Does Regence Cover Metformin

Explore Regence's Metformin coverage, reasons for denial, cost without insurance, and FAQs for a seamless medication experience.
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Does Regence Cover Metformin?

 

  • Regence typically covers metformin as a prescription medication under its health plans. Coverage may vary depending on the specific plan and state regulations.
  •  

  • Metformin is generally covered for the treatment of type 2 diabetes and sometimes for off-label uses such as polycystic ovary syndrome (PCOS), with appropriate documentation from a healthcare provider.
  •  

  • To qualify for coverage, the prescription must comply with Regence's formulary guidelines, meaning it should be prescribed by a licensed healthcare professional and filled at an in-network pharmacy.
  •  

  • Prior authorization might be required, where your healthcare provider must justify the medical necessity of metformin.
  •  

  • Copayments or coinsurance fees may apply based on your specific insurance plan. Details about cost-sharing can be found in your plan documents or by contacting Regence directly.

 

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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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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 Metformin Coverage with Regence

 

Check Your Regence Plan Details

 

  • Log into your Regence online account or obtain a copy of your policy documents. Familiarize yourself with the specific details regarding prescription drug coverage.
  •  

  • Look for information regarding the formulary. It is essential to confirm that Metformin is included in your plan's list of covered drugs.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Metformin with your healthcare provider. Obtain a prescription indicating the necessity for the medication.
  •  

  • Ensure your healthcare provider specifies the correct dosage and any necessary details required by Regence for coverage considerations.

 

Contact Regence Customer Service

 

  • Reach out to Regence customer service for guidance on how to proceed with getting coverage for Metformin. Note any specific procedures they mention.
  •  

  • Ask them for any forms or documentation needed to process the coverage of Metformin under your plan.

 

Submit Necessary Documentation

 

  • Compile all necessary paperwork, including your prescription and any forms received from Regence.
  •  

  • Ensure all sections of the forms are complete and accurately filled out before submission to your provider.

 

Follow Up with Regence

 

  • After submission, follow up with Regence to confirm they have received your documents and processed your request.
  •  

  • Inquire about the expected timeline for approval and any additional steps you may need to take.

 

Access Metformin with Coverage

 

  • Once your request is approved, proceed to fill your Metformin prescription at a participating pharmacy.
  •  

  • Verify with the pharmacy that the prescription is billed correctly to your insurance, ensuring you receive the benefits of your Regence coverage.

 

Review Statements and Maintain Records

 

  • Examine your Explanation of Benefits (EOB) documents or account statements from Regence to confirm accurate billing.
  •  

  • Maintain copies of all communications and approvals for future reference in case of billing issues or coverage changes.

 

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FAQs

Does Regence Cover Metformin

Explore Regence's Metformin coverage, reasons for denial, cost without insurance, and FAQs for a seamless medication experience.
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Is Metformin Covered by Regence

 

Does Regence Cover Metformin?

 

  • Regence typically covers metformin as a prescription medication under its health plans. Coverage may vary depending on the specific plan and state regulations.
  •  

  • Metformin is generally covered for the treatment of type 2 diabetes and sometimes for off-label uses such as polycystic ovary syndrome (PCOS), with appropriate documentation from a healthcare provider.
  •  

  • To qualify for coverage, the prescription must comply with Regence's formulary guidelines, meaning it should be prescribed by a licensed healthcare professional and filled at an in-network pharmacy.
  •  

  • Prior authorization might be required, where your healthcare provider must justify the medical necessity of metformin.
  •  

  • Copayments or coinsurance fees may apply based on your specific insurance plan. Details about cost-sharing can be found in your plan documents or by contacting Regence directly.

 

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Regence's Approved Criteria for Metformin Coverage

 

Metformin Coverage Criteria

 

  • Regence covers Metformin for the treatment of Type 2 Diabetes Mellitus when prescribed as part of a comprehensive treatment plan that includes diet and exercise.
  •  

  • Metformin is approved for individuals aged 10 years and older, requiring medical necessity and physician documentation of diagnosis.
  •  

  • Coverage extends to Metformin formulations, including immediate-release tablets, extended-release tablets, and oral solutions, providing flexibility for patient needs and physician discretion.
  •  

  • Metformin may be prescribed for women with Polycystic Ovary Syndrome (PCOS) to manage insulin resistance and associated symptoms, following a documented diagnosis by a qualified healthcare provider.
  •  

  • For patients with prediabetes, Metformin coverage may be considered if there is a provider-submitted request demonstrating high risk of progression to Type 2 Diabetes.
  •  

  • Regence requires physician confirmation that the patient has no contraindications for Metformin use, ensuring safety for those with renal dysfunction, heart failure, or liver disease.
  •  

  • The initial prescription requires dosage and administration guidance, supporting necessary adjustments based on therapeutic response and tolerance.
  •  

  • The plan covers up to the maximum approved daily dosage as per current clinical guidelines, ensuring compliance with established safety standards.

