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Does Security Health Plan Cover Lyrica

Explore if Security Health Plan covers Lyrica, reasons for denial, securing coverage, Lyrica costs without insurance, and get answers to common questions.
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Security Health Plan Coverage for Lyrica

 

  • Security Health Plan covers Lyrica under certain conditions, primarily for FDA-approved uses such as fibromyalgia, diabetic nerve pain, spinal cord injury nerve pain, and epilepsy.

    •  

  • Coverage usually applies when Lyrica is deemed medically necessary by a healthcare provider and alternatives have not been effective.

    •  

    Criteria for Coverage

     

  • Prior authorization is often required, meaning a healthcare provider must demonstrate the necessity and effectiveness of Lyrica for the patient.

    •  

  • The plan may require documentation of unsuccessful treatment with other medications before approving Lyrica.

    •  

    Basic Rules

     

  • Ensure prescriptions are filled at approved pharmacies within the plan's network for coverage to apply.

    •  

  • Patients may need to adhere to utilization management protocols like step therapy, where less expensive drugs are tried first.

 

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Clinical Support

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 Lyrica Coverage with Security Health Plan

 

Check Your Coverage Plan

 

  • Contact Security Health Plan directly by calling the customer service number on your insurance card. Ask for detailed information regarding prescription drug coverage, specifically for Lyrica (pregabalin).

    •  

  • Review your current health insurance policy documents to confirm whether Lyrica is included in your plan's drug formulary. This information can often be found on Security Health Plan's member portal as well.

 

Consult with Your Doctor

 

  • Discuss your need for Lyrica with your healthcare provider. Ensure that Lyrica is the right medication for your condition, as alternatives may be available that are covered under your plan.

    •  

  • Request your doctor to provide any necessary documentation or notes that may be required by the insurance company to obtain prior authorization for Lyrica.

 

Get Prior Authorization

 

  • If required by Security Health Plan, work with your physician to initiate a prior authorization request for Lyrica. The process might require specific forms and documentation that your doctor needs to complete and submit.

    •  

  • Ensure all necessary paperwork is submitted accurately to avoid delays. Security Health Plan may provide a decision on the authorization within a specified timeframe.

 

Fill Your Prescription

 

  • Once authorization is approved, take your prescription for Lyrica to a participating pharmacy within the Security Health Plan network. The approval will ensure that you receive your medication at the coverage rate outlined in your plan.

    •  

  • If you encounter any issues at the pharmacy, contact Security Health Plan’s customer service for assistance in resolving coverage problems.

 

Monitor Your Coverage

 

  • Stay informed about any changes in your insurance coverage or formulary lists that might affect your Lyrica prescription. Security Health Plan will typically notify you of changes during their open enrollment period or through direct communication.

    •  

  • Regularly review any Explanation of Benefits (EOB) statements from Security Health Plan to ensure that your medication is being billed correctly and covered as expected.

 

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Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

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Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Security Health Plan Cover Lyrica

Explore if Security Health Plan covers Lyrica, reasons for denial, securing coverage, Lyrica costs without insurance, and get answers to common questions.
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Is Lyrica Covered by Security Health Plan

 

Security Health Plan Coverage for Lyrica

 

  • Security Health Plan covers Lyrica under certain conditions, primarily for FDA-approved uses such as fibromyalgia, diabetic nerve pain, spinal cord injury nerve pain, and epilepsy.

    •  

  • Coverage usually applies when Lyrica is deemed medically necessary by a healthcare provider and alternatives have not been effective.

    •  

    Criteria for Coverage

     

  • Prior authorization is often required, meaning a healthcare provider must demonstrate the necessity and effectiveness of Lyrica for the patient.

    •  

  • The plan may require documentation of unsuccessful treatment with other medications before approving Lyrica.

    •  

    Basic Rules

     

  • Ensure prescriptions are filled at approved pharmacies within the plan's network for coverage to apply.

    •  

  • Patients may need to adhere to utilization management protocols like step therapy, where less expensive drugs are tried first.

 

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Security Health Plan's Approved Criteria for Lyrica Coverage

 

Criteria for Lyrica Coverage

 

  • Lyrica is approved for the treatment of neuropathic pain associated with diabetic peripheral neuropathy. Clinical documentation must clearly indicate a confirmed diagnosis of diabetic neuropathy for coverage consideration.

    •  

  • Security Health Plan covers Lyrica for the management of postherpetic neuralgia. The patient's medical records should reflect a diagnosis of postherpetic neuralgia, supported by relevant medical history and examination findings.

    •  

  • Coverage is available for Lyrica in the treatment of fibromyalgia. Patients must have a documented diagnosis of fibromyalgia accompanied by a trial and failure, or contraindication, to other standard therapies.

    •  

  • Lyrica is also approved for use in the management of neuropathic pain associated with spinal cord injury. Appropriate medical documentation must demonstrate such a diagnosis.

    •  

  • For patients with partial onset seizures, Lyrica may be considered for coverage as adjunctive therapy. A documented diagnosis of partial onset seizures with historical treatment plans should be included in the patient's file.

 

Why Security Health Plan Might Deny Lyrica Coverage

 

Criteria for Lyrica Coverage Denial

 

  • Lyrica is not covered for conditions or diagnoses that are not FDA-approved or lack substantial clinical evidence supporting efficacy for the condition specified.

    •  

  • Prescription is missing necessary documentation or has incomplete prior authorization requirements.

