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Does SelectHealth Cover Cosentyx

Explore SelectHealth's Cosentyx coverage, cost insights, and steps to secure approval. Get answers to FAQs and learn why coverage might be denied.

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Coverage for Cosentyx

SelectHealth typically covers Cosentyx for conditions such as plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis.

A pre-authorization is often required, meaning physicians must provide documentation supporting the necessity of this treatment.

Patients may need to demonstrate an inadequate response to or intolerance of conventional therapies.

Basic Criteria for Coverage

Patients must meet specific clinical criteria based on their diagnosis. For example, for psoriasis, affected individuals usually must have moderate-to-severe cases.

A specialist, such as a dermatologist or rheumatologist, is generally required to prescribe the treatment.

Coverage is subject to the specific plan details, so it's essential to review the plan’s formulary and contact SelectHealth for precise information.

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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 Cosentyx Coverage with SelectHealth

Begin by Reviewing Your Plan

Access your SelectHealth account online or review your plan documentation to ensure Cosentyx is covered under your specific plan. If not clear, contact SelectHealth customer service for clarification.
Verify whether you need prior authorization for Cosentyx under your plan terms.

Consult Your Healthcare Provider

Discuss your need for Cosentyx with your healthcare provider to ensure it is medically necessary.
Request that your healthcare provider submit any required supporting documentation to SelectHealth if prior authorization is needed.

Obtain Prior Authorization (If Required)

Coordinate with your healthcare provider to submit a prior authorization request to SelectHealth. This may include medical records or a statement of medical necessity.
Follow up with SelectHealth to check the status of your prior authorization request. This can often be done through their website or by calling customer service.

Explore Cost-Reduction Programs

Check if there are any manufacturer’s coupons or patient assistance programs available for Cosentyx. These can sometimes be found on the manufacturer’s website.
Inquire with your pharmacy about any additional savings programs or discounts applicable to your prescription.

Complete Prescription Process

If approved, have your healthcare provider send the Cosentyx prescription to a SelectHealth network pharmacy.
Pick up your medication from the pharmacy, and ensure your coverage is applied correctly to the purchase.

Monitor Your Coverage

Regularly review your SelectHealth statements to confirm that coverage for Cosentyx is applied correctly and charges are accurate.
Contact SelectHealth immediately if you notice any discrepancies or if coverage is unexpectedly denied.

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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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Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

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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Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option

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FAQs

Does SelectHealth Cover Cosentyx

Explore SelectHealth's Cosentyx coverage, cost insights, and steps to secure approval. Get answers to FAQs and learn why coverage might be denied.

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Is Cosentyx Covered by SelectHealth

Coverage for Cosentyx

SelectHealth typically covers Cosentyx for conditions such as plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis.

A pre-authorization is often required, meaning physicians must provide documentation supporting the necessity of this treatment.

Patients may need to demonstrate an inadequate response to or intolerance of conventional therapies.

Basic Criteria for Coverage

Patients must meet specific clinical criteria based on their diagnosis. For example, for psoriasis, affected individuals usually must have moderate-to-severe cases.

A specialist, such as a dermatologist or rheumatologist, is generally required to prescribe the treatment.

Coverage is subject to the specific plan details, so it's essential to review the plan’s formulary and contact SelectHealth for precise information.

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SelectHealth's Approved Criteria for Cosentyx Coverage

Criteria for Coverage of Cosentyx

**Diagnosis Requirements** - The patient must have a documented diagnosis of moderate to severe plaque psoriasis, active psoriatic arthritis, or ankylosing spondylitis.
**Previous Treatment** - The patient must have attempted and failed therapy with one or more topical therapies, phototherapy, or systemic treatments such as methotrexate, cyclosporine, or acitretin. - For psoriatic arthritis, the patient must have tried and not adequately responded to a non-biologic DMARD (Disease-Modifying Antirheumatic Drug).
**Age Requirements** - Cosentyx coverage is generally approved for adults aged 18 years and older.
**Prescribing Practitioner Requirements** - The prescribing healthcare provider must be a specialist such as a dermatologist, rheumatologist, or a healthcare practitioner with expertise in dermatological or rheumatological conditions.
**Dosage and Administration** - The patient must follow the recommended dosing guidelines of Cosentyx as per the FDA-approved labeling.
**Monitoring and Continued Therapy** - Regular follow-ups to assess effectiveness and any side effects are required. Adequate response to initial treatment must be documented for continued coverage.
**Combination Therapy** - Cosentyx may be used alone or in combination with methotrexate or other DMARDs unless specifically contraindicated.

Required Documentation

Documentation must include: - Confirmed diagnosis details and previous treatment history with outcomes. - Age of the patient. - Prescribing provider's specialty. - Evidence of adherence to dosing and administration guidelines. - Regular progress assessment records.

Why SelectHealth Might Deny Cosentyx Coverage

Reasons SelectHealth Might Deny Cosentyx Coverage

**Non-Approved Conditions**: SelectHealth might deny coverage if Cosentyx is prescribed for conditions not approved by the FDA or if it doesn't align with their list of covered indications.

**Lack of Medical Necessity**: Coverage could be denied if the prescribing physician fails to provide adequate documentation proving that Cosentyx is medically necessary for the patient's treatment.

