Does Scripps Health Cover Jardiance

Explore if Scripps Health covers Jardiance, reasons for denial, steps to secure coverage, cost insights, and FAQs in this comprehensive guide.
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Coverage for Jardiance by Scripps Health

 

  • Scripps Health may cover Jardiance as part of its prescription drug benefits. Coverage often depends on the individual's health plan, and prior authorization could be required.
  •  

  • Typically, Jardiance is covered for patients with Type 2 diabetes as adjunct therapy to diet and exercise to improve blood sugar control, and it may also be considered for heart failure patients to reduce cardiovascular risk.
  •  

  • For coverage, physicians might need to provide a rationale for using Jardiance over other less expensive alternatives during the authorization process.
  •  

  • Patients must check their specific plan details within Scripps Health to understand out-of-pocket costs, co-payments, or any tier placement affecting affordability.

 

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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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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 Jardiance Coverage with Scripps Health

 

Verify Your Eligibility for Coverage

 

  • Contact Scripps Health customer service to understand if Jardiance is covered under your current plan.
  • Check your insurance policy documents for any specific clauses about diabetic medications.
  • Ensure that your medical conditions align with Jardiance's prescribed uses.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with a Scripps Health-affiliated healthcare provider to discuss your medical condition and potential need for Jardiance.
  • Gather all necessary medical records and documentation that support the need for Jardiance.
  • Ensure your healthcare provider includes Jardiance as part of your treatment plan if deemed necessary.

 

Obtain a Prescription for Jardiance

 

  • Request your doctor to provide a formal prescription for Jardiance.
  • Make sure the prescription includes all pertinent details such as dosage, frequency, and duration.
  • Inquire if your doctor can provide any additional supporting documentation if required by your insurance.

 

Submit a Prior Authorization if Needed

 

  • Contact Scripps Health to inquire if prior authorization is necessary for Jardiance coverage.
  • Work with your healthcare provider to fill out any required forms for prior authorization.
  • Compile all required documentation, including the prescription and any medical history relevant to your condition.

 

Review Your Benefits and Costs

 

  • Consult your insurance plan to understand copayments, deductibles, or any out-of-pocket costs associated with Jardiance.
  • Identify if there are generic equivalents or alternatives to Jardiance that may significantly reduce costs.
  • Investigate any manufacturer discounts or pharmaceutical subsidy programs available for Jardiance users.

 

Fill Your Prescription

 

  • Submit your Jardiance prescription to a Scripps Health-affiliated pharmacy or an in-network pharmacy according to your health plan.
  • Ensure the pharmacy processes your insurance plan correctly to apply coverage benefits.
  • Verify that you receive the correct dosage and quantity as prescribed by your doctor.

 

Follow Up with Insurance and Healthcare Providers

 

  • Contact Scripps Health if there are any discrepancies or issues with your Jardiance coverage.
  • Maintain regular follow-ups with your healthcare provider to evaluate the effectiveness of Jardiance.
  • Ensure your healthcare plan is consistently updated with any changes to your treatment or medication needs.

 

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FAQs

Does Scripps Health Cover Jardiance

Explore if Scripps Health covers Jardiance, reasons for denial, steps to secure coverage, cost insights, and FAQs in this comprehensive guide.
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Is Jardiance Covered by Scripps Health

 

Coverage for Jardiance by Scripps Health

 

  • Scripps Health may cover Jardiance as part of its prescription drug benefits. Coverage often depends on the individual's health plan, and prior authorization could be required.
  •  

  • Typically, Jardiance is covered for patients with Type 2 diabetes as adjunct therapy to diet and exercise to improve blood sugar control, and it may also be considered for heart failure patients to reduce cardiovascular risk.
  •  

  • For coverage, physicians might need to provide a rationale for using Jardiance over other less expensive alternatives during the authorization process.
  •  

  • Patients must check their specific plan details within Scripps Health to understand out-of-pocket costs, co-payments, or any tier placement affecting affordability.

