Does Regence Cover Tirzepatide (Mounjaro)

Explore Regence coverage for Tirzepatide, reasons for denial, costs without insurance, and get tips for securing coverage. Comprehensive FAQ included.
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Coverage of Tirzepatide (Mounjaro)

 

  • Regence may cover Tirzepatide (Mounjaro) for adults with Type 2 diabetes, primarily when other treatments are ineffective or not suitable.
  •  

  • Coverage generally requires that it is prescribed by a healthcare provider who confirms the medication is medically necessary.

 

Criteria for Coverage

 

  • Patients must typically show documented evidence of previous unsuccessful trials with other diabetes medications.
  •  

  • A physician must provide a detailed justification, demonstrating the need based on the patient's unique medical condition.
  •  

  • Regular monitoring and follow-ups by a healthcare professional are required to maintain coverage.

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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 Tirzepatide (Mounjaro) Coverage with Regence

 

Initiate Your Coverage Inquiry

 

  • Contact Regence customer service to confirm your current health plan's coverage policies regarding Tirzepatide (Mounjaro). Ask for any specific documentation or requirements needed to support your case.
  •  

  • Check if Tirzepatide (Mounjaro) is listed under your plan's formulary and if any alternatives are preferred, which might require prior authorization or step therapy.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your medical necessity for Tirzepatide (Mounjaro). They can help provide a detailed justification based on your health status and treatment history.
  •  

  • Request that your healthcare provider prepares a letter of medical necessity, highlighting the reasons Tirzepatide (Mounjaro) is appropriate for your treatment and why alternative medications may not be viable.

 

Prepare and Submit Required Documentation

 

  • Gather all necessary documents, including your prescription, the letter of medical necessity from your physician, and any relevant medical records or lab results that support the necessity of the medication.
  •  

  • Complete any forms required by Regence, ensuring all information is accurate and comprehensive to avoid delays in processing.

 

Follow Up and Communicate with Regence

 

  • Submit your documents to Regence through the appropriate channels, whether it's online, by mail, or through your healthcare provider's electronic system.
  •  

  • Regularly follow up with Regence regarding the status of your request. Keep records of your communications, including dates, times, and the representatives you speak with.

 

Appeal If Necessary

 

  • If your initial request is denied, review the denial letter to understand the reasons behind the decision. Gather additional supporting evidence if necessary.
  •  

  • Initiate the appeal process by preparing a written appeal. Provide any additional documentation or explanations needed to support your case for coverage of Tirzepatide (Mounjaro).

 

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FAQs

Does Regence Cover Tirzepatide (Mounjaro)

Explore Regence coverage for Tirzepatide, reasons for denial, costs without insurance, and get tips for securing coverage. Comprehensive FAQ included.
Curex allergy drops unboxing

Is Tirzepatide (Mounjaro) Covered by Regence

 

Coverage of Tirzepatide (Mounjaro)

 

  • Regence may cover Tirzepatide (Mounjaro) for adults with Type 2 diabetes, primarily when other treatments are ineffective or not suitable.
  •  

  • Coverage generally requires that it is prescribed by a healthcare provider who confirms the medication is medically necessary.

 

Criteria for Coverage

 

  • Patients must typically show documented evidence of previous unsuccessful trials with other diabetes medications.
  •  

  • A physician must provide a detailed justification, demonstrating the need based on the patient's unique medical condition.
  •  

  • Regular monitoring and follow-ups by a healthcare professional are required to maintain coverage.

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Regence's Approved Criteria for Tirzepatide (Mounjaro) Coverage

 

Criteria for Regence Coverage of Tirzepatide (Mounjaro)

 

  • Tirzepatide (Mounjaro) eligibility is granted for adult patients diagnosed with type 2 diabetes mellitus who have demonstrated an inadequate response to, or cannot tolerate, metformin unless contraindicated.
  •  

  • Patients must have either a documented history of cardiovascular disease or be at high risk for cardiovascular events.
  •  

  • The patient should have a body mass index (BMI) of 30 kg/m² or greater, indicating clinically significant obesity, or have a BMI of 27 kg/m² or greater with a comorbid weight-related condition such as hypertension, dyslipidemia, or obstructive sleep apnea.
  •  

  • Regence coverage is dependent on the physician providing evidence of previous attempts to implement lifestyle interventions such as diet and exercise, alongside conventional diabetes therapy.
  •  

  • Treatment continuation requires demonstration of clinically significant improvement in glycemic control as evidenced by reductions in HbA1c levels, or achievement of other therapeutic goals determined by the healthcare provider.
  •  

 

Why Regence Might Deny Tirzepatide (Mounjaro) Coverage

 

Situations Where Regence Might Deny Coverage for Tirzepatide (Mounjaro)

 

  • **Experimental or Investigational:** If Tirzepatide (Mounjaro) is deemed experimental or investigational for treating a specific condition by Regence, coverage may be denied.
  •  

  • **Lack of FDA Approval:** Regence might not cover Tirzepatide if it has not received FDA approval for the indication it is being prescribed for.
  •  

  • **Non-approved Indication:** If the medication is prescribed for an off-label use that is not supported by substantial scientific evidence or recognized guidelines, coverage may be denied.
  •  

  • **Absence of Medical Necessity:** In cases where Regence determines that Tirzepatide is not medically necessary for a patient's specific health condition or situation, it might refuse coverage.
  •  

  • **Failure to Meet Prescribing Guidelines:** If the prescribed use of Tirzepatide does not align with Regence's clinical guidelines, including dosage and treatment protocols, it may not be covered.
  •  

  • **Availability of Suitable Alternatives:** Coverage might be denied if there are other less expensive or more clinically effective medications available for the condition being treated.
  •  

  • **Prior Authorization Requirements:** If Tirzepatide requires a prior authorization that is not obtained, or the request does not provide sufficient documentation to justify its necessity, coverage could be denied.
  •  

  • **Benefit Exclusion in Policy:** If a patient's insurance policy specifically excludes the coverage of certain drugs like Tirzepatide, it will not be covered.

