review Your Explanation of Benefits (EOB)

 

  • After receiving Januvia, review the Explanation of Benefits document from Regence to ensure that the coverage reflects any agreed terms.
  •  

  • Address any discrepancies immediately by contacting Regence's customer service for clarification or correction.

 

Consider Appeal Options

 

  • If your request for coverage is denied, review the reasons provided by Regence and gather additional documentation or a letter of necessity from your healthcare provider.
  •  

  • Submit an appeal to Regence, following their outlined procedure, to contest the denial and provide additional evidence supporting the need for coverage.

 

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FAQs

Does Regence Cover Januvia

Explore Januvia coverage with Regence. Learn why it might be denied, how to gain approval, costs without insurance, and FAQs in this detailed guide.
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Is Januvia Covered by Regence

 

Regence Coverage for Januvia

 

  • Regence generally covers Januvia, a diabetes medication used to manage blood sugar levels in adults with type 2 diabetes, when medically necessary.
  •  

  • Coverage criteria include a diagnosis of type 2 diabetes, and that Januvia is prescribed as part of a comprehensive diabetes management plan.
  •  

  • A healthcare provider must demonstrate that Januvia is appropriate by providing documentation of previous treatments and their outcomes.
  •  

  • Prior authorization is often required to ensure coverage. This involves submitting a request with supporting clinical information to Regence.
  •  

  • Coverage can vary based on individual plans, so it's important to verify specific benefits directly through Regence or the member's policy documents.

 

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Regence's Approved Criteria for Januvia Coverage

 

Coverage Criteria for Januvia

 

  • Patient must be aged 18 or older and have a diagnosis of Type 2 Diabetes Mellitus.
  •  

  • The patient has not achieved glycemic control with lifestyle modifications alone, such as diet and exercise.
  •  

  • Januvia may be covered as part of a dual therapy in combination with metformin or another diabetes medication when monotherapy does not adequately control blood sugar levels.
  •  

  • For patients unable to tolerate metformin, Januvia may be used in combination with alternative oral antidiabetic agents approved by Regence.
  •  

  • Patients who have contraindications or intolerance to metformin can be considered for Januvia coverage as a monotherapy.
  •  

  • Documentation must be provided showing a failure to achieve blood glucose control with at least one other antidiabetic regimen prior to Januvia initiation.
  •  

  • Januvia can be prescribed as part of a triple therapy, in combination with two other oral diabetes medications when dual therapy does not meet glycemic targets.
  •  

  • For continuation of therapy, documentation must show a significant improvement in glycemic control, measured by a reduction in HbA1c levels.

 

Why Regence Might Deny Januvia Coverage

 

Reasons Regence Might Deny Januvia Coverage

 

  • Januvia is prescribed for a medical condition that is not covered under the Regence plan. Coverage is usually specific to certain conditions, and use outside of these may lead to denial.
  •  

  • Lack of demonstrated medical necessity. If there is insufficient evidence to show Januvia is necessary for the treatment of the condition, Regence may deny coverage.
  •  

  • Use of Januvia as an off-label treatment. If it is prescribed for conditions that haven’t been approved by regulatory agencies, coverage could be denied.
  •  

  • Failure to meet prior authorization requirements. If prior authorization procedures are not properly followed or information provided is inadequate, coverage may be denied.
  •  

  • Availability of a more cost-effective alternative. Regence may deny coverage if there is a less expensive equivalent that is considered equally effective for the condition.
  •  

  • Non-compliance with formulary guidelines. Januvia may not be included within the covered drug list or formulary, resulting in coverage denial.

 

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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 Regence

 

Verify Your Current Coverage

 

  • Begin by reviewing your current Regence insurance policy documents to understand your existing prescription drug coverage.
  •  

  • Check the formulary provided by Regence, which lists all the medications they cover. Look specifically for Januvia to see if it’s included.

 

Consult with Your Healthcare Provider

 

  • Discuss your medical condition and the necessity of Januvia with your healthcare provider. They might have insights on coverage or potential alternatives.
  •  

  • Request that your healthcare provider prepares any required documentation or prior authorization forms needed by Regence for coverage approval.

 

Contact Regence Customer Service

 

  • Call Regence's customer service to inquire about the coverage process for Januvia specifically. Having your policy number ready can expedite the conversation.
  •  

  • Ask about any specific steps or forms you need to complete to ensure Januvia is covered under your plan.

 

Submit Prior Authorization, if Necessary

 

  • If prior authorization is required, work with your healthcare provider to complete and submit the necessary form to Regence.
  •  

  • Ensure that all supporting medical documentation is included to strengthen your case for coverage.

 

Explore Savings Programs

 

  • Research savings programs provided by the manufacturer of Januvia, as they might offer assistance or copay discounts, which can be combined with your insurance coverage.
  •  

  • Discuss with Regence if they recognize or work with any third-party discount programs to help reduce out-of-pocket costs.

 

Follow Up Regularly

 

  • Keep in touch with Regence to monitor the status of your coverage application or any claims submitted for Januvia.
  •  

  • Document all interactions with Regence for future reference, including dates, times, and names of representatives spoken to.

 

Review Your Explanation of Benefits (EOB)

 

  • After receiving Januvia, review the Explanation of Benefits document from Regence to ensure that the coverage reflects any agreed terms.
  •  

  • Address any discrepancies immediately by contacting Regence's customer service for clarification or correction.

 

Consider Appeal Options

 

  • If your request for coverage is denied, review the reasons provided by Regence and gather additional documentation or a letter of necessity from your healthcare provider.
  •  

  • Submit an appeal to Regence, following their outlined procedure, to contest the denial and provide additional evidence supporting the need for coverage.

 

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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.

 

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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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