 

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Scripps Health's Approved Criteria for Jardiance Coverage

 

Eligibility for Jardiance Coverage

 

  • Patients must have a documented diagnosis of type 2 diabetes mellitus.
  •  

  • Jardiance is prescribed as part of a comprehensive treatment plan for diabetes, including lifestyle modifications such as diet and exercise.
  •  

  • Patients should have evidence of stable renal function, with an estimated glomerular filtration rate (eGFR) of at least 45 mL/min/1.73 m², unless specified otherwise by a healthcare provider.
  •  

  • Jardiance may be approved for patients with a history of cardiovascular disease or a high risk of developing cardiovascular events, to reduce the risk of cardiovascular death.
  •  

  • Documentation of previous failure, intolerance, or contraindication to other preferred antidiabetic medications may be required.

 

Required Documentation

 

  • A current prescription from a licensed healthcare provider indicating the necessity for Jardiance.
  •  

  • Medical records or test results supporting the diagnosis of type 2 diabetes mellitus and any other relevant comorbid conditions.
  •  

  • Return to view certification of other treatment options that have been tried and the reason for transitioning to Jardiance.

 

Renewal Criteria

 

  • Documentation demonstrating continued benefit from the medication as evidenced by improved glycemic control and/or reduction in cardiovascular events.
  •  

  • No adverse effects or contraindications necessitating the discontinuation of Jardiance.
  •  

  • Compliance with ongoing diabetes management plans, including follow-up appointments and lab tests as recommended by the healthcare provider.

 

Why Scripps Health Might Deny Jardiance Coverage

 

Scripps Health Denial Criteria for Jardiance Coverage

 

  • Scripps Health might deny coverage for Jardiance if the prescribed usage does not align with FDA-approved indications. Jardiance is typically indicated for specific conditions such as Type 2 Diabetes, and off-label uses may not be covered.
  •  

  • If Jardiance is prescribed in a manner inconsistent with standard dosing guidelines or lacks sufficient supporting documentation, Scripps Health may not approve coverage.
  •  

  • Coverage might be denied if the patient's medical records do not demonstrate an inadequate response or contraindication to more cost-effective therapeutic alternatives.
  •  

  • Scripps Health could deny Jardiance coverage if the patient fails to meet the age restrictions typically outlined in the insurer's formulary guidelines.
  •  

  • Financial authorization issues or lapses in the patient's insurance policy related to premium payments might also result in denial of coverage for Jardiance.
  •  

  • Situations where prior authorization requirements have not been met or necessary paperwork is incomplete can lead to denial of coverage.
  •  

  • Jardiance might not be covered if the patient’s medication history indicates non-adherence or failure to comply with prescribed treatment plans without documented justifications.
  •  

  • If clinical trials or updated guidelines have identified potential risks or limitations with Jardiance for certain populations or conditions, this might affect coverage decisions negatively.
  •  

  • In cases where Jardiance is a duplicate therapy for existing medications covered under the patient’s plan, Scripps Health might deny additional coverage.

 

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How Much Does Jardiance Cost without Insurance?

 

Estimated Cost of Jardiance Without Insurance

 

  • The cost of Jardiance can vary depending on the pharmacy you visit, but as an oral medication used primarily to treat type 2 diabetes, it is often priced at a premium. Without insurance, the average monthly cost is approximately $550 to $650 for a 30-day supply of 10 mg or 25 mg tablets.
  •  

  • Prices can also vary based on location, pharmacy discounts, and available manufacturer coupons, so it's advisable to shop around or look for any available patient assistance programs to potentially lower the out-of-pocket cost.

 

Ways to Lower the Cost of Jardiance

 

  • **Pharmacy Discount Cards:** Utilizing pharmacy discount cards can sometimes provide substantial savings on your prescription, reducing the price by a notable percentage.
  •  

  • **Manufacturer Coupons and Programs:** Eli Lilly, the manufacturer of Jardiance, may offer savings cards or assistance programs to help eligible patients reduce their costs. It's worth checking through their official website or consulting with your healthcare provider.
  •  

  • **Generic Alternatives:** Although there may not be a generic version of Jardiance available currently, consulting with your healthcare provider about other generic medications for your condition may offer a more budget-friendly option.
  •  

  • **Bulk Purchasing Options:** Some pharmacies might offer discounts for purchasing a 90-day supply instead of a 30-day supply, which can lead to savings in the long term.