 

Why Regence Might Deny Metformin Coverage

 

Conditions Where Regence Might Deny Metformin Coverage

 

  • Metformin is prescribed for non-approved uses not recognized by the FDA or lacking sufficient clinical evidence.
  •  

  • The pharmaceutical form of Metformin is not included in the approved formulary list as per Regence’s current policy.
  •  

  • The patient’s medical condition doesn't meet the specific criteria set by Regence for Metformin coverage, such as certain levels of blood sugar or hemoglobin A1c criteria that are not satisfied.
  •  

  • Metformin is part of a combination therapy and Regence has a policy that limits coverage to monotherapy or specific approved combinations only.
  •  

  • The request lacks necessary prior authorization or the submitted documentation fails to justify the medical necessity as defined by Regence guidelines.
  •  

  • Patient has exceeded the quantity limits set by Regence’s prescription coverage policy, without approved exceptions.
  •  

 

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How Much Does Metformin Cost without Insurance?

 

Approximate Cost of Metformin Without Insurance

 

  • The cost of Metformin without insurance can vary based on the dosage and quantity of the tablets. Generally, a 30-day supply of the generic version of Metformin (500 mg) might cost around $4 to $15 at major retail pharmacies in the United States.
  •  

  • Prices can differ significantly between pharmacies, so it is advisable to check multiple sources for pricing. Some discount programs or pharmacy discount cards may offer lower prices.
  •  

  • It’s important to note that prices for the branded versions, such as Glucophage, can be higher, typically ranging from $50 to $100, depending on the pharmacy and dosage.
  •  

  • For individuals looking for potential savings, generic versions of Metformin are usually the most economical 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 Metformin Coverage with Regence

 

Check Your Regence Plan Details

 

  • Log into your Regence online account or obtain a copy of your policy documents. Familiarize yourself with the specific details regarding prescription drug coverage.
  •  

  • Look for information regarding the formulary. It is essential to confirm that Metformin is included in your plan's list of covered drugs.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Metformin with your healthcare provider. Obtain a prescription indicating the necessity for the medication.
  •  

  • Ensure your healthcare provider specifies the correct dosage and any necessary details required by Regence for coverage considerations.

 

Contact Regence Customer Service

 

  • Reach out to Regence customer service for guidance on how to proceed with getting coverage for Metformin. Note any specific procedures they mention.
  •  

  • Ask them for any forms or documentation needed to process the coverage of Metformin under your plan.

 

Submit Necessary Documentation

 

  • Compile all necessary paperwork, including your prescription and any forms received from Regence.
  •  

  • Ensure all sections of the forms are complete and accurately filled out before submission to your provider.

 

Follow Up with Regence

 

  • After submission, follow up with Regence to confirm they have received your documents and processed your request.
  •  

  • Inquire about the expected timeline for approval and any additional steps you may need to take.

 

Access Metformin with Coverage

 

  • Once your request is approved, proceed to fill your Metformin prescription at a participating pharmacy.
  •  

  • Verify with the pharmacy that the prescription is billed correctly to your insurance, ensuring you receive the benefits of your Regence coverage.

 

Review Statements and Maintain Records

 

  • Examine your Explanation of Benefits (EOB) documents or account statements from Regence to confirm accurate billing.
  •  

  • Maintain copies of all communications and approvals for future reference in case of billing issues or coverage changes.

 

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Metformin FAQ

What are common side effects of Metformin?

 

Common Side Effects of Metformin

 

  • Nausea  and  vomiting:  Initial  use  often  leads  to  gastrointestinal  discomfort.
  •  

  • Diarrhea: Can occur as the body adjusts to the medication.
  •  

  • Stomach pain: Abdominal discomfort may occur, especially in the beginning.
  •  

  • Loss of appetite: A reduction in appetite is sometimes reported.
  •  

  • Metallic taste: Some users experience an unusual taste in the mouth.
  •  

  • Fatigue: Occasionally, tiredness or weakness may develop.
  •  

  • Lactic acidosis: Rare yet serious; symptoms include muscle pain, trouble breathing, or slow heart rate. Seek immediate medical attention if suspected.

 

Can Metformin help with weight loss?

 

Metformin and Weight Loss

 

  • Metformin is primarily a medication for type 2 diabetes, but it can lead to modest weight loss. This effect is due mainly to its impact on insulin sensitivity and appetite regulation.
  •  

  • It lowers insulin levels and can reduce hunger, leading some patients to eat fewer calories unintentionally.
  •  

  • Metformin is not FDA-approved for weight loss. It should not be used solely for this purpose unless prescribed by a healthcare provider.
  •  

  • While some people may experience weight loss, results can vary. Lifestyle changes, such as diet and exercise, are essential for substantial weight management.
  •  

 

Is Metformin used for treating prediabetes?

 

Metformin for Prediabetes

 

  • Metformin is a first-line medication primarily used to treat type 2 diabetes, but it also plays a role in managing prediabetes.
  •  

  • Studies suggest that Metformin can reduce the progression from prediabetes to diabetes, especially in individuals with a BMI over 35, those under 60, and women with a history of gestational diabetes.
  •  

  • Metformin works by improving insulin sensitivity and decreasing liver glucose production, which helps in controlling blood sugar levels effectively.
  •  

  • While lifestyle changes remain the cornerstone of prediabetes management, Metformin can be an adjunct therapy under a doctor's supervision.
  •  

  • It's important for patients to discuss potential benefits and side effects with their healthcare provider, as individual needs may vary.

 

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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.

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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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