    •  

  • Use of Lyrica when there is a more cost-effective alternative available, such as a generic equivalent, that adequately treats the condition for which Lyrica is prescribed.

    •  

  • Continuation of Lyrica for longer than the medically necessary duration without proper justification or reevaluation by the prescribing healthcare provider.

    •  

  • Lyrica prescribed at a dosage that does not align with standard medical practice or exceeds the maximum recommended dose without valid clinical indication.

    •  

  • Use of Lyrica for off-label purposes not considered medically necessary according to the health plan's policy guidelines.

 

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How Much Does Lyrica Cost without Insurance?

 

Cost of Lyrica Without Insurance

 

  • The price of Lyrica without insurance can vary significantly depending on the pharmacy, geographic location, dosage, and quantity. On average, the cost can range between $460 to $720 for a 30-day supply when filling a common dosage such as 150 mg capsules.

    •  

  • Generic versions of Lyrica, known as pregabalin, are often significantly cheaper. The average cost for the generic version might be closer to $30 to $70 for a similar quantity and dosage.

    •  

  • Prices may also vary due to manufacturer's discounts, pharmacy membership programs, or coupon usage, which can help reduce the overall cost.

    •  

  • Comparing prices between local pharmacies or using online price comparison tools can help find the most affordable option.

 

Clinical Support

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 Lyrica Coverage with Security Health Plan

 

Check Your Coverage Plan

 

  • Contact Security Health Plan directly by calling the customer service number on your insurance card. Ask for detailed information regarding prescription drug coverage, specifically for Lyrica (pregabalin).

    •  

  • Review your current health insurance policy documents to confirm whether Lyrica is included in your plan's drug formulary. This information can often be found on Security Health Plan's member portal as well.

 

Consult with Your Doctor

 

  • Discuss your need for Lyrica with your healthcare provider. Ensure that Lyrica is the right medication for your condition, as alternatives may be available that are covered under your plan.

    •  

  • Request your doctor to provide any necessary documentation or notes that may be required by the insurance company to obtain prior authorization for Lyrica.

 

Get Prior Authorization

 

  • If required by Security Health Plan, work with your physician to initiate a prior authorization request for Lyrica. The process might require specific forms and documentation that your doctor needs to complete and submit.

    •  

  • Ensure all necessary paperwork is submitted accurately to avoid delays. Security Health Plan may provide a decision on the authorization within a specified timeframe.

 

Fill Your Prescription

 

  • Once authorization is approved, take your prescription for Lyrica to a participating pharmacy within the Security Health Plan network. The approval will ensure that you receive your medication at the coverage rate outlined in your plan.

    •  

  • If you encounter any issues at the pharmacy, contact Security Health Plan’s customer service for assistance in resolving coverage problems.

 

Monitor Your Coverage

 

  • Stay informed about any changes in your insurance coverage or formulary lists that might affect your Lyrica prescription. Security Health Plan will typically notify you of changes during their open enrollment period or through direct communication.

    •  

  • Regularly review any Explanation of Benefits (EOB) statements from Security Health Plan to ensure that your medication is being billed correctly and covered as expected.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Lyrica FAQ

What are the common side effects of Lyrica?

 

Common Side Effects of Lyrica

 

  • Dizziness: Frequently reported, often occurring shortly after starting treatment.
  • Sleepiness: Commonly affects daily activities due to its sedative effects.
  • Weight Gain: Notable for some, monitoring weight is advised.
  • Swelling: Particularly in hands and feet; may require medical attention if severe.
  • Blurred Vision: Usually temporary but should be reported if persistent.
  • Dry Mouth: Sometimes improved with increased fluid intake.
  • Difficulty concentrating: Can affect mental clarity and focus.

 

Is Lyrica the same as gabapentin?

 

Differences Between Lyrica and Gabapentin

 

  • Classification: Both are anticonvulsants but with different active ingredients. Lyrica contains pregabalin, while gabapentin itself is the active substance in gabapentin medications.

    •  

  • FDA Approval: Lyrica is approved for treating fibromyalgia, neuropathic pain, seizures, and generalized anxiety disorder in certain regions. Gabapentin's primary uses are for seizures and nerve pain.

    •  

  • Potency and Dosing: Lyrica is often considered more potent, requiring lower doses to achieve similar effects compared to gabapentin.

    •  

  • Side Effects: Both can cause dizziness and fatigue, but the severity and other side effects can vary between individuals.

 

Can Lyrica help with anxiety?

 

Understanding Lyrica and Anxiety

 

  • Lyrica (pregabalin) is primarily approved for treating nerve pain, fibromyalgia, and seizures.

    •  

  • Although not FDA-approved for anxiety, it has been used off-label to help some patients manage anxiety symptoms, especially in generalized anxiety disorder (GAD).

 

Mechanism and Effectiveness

 

  • Lyrica works by calming hyper-excited nerves, which may reduce anxiety symptoms by stabilizing neuronal activity.

    •  

  • Clinical studies suggest it can reduce anxiety more effectively than a placebo and comparable to some anxiety medications.

 

Considerations and Side Effects

 

  • Possible side effects include dizziness, sleepiness, and weight gain, which should be considered before off-label use.

    •  

  • Consult your doctor to assess if Lyrica aligns with your specific health needs and to discuss alternate anxiety treatments.

 

Have questions left?

‍

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Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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A weight management program tailored to you

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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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