 

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 Jardiance Coverage with Scripps Health

 

Verify Your Eligibility for Coverage

 

  • Contact Scripps Health customer service to understand if Jardiance is covered under your current plan.
  • Check your insurance policy documents for any specific clauses about diabetic medications.
  • Ensure that your medical conditions align with Jardiance's prescribed uses.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with a Scripps Health-affiliated healthcare provider to discuss your medical condition and potential need for Jardiance.
  • Gather all necessary medical records and documentation that support the need for Jardiance.
  • Ensure your healthcare provider includes Jardiance as part of your treatment plan if deemed necessary.

 

Obtain a Prescription for Jardiance

 

  • Request your doctor to provide a formal prescription for Jardiance.
  • Make sure the prescription includes all pertinent details such as dosage, frequency, and duration.
  • Inquire if your doctor can provide any additional supporting documentation if required by your insurance.

 

Submit a Prior Authorization if Needed

 

  • Contact Scripps Health to inquire if prior authorization is necessary for Jardiance coverage.
  • Work with your healthcare provider to fill out any required forms for prior authorization.
  • Compile all required documentation, including the prescription and any medical history relevant to your condition.

 

Review Your Benefits and Costs

 

  • Consult your insurance plan to understand copayments, deductibles, or any out-of-pocket costs associated with Jardiance.
  • Identify if there are generic equivalents or alternatives to Jardiance that may significantly reduce costs.
  • Investigate any manufacturer discounts or pharmaceutical subsidy programs available for Jardiance users.

 

Fill Your Prescription

 

  • Submit your Jardiance prescription to a Scripps Health-affiliated pharmacy or an in-network pharmacy according to your health plan.
  • Ensure the pharmacy processes your insurance plan correctly to apply coverage benefits.
  • Verify that you receive the correct dosage and quantity as prescribed by your doctor.

 

Follow Up with Insurance and Healthcare Providers

 

  • Contact Scripps Health if there are any discrepancies or issues with your Jardiance coverage.
  • Maintain regular follow-ups with your healthcare provider to evaluate the effectiveness of Jardiance.
  • Ensure your healthcare plan is consistently updated with any changes to your treatment or medication needs.

 

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Jardiance FAQ

What is Jardiance used for?

 

What is Jardiance Used For?

 

  • Jardiance is primarily used to manage type 2 diabetes by helping to lower blood sugar levels in adults.
  •  

  • It works by promoting the excretion of excess glucose through urine, thus reducing the amount of sugar the body absorbs.
  •  

  • In addition to blood sugar management, Jardiance is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.
  •  

  • Patients with heart failure may benefit from Jardiance as it helps in reducing the risk of hospitalization due to heart failure.

 

What are the side effects of Jardiance?

 

Common Side Effects of Jardiance

 

  • Urinary tract infections: Symptoms may include burning sensation while urinating and frequent urges.
  • Increased urination: This is due to Jardiance's mechanism of removing excess glucose via urine.

 

Serious Side Effects

 

  • Ketoacidosis: This rare condition might present as difficulty breathing, nausea, or confusion.
  • Dehydration: Symptoms can be dizziness or light-headedness, especially upon standing.

 

Allergic Reactions

 

  • Rash or hives can occur, requiring immediate medical attention.

 

Precautions

 

  • Consult your healthcare provider before starting if you have kidney issues or are on diuretics.

 

Can Jardiance cause weight loss?

 

Can Jardiance Cause Weight Loss?

 

  • Yes, Jardiance (empagliflozin) can lead to weight loss. This medication is primarily used to treat type 2 diabetes.
  •  

  • It works by preventing glucose reabsorption in the kidneys, leading to glucose excretion through urine, which may also result in calorie loss.
  •  

  • Clinical trials have shown weight reduction as a common side effect, often averaging 2-3 kg.
  •  

  • This loss can differ among individuals; factors like diet and exercise may influence the extent of weight change.
  •  

  • Always consult with healthcare professionals to understand the benefits and risks associated with your specific health condition.

 

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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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