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Does Security Health Plan Cover Prolia

Explore Prolia coverage with Security Health Plan, denial reasons, coverage tips, costs without insurance, and FAQs in our detailed guide.

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Does Security Health Plan Cover Prolia?

Security Health Plan may cover Prolia, a medication used for osteoporosis treatment, when prescribed for medically necessary reasons.

Coverage typically depends on the individual's specific plan and policy terms. Patients should verify benefits with Security Health Plan directly.

Criteria for Coverage

Prolia coverage often requires a prior authorization to confirm medical necessity and ensure appropriate use according to established guidelines.

The patient usually must have a diagnosis of osteoporosis with a high risk of fracture, or the inability to use other osteoporosis treatments.

Evidence of trial and failure, contraindications, or intolerance to other standard treatments like bisphosphonates might be necessary.

Basic Rules

Patients are generally required to visit in-network healthcare providers to receive the best cost coverage.

Coverage may also stipulate adherence to prescribing guidelines and proper documentation from healthcare providers.

Verification

To ensure Prolia is covered, contact Security Health Plan customer service with your policy details to verify and understand specific coverage limits and requirements.

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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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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 Prolia Coverage with Security Health Plan

Initiate Contact with Security Health Plan

Call the customer service number on the back of your Security Health Plan member ID card. Request to speak with a representative regarding prescription coverage.

Prepare your member ID, your healthcare provider’s contact details, and any information specific to your Prolia prescription.

Verify Prolia Coverage Under Your Current Plan

Ask the representative if Prolia is included in your coverage plan. They will be able to confirm whether it is considered a covered medication and any associated criteria.

Inquire about any required co-payments, deductibles, or percentage of coverage for the medication.

Understand Necessary Preauthorization Requirements

Check if Prolia requires prior authorization from Security Health Plan. Most plans require a formal process to ensure the medication is medically necessary.

Obtain necessary preauthorization forms from the representative or from the Security Health Plan website.

Collaborate with Your Healthcare Provider

Discuss with your healthcare provider the need for Prolia in your treatment plan. Ensure they provide clinical justification which will be required during preauthorization.

Your healthcare provider should provide a Letter of Medical Necessity detailing why Prolia is recommended for your treatment.

Submit Preauthorization Request

Fill out the preauthorization forms acquired from Security Health Plan and include the Letter of Medical Necessity.

Submit these documents via the preferred method indicated by Security Health Plan, such as fax, mail, or online submission through their member portal.

Follow Up on Preauthorization Status

Regularly check the status of your preauthorization request. Follow up with Security Health Plan if there are delays or if additional information is requested.

Communicate with your healthcare provider about the status, as they may need to respond to inquiries or submit additional documents.

Appeal a Denied Request if Necessary

If your request for Prolia coverage is denied, ask for a detailed explanation from Security Health Plan regarding the denial.

Work with your healthcare provider to address any concerns or additional requirements. You can request an appeal with the Security Health Plan’s designated appeals process.

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FAQs

Does Security Health Plan Cover Prolia

Explore Prolia coverage with Security Health Plan, denial reasons, coverage tips, costs without insurance, and FAQs in our detailed guide.

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Is Prolia Covered by Security Health Plan

Does Security Health Plan Cover Prolia?

Security Health Plan may cover Prolia, a medication used for osteoporosis treatment, when prescribed for medically necessary reasons.

Coverage typically depends on the individual's specific plan and policy terms. Patients should verify benefits with Security Health Plan directly.

Criteria for Coverage

Prolia coverage often requires a prior authorization to confirm medical necessity and ensure appropriate use according to established guidelines.

The patient usually must have a diagnosis of osteoporosis with a high risk of fracture, or the inability to use other osteoporosis treatments.

Evidence of trial and failure, contraindications, or intolerance to other standard treatments like bisphosphonates might be necessary.

Basic Rules

Patients are generally required to visit in-network healthcare providers to receive the best cost coverage.

Coverage may also stipulate adherence to prescribing guidelines and proper documentation from healthcare providers.

Verification

To ensure Prolia is covered, contact Security Health Plan customer service with your policy details to verify and understand specific coverage limits and requirements.

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Security Health Plan's Approved Criteria for Prolia Coverage

Approved Criteria for Prolia Coverage

Prolia is covered for patients diagnosed with postmenopausal osteoporosis who are at high risk for fracture.

Patients with history of osteoporotic fracture who meet coverage requirements can receive Prolia.

Coverage is provided for patients who have a documented failure or significant intolerance to other osteoporosis therapies.

Men with osteoporosis at high risk for fracture, such as those with a history of low trauma fractures, are eligible for coverage.

Prolia is approved for patients undergoing certain cancer treatments that lead to bone loss and are at a high risk of fracture.

It is covered when prescribed as a treatment for patients with glucocorticoid-induced osteoporosis who are at high risk for fracture.

Patients with contraindications or hypersensitivity to alternative osteoporosis medications are eligible for Prolia coverage.

Coverage includes specified patients for whom Prolia is deemed necessary by healthcare professionals based on clinical guidelines and assessments.

Why Security Health Plan Might Deny Prolia Coverage

Criteria for Denial of Prolia Coverage

Prolia is requested for non-FDA-approved indications, meaning the medication is sought for conditions not recognized by the Food and Drug Administration.

The patient does not meet the age requirements specified by the plan for Prolia coverage, such as being outside the indicated age range for osteoporosis treatment.

The prescribed Prolia treatment lacks documented evidence of medical necessity, such as a failure to demonstrate comprehensive evaluation or need beyond lifestyle interventions and other medications.

