Does Security Health Plan Cover Tirzepatide (Mounjaro)

Explore if Security Health Plan covers Tirzepatide, learn reasons for denial, cost without insurance, and how to get coverage in this comprehensive guide.
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Coverage Details for Tirzepatide (Mounjaro) under Security Health Plan

 

  • Tirzepatide (Mounjaro) is primarily covered for managing Type 2 Diabetes, under strict guidelines.
  •  

  • Covers patients unable to achieve glycemic control with other medications like metformin, sulfonylurea, or insulin.
  •  

  • Prior Authorization is required. You need to prove medical necessity, often through detailed medical documentation.
  •  

  • Typically covered if patient has a history of cardiovascular disease or chronic kidney disease, proving increased risk without the medication.
  •  

    Criteria for Coverage

     

    • Must be prescribed by an endocrinologist or specific diabetes care physician.
    •  

    • Patient BMI or specific health conditions might also affect eligibility criteria.
    •  

    • Regular follow-ups and documentation submission are crucial for continued coverage.
    •  

    • Eligibility usually reviewed annually to reassess the necessity and effectiveness of the medication.

     

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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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Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

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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 Tirzepatide (Mounjaro) Coverage with Security Health Plan

 

Check Eligibility Requirements

 

  • Visit the Security Health Plan website and review their coverage policies concerning prescription medications.
  •  

  • Consult their Medicare or Commercial drug formulary list to confirm if Tirzepatide (Mounjaro) is included.
  •  

  • Contact Security Health Plan's customer service for personalized assistance regarding your eligibility for coverage.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the potential benefits of Tirzepatide for your condition.
  •  

  • Make sure your healthcare provider is aware of your insurance with Security Health Plan and can assist in the completion of any necessary paperwork.

 

Obtain a Prescription

 

  • Ask your healthcare provider for a prescription for Tirzepatide (Mounjaro) if they deem it appropriate for your treatment.
  •  

  • Ensure that the prescription is sent to a pharmacy that is in-network with Security Health Plan.

 

Submit Prior Authorization

 

  • Check if Security Health Plan requires prior authorization for Tirzepatide under your plan benefits.
  •  

  • Work with your healthcare provider to fill out and submit any required prior authorization forms.
  •  

  • Follow up with Security Health Plan to ensure prior authorization is processed and approved.

 

Review Out-of-Pocket Costs

 

  • Log into your Security Health Plan member portal to see potential out-of-pocket expenses related to the prescription, including copays and deductibles.
  •  

  • Evaluate if there are savings or assistance programs available for Tirzepatide that can lower your costs further.

 

Fill the Prescription

 

  • Once approval is obtained, visit the chosen in-network pharmacy to fill your prescription for Tirzepatide.
  •  

  • Ensure the pharmacy processes the claim through Security Health Plan to take advantage of your insurance benefits.

 

Monitor and Appeal if Necessary

 

  • If your claim is denied, review the denial notice to understand the reasons behind it and the steps for appeal.
  •  

  • Collaborate with your healthcare provider on appealing the decision if necessary, providing additional documentation or justification for the need of Tirzepatide.

 

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Does Security Health Plan Cover Tirzepatide (Mounjaro)

Explore if Security Health Plan covers Tirzepatide, learn reasons for denial, cost without insurance, and how to get coverage in this comprehensive guide.
Curex allergy drops unboxing

Is Tirzepatide (Mounjaro) Covered by Security Health Plan

 

Coverage Details for Tirzepatide (Mounjaro) under Security Health Plan

 

  • Tirzepatide (Mounjaro) is primarily covered for managing Type 2 Diabetes, under strict guidelines.
  •  

  • Covers patients unable to achieve glycemic control with other medications like metformin, sulfonylurea, or insulin.
  •  

  • Prior Authorization is required. You need to prove medical necessity, often through detailed medical documentation.
  •  

  • Typically covered if patient has a history of cardiovascular disease or chronic kidney disease, proving increased risk without the medication.
  •  

    Criteria for Coverage

     

    • Must be prescribed by an endocrinologist or specific diabetes care physician.
    •  

    • Patient BMI or specific health conditions might also affect eligibility criteria.
    •  

    • Regular follow-ups and documentation submission are crucial for continued coverage.
    •  

    • Eligibility usually reviewed annually to reassess the necessity and effectiveness of the medication.