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Tirzepatide (Mounjaro) Cost without Insurance?

 

Cost of Tirzepatide (Mounjaro) Without Insurance

 

  • The approximate cost of Tirzepatide, commonly known by its brand name Mounjaro, can vary based on several factors including the pharmacy location and any available discounts.
  •  

  • On average, the price for four doses of Mounjaro, which is typically a one-month supply, is estimated to be between $1,000 and $1,250 without any insurance coverage.
  •  

  • It's essential for patients to check with different pharmacies and consider available savings programs or manufacturer coupons which might offer significant reductions or discounts.
  •  

  • Additionally, some pharmacies might provide membership programs or discount cards that could further lower the costs.

 

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 Tirzepatide (Mounjaro) Coverage with Regence

 

Initiate Your Coverage Inquiry

 

  • Contact Regence customer service to confirm your current health plan's coverage policies regarding Tirzepatide (Mounjaro). Ask for any specific documentation or requirements needed to support your case.
  •  

  • Check if Tirzepatide (Mounjaro) is listed under your plan's formulary and if any alternatives are preferred, which might require prior authorization or step therapy.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your medical necessity for Tirzepatide (Mounjaro). They can help provide a detailed justification based on your health status and treatment history.
  •  

  • Request that your healthcare provider prepares a letter of medical necessity, highlighting the reasons Tirzepatide (Mounjaro) is appropriate for your treatment and why alternative medications may not be viable.

 

Prepare and Submit Required Documentation

 

  • Gather all necessary documents, including your prescription, the letter of medical necessity from your physician, and any relevant medical records or lab results that support the necessity of the medication.
  •  

  • Complete any forms required by Regence, ensuring all information is accurate and comprehensive to avoid delays in processing.

 

Follow Up and Communicate with Regence

 

  • Submit your documents to Regence through the appropriate channels, whether it's online, by mail, or through your healthcare provider's electronic system.
  •  

  • Regularly follow up with Regence regarding the status of your request. Keep records of your communications, including dates, times, and the representatives you speak with.

 

Appeal If Necessary

 

  • If your initial request is denied, review the denial letter to understand the reasons behind the decision. Gather additional supporting evidence if necessary.
  •  

  • Initiate the appeal process by preparing a written appeal. Provide any additional documentation or explanations needed to support your case for coverage of Tirzepatide (Mounjaro).

 

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Tirzepatide (Mounjaro) FAQ

What are common side effects of Tirzepatide (Mounjaro)?

 

Common Side Effects of Tirzepatide (Mounjaro)

 

  • Nausea: Frequently reported, especially when starting treatment or increasing the dose.
  •  

  • Diarrhea: Some patients experience loose stools during treatment.
  •  

  • Decreased Appetite: Commonly occurs and can aid in weight management.
  •  

  • Vomiting: May happen occasionally, often alongside nausea.
  •  

  • Constipation: Some individuals might experience slower bowel movements.
  •  

  • Abdominal Pain: Discomfort or pain may occur during therapy.
  •  

  • Fatigue: A feeling of tiredness or exhaustion might present itself in some users.
  •  

  • In rare cases, hypoglycemia occurs, especially if combined with insulin or sulfonylureas.

 

How does Tirzepatide (Mounjaro) help with weight loss?

 

How Tirzepatide Aids Weight Loss

 

  • Dual Agonist Action: Tirzepatide acts on both GLP-1 and GIP receptors. These hormones help regulate appetite and glucose, influencing energy balance and metabolism.
  •  

  • Appetite Suppression: By mimicking these hormones, it reduces hunger, promoting lower calorie intake.
  •  

  • Increased Satiety: Delays gastric emptying, enhancing fullness and reducing meal frequency.
  •  

  • Improved Blood Sugar Control: Helps stabilize blood glucose levels, reducing insulin spikes that can stimulate hunger.
  •  

  • Enhanced Energy Expenditure: Modulates metabolic pathways to increase calorie burning, aiding fat loss.

 

Is Tirzepatide (Mounjaro) the same as Ozempic or Wegovy?

 

Comparing Tirzepatide with Ozempic and Wegovy

 

  • Composition: Tirzepatide (Mounjaro), Ozempic, and Wegovy are different medications. Tirzepatide is a dual GIP and GLP-1 receptor agonist, whereas Ozempic and Wegovy contain semaglutide, a GLP-1 receptor agonist.
  •  

  • Indications: Both Ozempic and Mounjaro target type 2 diabetes, but Wegovy is approved mainly for chronic weight management.
  •  

  • Mechanism: All induce insulin secretion and appetite suppression, yet Mounjaro's dual action may offer distinct benefits in glucose control and weight loss.
  •  

  • Dosage and Administration: Dosage forms and protocols vary; always follow medical guidance specific to the prescribed drug.
  •  

  • Considerations: Always consult your healthcare provider to determine the best option based on personal health needs and conditions.

 

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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 (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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