The request for Prolia comes without prior trial or documented intolerance or contraindication to other treatments typically required first, such as bisphosphonates.

There is an absence of necessary documentation, such as bone mineral density (BMD) test results, that support the diagnosis associated with the condition Prolia aims to treat.

Prolia is sought for use in a patient with a pre-existing condition that contraindicates its use, where the known risks outweigh the benefits according to plan guidelines.

The prescribing healthcare provider is not within the network or lacks necessary credentials, resulting in non-coverage under certain health insurance plans.

Requests are made for quantities or frequencies of administration that exceed the recommended dosage or established treatment duration guidelines without substantial medical justification.

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How Much Does Prolia Cost without Insurance?

Prolia Cost Without Insurance

Prolia (denosumab) is a prescription medication primarily used to treat osteoporosis in postmenopausal women and men at high risk of fractures. Without insurance, the cost of Prolia can be significant.

The approximate cost for a single 60mg/ml injection of Prolia is around $1,500 to $2,000. This price may vary based on location, pharmacy pricing, and additional dispensing fees.

It's important to note that prices can fluctuate and might be subject to discounts or coupons offered by pharmacies or through the manufacturer's patient assistance programs.

Patients without insurance coverage for Prolia might also consider reaching out to Amgen, the manufacturer, for potential cost-assistance programs or savings options that may be available.

Pharmacies, including major chains and independent stores, may offer price matching or competitive pricing, so it's advisable to compare prices across different providers.

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

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

Kayla Mardaga, NP

How to Get Prolia Coverage with Security Health Plan

Initiate Contact with Security Health Plan

Call the customer service number on the back of your Security Health Plan member ID card. Request to speak with a representative regarding prescription coverage.

Prepare your member ID, your healthcare provider’s contact details, and any information specific to your Prolia prescription.

Verify Prolia Coverage Under Your Current Plan

Ask the representative if Prolia is included in your coverage plan. They will be able to confirm whether it is considered a covered medication and any associated criteria.

Inquire about any required co-payments, deductibles, or percentage of coverage for the medication.

Understand Necessary Preauthorization Requirements

Check if Prolia requires prior authorization from Security Health Plan. Most plans require a formal process to ensure the medication is medically necessary.

Obtain necessary preauthorization forms from the representative or from the Security Health Plan website.

Collaborate with Your Healthcare Provider

Discuss with your healthcare provider the need for Prolia in your treatment plan. Ensure they provide clinical justification which will be required during preauthorization.

Your healthcare provider should provide a Letter of Medical Necessity detailing why Prolia is recommended for your treatment.

Submit Preauthorization Request

Fill out the preauthorization forms acquired from Security Health Plan and include the Letter of Medical Necessity.

Submit these documents via the preferred method indicated by Security Health Plan, such as fax, mail, or online submission through their member portal.

Follow Up on Preauthorization Status

Regularly check the status of your preauthorization request. Follow up with Security Health Plan if there are delays or if additional information is requested.

Communicate with your healthcare provider about the status, as they may need to respond to inquiries or submit additional documents.

Appeal a Denied Request if Necessary

If your request for Prolia coverage is denied, ask for a detailed explanation from Security Health Plan regarding the denial.

Work with your healthcare provider to address any concerns or additional requirements. You can request an appeal with the Security Health Plan’s designated appeals process.

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Prolia FAQ

What are the side effects of Prolia?

Common Side Effects of Prolia

Back pain
Muscle pain
Joint pain
Increased cholesterol levels
Bladder infection

Serious Side Effects

Serious allergic reactions: Difficulty breathing and rash
Severe bone/joint/muscle pain
Low blood calcium levels
Jawbone problems (osteonecrosis)
Unusual thigh bone fractures

Important Notes

Always report any unusual symptoms to your healthcare provider.
Maintain regular follow-up appointments to monitor your health.
This is not an exhaustive list; consult your doctor or pharmacist for more information.

How long does Prolia stay in your system?

How Long Does Prolia Stay in Your System

Prolia, or denosumab, is a medication used for osteoporosis treatment. After administration, its active effects last around 6 months, which is why it's typically given bi-annually.

The drug's elimination from the body may take longer due to its biological nature and mechanism. Prolia is a monoclonal antibody and is mainly cleared through the reticuloendothelial system, involving processes like protein degradation.

An important factor is the half-life of Prolia, which averages 25 to 28 days. Complete clearance from the system can vary, potentially extending up to 9 months after the last dose.

Individual factors, such as metabolic rate and kidney function, can affect the duration Prolia remains detectable in the body. Consultation with a healthcare professional is advised to understand its impact on specific health concerns.

Is Prolia the same as Reclast?

Comparison of Prolia and Reclast

Prolia: A brand name for denosumab, Prolia is an injectable biophosphonate used to treat osteoporosis by inhibiting bone resorption. It's administered every 6 months as a subcutaneous injection.

Reclast: Known as zoledronic acid, Reclast is also a biophosphonate but given as an intravenous infusion. It works similarly by decreasing bone loss and is typically administered once a year.

Mechanism: While both drugs target bone resorption, Prolia and Reclast function differently at a cellular level. Prolia inhibits RANK ligand, while Reclast inhibits osteoclast activity.

Side Effects: Both medications may cause nausea, fatigue, and joint pain. However, Prolia can also lead to hypocalcemia, while Reclast may cause flu-like symptoms post-infusion.

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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.

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Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does Security Health Plan Cover Prolia

Explore Prolia coverage with Security Health Plan, denial reasons, coverage tips, costs without insurance, and FAQs in our detailed guide.

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