Does Scripps Health Cover Lantus

Explore why Scripps Health might deny Lantus, how to secure coverage, the cost without insurance, plus answers to FAQs in this insightful article.
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Coverage Overview

 

  • Scripps Health typically covers Lantus, a long-acting insulin, as per their pharmacy benefits plan, subject to individual policy details.

 

Situations Covered

 

  • Coverage usually applies to patients with a diabetes diagnosis requiring insulin therapy.
  • It may require prior authorization based on clinical necessity.

 

Rules and Criteria

 

  • Patients must be enrolled in a Scripps Health plan with prescription drug coverage.
  • A prescription from a healthcare provider is mandatory.
  • Formulary status can affect coverage, potentially requiring a formulary alternative first.

 

Getting Coverage

 

  • Contact Scripps Health customer service for specific plan details and coverage confirmation.
  • Consult with your healthcare provider to ensure all required documentation and criteria are met for approval.

 

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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 Lantus Coverage with Scripps Health

 

Contact Scripps Health Pharmacy Benefits

 

  • Reach out to Scripps Health's member services to inquire about pharmacy coverage. Have your member ID ready for reference.
  •  

  • Request information on preferred pharmacies and the procedure to obtain Lantus coverage.

 

Verify Formulary Inclusion

 

  • Check if Lantus is included in the Scripps Health formulary, which outlines covered medications.
  •  

  • If you do not have access to the formulary, ask a customer service representative to verify if Lantus is covered.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider affiliated with Scripps Health to discuss your need for Lantus.
  •  

  • Ensure your healthcare provider is aware of your insurance plan details with Scripps Health to facilitate approval for Lantus.

 

Request Prior Authorization

 

  • Inquire if prior authorization is necessary for Lantus coverage. This process involves your doctor submitting a request to your insurance provider to justify the need for the medication.
  •  

  • Work directly with your healthcare provider's office to ensure all necessary documentation is submitted to Scripps Health for prior authorization.

 

Utilize Scripps Health Pharmacy Services

 

  • Consider using Scripps Health's in-house pharmacy services for potential savings and streamlined processing of your Lantus prescription.
  •  

  • Ask about their mail-order pharmacy option, which might offer additional convenience and financial benefits.

 

Explore Financial Assistance Programs

 

  • If there are issues with coverage or affordability, inquire about patient assistance programs for Lantus, which may help reduce out-of-pocket costs.
  •  

  • Contact the Lantus manufacturer directly or visit their website to check for any available discounts or copay assistance programs.

 

Confirm Coverage Details

 

  • Once authorized, verify the details such as copay amounts, refill processes, and coverage duration for Lantus with Scripps Health.
  •  

  • Keep a record of all communications and confirmations for future reference and troubleshooting.

 

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FAQs

Does Scripps Health Cover Lantus

Explore why Scripps Health might deny Lantus, how to secure coverage, the cost without insurance, plus answers to FAQs in this insightful article.
Curex allergy drops unboxing

Is Lantus Covered by Scripps Health

 

Coverage Overview

 

  • Scripps Health typically covers Lantus, a long-acting insulin, as per their pharmacy benefits plan, subject to individual policy details.

 

Situations Covered

 

  • Coverage usually applies to patients with a diabetes diagnosis requiring insulin therapy.
  • It may require prior authorization based on clinical necessity.

 

Rules and Criteria

 

  • Patients must be enrolled in a Scripps Health plan with prescription drug coverage.
  • A prescription from a healthcare provider is mandatory.
  • Formulary status can affect coverage, potentially requiring a formulary alternative first.

 

Getting Coverage

 

  • Contact Scripps Health customer service for specific plan details and coverage confirmation.
  • Consult with your healthcare provider to ensure all required documentation and criteria are met for approval.

 

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Scripps Health's Approved Criteria for Lantus Coverage

 

Scripps Health's Approved Criteria for Lantus Coverage

 

  • **Diagnosis Requirement**: Coverage for Lantus is typically provided for patients with a confirmed diagnosis of Type 1 or Type 2 diabetes that requires basal insulin therapy.
  •  

  • **Treatment History**: Patients should demonstrate a history of using other forms of insulin therapy without achieving adequate glycemic control, necessitating the use of long-acting insulin like Lantus.
  •  

  • **Blood Sugar Control**: Clinical evidence of uncontrolled blood glucose levels, as indicated by hemoglobin A1c levels above target despite previous use of other insulin therapy, is necessary for coverage consideration.
  •  

  • **Doctor's Recommendation**: A written recommendation or prescription from a licensed healthcare provider who attests to the medical necessity of using Lantus over other alternatives.
  •  

  • **Age and Weight Factors**: Age and weight factors may influence the decision, especially in pediatric patients. Coverage is typically available for individuals of all ages needing basal insulin regulation.
  •  

  • **Comprehensive Treatment Plan**: The patient's treatment plan should include a comprehensive approach to diabetes management, including lifestyle modifications and possibly other medications, alongside Lantus.
  •  

  • **Prior Authorization**: Submissions for prior authorization must be completed and approved before accessing treatment, including documentation of the patient’s medical history and necessity for Lantus.
  •  

 

Why Scripps Health Might Deny Lantus Coverage

 

Reasons for Denial of Lantus Coverage by Scripps Health

 