**Alternative Treatments**: If there are less expensive or more established treatment alternatives available that can effectively manage the condition, SelectHealth may deny coverage for Cosentyx.

**No Prior Authorization**: Cosentyx may not be covered if prior authorization was required but not obtained before the prescription was filled.

**Non-Formulary Medication**: SelectHealth might not cover Cosentyx if it is not included in their formulary, or preferred drug list, which outlines the approved medications covered under the plan.

**Inadequate Trial and Failure with Other Therapies**: If the patient has not tried and failed other less costly therapies first, SelectHealth may reject the claim for Cosentyx based on their step therapy requirements.

**Policy Restrictions and Exclusions**: Specific policy exclusions or restrictions might be in place that directly rule out coverage for biologic medications like Cosentyx.

**Out-of-Network Provider**: If Cosentyx is prescribed or administered by a healthcare provider who is not within the SelectHealth network, coverage might be denied due to network restrictions.

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How Much Does Cosentyx Cost without Insurance?

Cost of Cosentyx Without Insurance

The cost of Cosentyx without insurance can vary depending on the pharmacy and location. However, the average retail price is typically around $5,500 to $6,000 per 150 mg dose.

Patients often need multiple doses, so the total cost can increase significantly depending on treatment duration and dosing requirements prescribed by a healthcare provider.

The pricing may also differ if there are discounts, special pharmacy funding programs, or if a patient qualifies for any manufacturer-sponsored assistance programs.

Generic versions are not available, as Cosentyx is a brand-name biologic medication.

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 Cosentyx Coverage with SelectHealth

Begin by Reviewing Your Plan

Access your SelectHealth account online or review your plan documentation to ensure Cosentyx is covered under your specific plan. If not clear, contact SelectHealth customer service for clarification.
Verify whether you need prior authorization for Cosentyx under your plan terms.

Consult Your Healthcare Provider

Discuss your need for Cosentyx with your healthcare provider to ensure it is medically necessary.
Request that your healthcare provider submit any required supporting documentation to SelectHealth if prior authorization is needed.

Obtain Prior Authorization (If Required)

Coordinate with your healthcare provider to submit a prior authorization request to SelectHealth. This may include medical records or a statement of medical necessity.
Follow up with SelectHealth to check the status of your prior authorization request. This can often be done through their website or by calling customer service.

Explore Cost-Reduction Programs

Check if there are any manufacturer’s coupons or patient assistance programs available for Cosentyx. These can sometimes be found on the manufacturer’s website.
Inquire with your pharmacy about any additional savings programs or discounts applicable to your prescription.

Complete Prescription Process

If approved, have your healthcare provider send the Cosentyx prescription to a SelectHealth network pharmacy.
Pick up your medication from the pharmacy, and ensure your coverage is applied correctly to the purchase.

Monitor Your Coverage

Regularly review your SelectHealth statements to confirm that coverage for Cosentyx is applied correctly and charges are accurate.
Contact SelectHealth immediately if you notice any discrepancies or if coverage is unexpectedly denied.

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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.

Cosentyx FAQ

1. What are the side effects of Cosentyx?

Potential Side Effects of Cosentyx

Common Side Effects: These include upper respiratory tract infections, headache, and diarrhea. Users might also experience cold-like symptoms.

Serious Side Effects: Serious infections can occur due to immune suppression. Patients should monitor for signs of infections, such as persistent fever or cough.

Allergic Reactions: Watch for signs like difficulty breathing, swelling, or rash; these may indicate a severe allergic reaction.

Laboratory Abnormalities: Changes in white blood cell counts and liver enzymes may surface, necessitating monitoring.

2. How does Cosentyx work for psoriasis?

How Cosentyx Works

Cosentyx is a biologic medication specifically targeting the immune system by inhibiting interleukin-17A (IL-17A), a protein that plays a key role in inflammation.

By blocking IL-17A, Cosentyx reduces inflammation, thus decreasing the symptoms and plaques associated with psoriasis.

It helps control the abnormal skin cell growth and can lead to significant skin clearance in many patients.

Usage and Administration

Cosentyx is administered via subcutaneous injection, typically beginning with a loading dose followed by a maintenance dose.

It is crucial for the success of the treatment to follow the prescribed dosing schedule closely.

Potential Side Effects

Common side effects include respiratory infections, headache, and injection site reactions.

Patients should consult their healthcare provider for any severe or unusual symptoms.

3. Is Cosentyx a biologic medication?

Is Cosentyx a Biologic Medication?

Yes, Cosentyx is a biologic medication. It is a human monoclonal antibody that selectively binds to the interleukin-17A (IL-17A) cytokine, which plays a major role in inflammatory conditions.

Biologics are typically derived from living cells and are used in the treatment of various autoimmune diseases. Cosentyx is specifically used for conditions such as plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis.

Unlike traditional small-molecule drugs, biologics like Cosentyx target specific components of the immune system.

Cosentyx is administered through subcutaneous injections, typically prescribed after other treatments have not provided adequate symptom control.

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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. 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 SelectHealth Cover Cosentyx

Explore SelectHealth's Cosentyx coverage, cost insights, and steps to secure approval. Get answers to FAQs and learn why coverage might be denied.

Achieve Your Goals Faster with Curex