     

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Security Health Plan's Approved Criteria for Tirzepatide (Mounjaro) Coverage

 

Criteria for Coverage of Tirzepatide (Mounjaro)

 

  • Diagnosis of Type 2 Diabetes Mellitus, confirmed by medical records, where the patient is 18 years or older.
  •  

  • Demonstration of previous inadequate response to at least two different antidiabetic medications, such as Metformin and a Sulfonylurea, both at maximally tolerated doses, unless contraindicated.
  •  

  • Evidence of lifestyle interventions, including dietary modifications and exercise programs, without achieving adequate glycemic control.
  •  

  • Presence of one or more weight-related co-morbidities, such as hypertension, dyslipidemia, or obstructive sleep apnea, with documentation supporting the clinical necessity of weight management.
  •  

  • Commitment to follow-up appointments and adherence to prescribed treatment regimens, as documented by healthcare provider notes.
  •  

  • Continuous enrollment in a comprehensive diabetes self-management educational program recognized by the American Diabetes Association, ensuring patient engagement and understanding of treatment objectives.
  •  

  • No history of untreated thyroid carcinoma or medullary thyroid carcinoma in the family, as screening indications must show no related contraindications.
  •  

  • Documentation indicating periodic evaluation and monitoring of HbA1c levels, kidney function, and other relevant metabolic parameters as per physician recommendations.
  •  

  • Insurance coverage is contingent on prior authorization, requiring submission of records that support clinical criteria and necessity for Tirzepatide therapy.

 

Why Security Health Plan Might Deny Tirzepatide (Mounjaro) Coverage

 

Reasons for Tirzepatide (Mounjaro) Coverage Denial by Security Health Plan

 

  • The medication is prescribed for conditions other than those approved by the FDA for Tirzepatide, such as non-diabetic weight loss.
  •  

  • The patient does not meet the clinical criteria defined by the plan, such as specific A1C levels or other documented medical necessity requirements.
  •  

  • No prior authorization request was submitted, or the request was incomplete, resulting in automatic denial.
  •  

  • The patient has not tried or shown inadequate response to alternative, first-line treatments as required by the plan's step therapy protocol.
  •  

  • The prescription is for off-label use which is not supported by peer-reviewed research or included in compendia recognized by the plan.
  •  

  • The medication is prescribed in dosages that exceed the plan's approved dosage limits without sufficient justification.
  •  

  • The patient's pharmacy benefits do not include coverage for injectables or specialty medications, depending on the specific health plan policy.

 

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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 Security Health Plan

 

Check Eligibility Requirements

 

  • Visit the Security Health Plan website and review their coverage policies concerning prescription medications.
  •  

  • Consult their Medicare or Commercial drug formulary list to confirm if Tirzepatide (Mounjaro) is included.
  •  

  • Contact Security Health Plan's customer service for personalized assistance regarding your eligibility for coverage.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the potential benefits of Tirzepatide for your condition.
  •  

  • Make sure your healthcare provider is aware of your insurance with Security Health Plan and can assist in the completion of any necessary paperwork.

 

Obtain a Prescription

 

  • Ask your healthcare provider for a prescription for Tirzepatide (Mounjaro) if they deem it appropriate for your treatment.
  •  

  • Ensure that the prescription is sent to a pharmacy that is in-network with Security Health Plan.

 

Submit Prior Authorization

 

  • Check if Security Health Plan requires prior authorization for Tirzepatide under your plan benefits.
  •  

  • Work with your healthcare provider to fill out and submit any required prior authorization forms.
  •  

  • Follow up with Security Health Plan to ensure prior authorization is processed and approved.

 

Review Out-of-Pocket Costs

 

  • Log into your Security Health Plan member portal to see potential out-of-pocket expenses related to the prescription, including copays and deductibles.
  •  

  • Evaluate if there are savings or assistance programs available for Tirzepatide that can lower your costs further.

 

Fill the Prescription

 

  • Once approval is obtained, visit the chosen in-network pharmacy to fill your prescription for Tirzepatide.
  •  

  • Ensure the pharmacy processes the claim through Security Health Plan to take advantage of your insurance benefits.

 

Monitor and Appeal if Necessary

 

  • If your claim is denied, review the denial notice to understand the reasons behind it and the steps for appeal.
  •  

  • Collaborate with your healthcare provider on appealing the decision if necessary, providing additional documentation or justification for the need of Tirzepatide.

 

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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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