  • Lantus is prescribed for a use that is not approved by the FDA or lacks solid evidence supporting its off-label efficacy and safety.
  •  

  • Alternative, more cost-effective medications or treatment options are deemed sufficient and appropriate by Scripps Health for the individual’s specific medical condition.
  •  

  • The prescribed dosage of Lantus exceeds the recommendations made within clinical guidelines or the prescribing practices considered standard within the medical community without substantiated medical justification.
  •  

  • The prescription does not meet specific prior authorization criteria or step therapy protocols established by Scripps Health, requiring patients to try specified less expensive options first.
  •  

  • Lantus is prescribed in a combination or alongside another non-covered medication, thereby affecting the overall coverage determination.
  •  

  • Patient information and medical necessity documentation provided do not sufficiently justify the need for Lantus under Scripps’ policy criteria.

 

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

  • The price of Lantus (insulin glargine) without insurance can vary based on factors such as the pharmacy, location, and available discounts. Typically, the retail price ranges between $250 and $350 for a 10ml vial at a retail pharmacy.
  •  

  • For the Lantus SoloStar pen, which is a more convenient option for some, the price is generally similar, ranging from $400 to $500 for a pack of five pens.
  •  

  • Prices can fluctuate slightly, so it is advisable to check with local pharmacies or online services for the most current prices and potential savings options.
  •  

  • Consider exploring patient assistance programs offered by the manufacturer or third-party organizations, which might offer Lantus at reduced prices or even for free if you qualify based on income.

 

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 Lantus Coverage with Scripps Health

 

Contact Scripps Health Pharmacy Benefits

 

  • Reach out to Scripps Health's member services to inquire about pharmacy coverage. Have your member ID ready for reference.
  •  

  • Request information on preferred pharmacies and the procedure to obtain Lantus coverage.

 

Verify Formulary Inclusion

 

  • Check if Lantus is included in the Scripps Health formulary, which outlines covered medications.
  •  

  • If you do not have access to the formulary, ask a customer service representative to verify if Lantus is covered.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider affiliated with Scripps Health to discuss your need for Lantus.
  •  

  • Ensure your healthcare provider is aware of your insurance plan details with Scripps Health to facilitate approval for Lantus.

 

Request Prior Authorization

 

  • Inquire if prior authorization is necessary for Lantus coverage. This process involves your doctor submitting a request to your insurance provider to justify the need for the medication.
  •  

  • Work directly with your healthcare provider's office to ensure all necessary documentation is submitted to Scripps Health for prior authorization.

 

Utilize Scripps Health Pharmacy Services

 

  • Consider using Scripps Health's in-house pharmacy services for potential savings and streamlined processing of your Lantus prescription.
  •  

  • Ask about their mail-order pharmacy option, which might offer additional convenience and financial benefits.

 

Explore Financial Assistance Programs

 

  • If there are issues with coverage or affordability, inquire about patient assistance programs for Lantus, which may help reduce out-of-pocket costs.
  •  

  • Contact the Lantus manufacturer directly or visit their website to check for any available discounts or copay assistance programs.

 

Confirm Coverage Details

 

  • Once authorized, verify the details such as copay amounts, refill processes, and coverage duration for Lantus with Scripps Health.
  •  

  • Keep a record of all communications and confirmations for future reference and troubleshooting.

 

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Lantus FAQ

What is Lantus used for?

 

What is Lantus Used For?

 

  • Lantus is primarily used to manage blood sugar levels in individuals with type 1 and type 2 diabetes.
  •  

  • It is a long-acting insulin, providing a steady release of insulin over a 24-hour period with no pronounced peak, mimicking natural insulin secretion.
  •  

  • It's taken once daily, often at the same time each day, helping to maintain consistent blood glucose control.
  •  

  • Beneficial for patients requiring basal insulin to prevent hyperglycemia between meals and overnight.
  •  

  • Alongside diet and exercise, Lantus is vital for comprehensive diabetes management.

 

How does Lantus work in the body?

 

How Lantus Works

 

  • Lantus is a long-acting insulin, also known as insulin glargine. It provides a stable and continuous release of insulin to control blood sugar levels.
  •  

  • The formulation of Lantus enables it to dissolve slowly upon injection, creating a slow and steady insulin level that lasts up to 24 hours.
  •  

  • This minimizes the risk of blood sugar peaks and troughs, providing more consistent blood glucose management.
  •  

  • Lantus mimics the basal level of insulin production in the pancreas, thus helping to maintain glucose balance between meals and overnight.
  •  

  • It binds to insulin receptors, facilitating glucose uptake into muscle and fat tissues, while inhibiting hepatic glucose production.

 

What are the side effects of Lantus?

 

Common Side Effects

 

  • Injection site reactions such as redness, swelling, or itching can occur.
  • Hypoglycemia, or low blood sugar, is a frequent side effect.
  • Weight gain may happen due to improved glucose utilization.

 

Less Common Side Effects

 

  • Allergic reactions like rash or itching may occur but are rare.
  • Systemic reactions such as swelling of hands/feet can occur.
  • Visual changes might be experienced during initial treatment.

 

Serious Side Effects

 

  • Severe hypoglycemia requiring intervention.
  • Signs of allergic reactions like difficulty breathing, require immediate attention.
  • Hypokalemia may develop, leading to muscle weakness or cramps.

 

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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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