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Does SelectHealth Cover Jardiance

Explore SelectHealth Jardiance coverage, reasons for denial, ways to secure coverage, costs without insurance, and answers to common questions.

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Does SelectHealth Cover Jardiance?

SelectHealth may cover Jardiance for patients diagnosed with type 2 diabetes, especially if diet and exercise have not been sufficient to control blood sugar levels.

Coverage typically requires Jardiance to be prescribed according to FDA-approved indications and dosage.

Patients might need prior authorization, necessitating the healthcare provider to show Jardiance is medically necessary.

Check specific plan benefits as coverage can vary based on the type of SelectHealth plan.

Patients may also be required to have failed treatment with other medications before approval.

Verify formulary status of Jardiance under your specific health plan via the SelectHealth website or customer service.

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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.

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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 Jardiance Coverage with SelectHealth

Understand Your SelectHealth Insurance Plan

Review your policy documents or log in to your online SelectHealth account to understand what is covered under your plan. Look for information regarding prescription drug coverage.

Determine if your plan includes a formulary, which is a list of medications covered by your insurance. Check if Jardiance is listed in the formulary.

Consult with Your Healthcare Provider

Discuss with your doctor about your need for Jardiance. Your healthcare provider can help justify the necessity of Jardiance for your treatment.

Ensure that your doctor provides necessary documentation, such as a prescription and any other supporting medical records that explain why Jardiance is needed for your health condition.

Contact SelectHealth for Benefits Details

Call the customer service number on your SelectHealth insurance card to inquire about Jardiance coverage specifics under your plan.

Ask about any requirements, such as prior authorization or step therapy, that might apply to get coverage for Jardiance.

Obtain Prior Authorization if Required

If SelectHealth requires prior authorization for Jardiance, ask your healthcare provider to submit the necessary request. This typically involves filling out a form and providing documentation of medical necessity.

Monitor the status of your prior authorization by checking with both your healthcare provider and SelectHealth to ensure timely processing.

Use In-Network Pharmacies

To maximize your benefits and reduce out-of-pocket costs, fill your Jardiance prescription at a pharmacy that is part of the SelectHealth network.

Verify with the pharmacy that they accept your SelectHealth insurance and check if they have Jardiance in stock.

Appeal If Necessary

If your claim for Jardiance coverage is denied, you can appeal the decision. Start by requesting an explanation of the denial from SelectHealth.

Prepare any additional documentation or justification needed to support your appeal. Work with your healthcare provider to strengthen your case, if required.

Evaluate Financial Assistance Programs

If you face challenges in obtaining coverage or affording Jardiance, consider exploring manufacturer assistance programs or non-profit programs that provide financial aid for prescription medications.

Contact Jardiance’s manufacturer for information on assistance programs they might offer directly to patients.

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Does SelectHealth Cover Jardiance

Explore SelectHealth Jardiance coverage, reasons for denial, ways to secure coverage, costs without insurance, and answers to common questions.

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Is Jardiance Covered by SelectHealth

Does SelectHealth Cover Jardiance?

SelectHealth may cover Jardiance for patients diagnosed with type 2 diabetes, especially if diet and exercise have not been sufficient to control blood sugar levels.

Coverage typically requires Jardiance to be prescribed according to FDA-approved indications and dosage.

Patients might need prior authorization, necessitating the healthcare provider to show Jardiance is medically necessary.

Check specific plan benefits as coverage can vary based on the type of SelectHealth plan.

Patients may also be required to have failed treatment with other medications before approval.

Verify formulary status of Jardiance under your specific health plan via the SelectHealth website or customer service.

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SelectHealth's Approved Criteria for Jardiance Coverage

Covered Indications for Jardiance

Jardiance may be covered for individuals diagnosed with Type 2 Diabetes Mellitus when it is utilized as an adjunct to diet and exercise for improved glycemic control.

Coverage may be extended to patients with heart failure to reduce the risk of cardiovascular death and hospitalization for heart failure in adults.

Jardiance can be authorized for patients with chronic kidney disease to slow the progression of renal disease.

Patient Eligibility Criteria

Documentation of a confirmed diagnosis of Type 2 Diabetes Mellitus is required, with records demonstrating inadequate glycemic control with existing antidiabetic therapy, including metformin, unless contraindicated or not tolerated.

For heart failure, patients must have a history or current symptoms of heart failure along with reduced ejection fraction, indicating diminished heart pump function.

For use related to chronic kidney disease, evidence of renal function decline is required with measurable decreased glomerular filtration rate or albuminuria.

Individual must be 18 years of age or older to qualify for coverage.

Prescription Requirements

Proof of prescription by a licensed healthcare provider specializing in diabetes management, cardiology, or nephrology is necessary.

The healthcare provider must affirm that Jardiance is a part of a comprehensive management plan, including lifestyle modifications such as diet and exercise.

Step Therapy Criteria

Patients may need to exhibit a trial and failure of or contraindication to other preferred antidiabetic agents before approval of Jardiance. Documentation supporting these conditions should be provided.

The requirement for alternative therapy trial may be waived if there are contraindications, risk factors, or adverse reactions associated with other medication options.

Renewal and Monitoring Criteria

Ongoing coverage may require periodic documentation from the provider demonstrating clinical benefit or stabilization in blood sugar levels for diabetic users, or heart or kidney function for other indications.

Providers may be asked to submit regular updates of the patient’s condition, treatment adherence, and outcome improvements to justify renewal of the prescription benefit.

Why SelectHealth Might Deny Jardiance Coverage

Reasons for Denial of Jardiance Coverage by SelectHealth

**Non-Formulary Medication:** Jardiance might not be listed on SelectHealth's formulary, which includes medications that are approved for coverage.

**Lack of Prior Authorization:** Jardiance requires prior authorization from SelectHealth, and failure to obtain this approval could result in denial of coverage.

**Off-Label Use:** If Jardiance is prescribed for an off-label use that is not approved by SelectHealth, coverage might be denied.

**Non-Compliance with Step Therapy Requirements:** Jardiance may require patients to try and fail less expensive alternatives before it is covered; failure to adhere to this protocol could result in denial.

**Policy Exclusions:** Specific exclusions in a patient’s policy may lead to denied coverage for Jardiance, particularly if diabetes treatments are specifically excluded.

**Pre-existing Condition Limitations:** If Jardiance is prescribed for a condition not covered due to pre-existing condition clauses in the patient’s policy, coverage might be denied.

**Inadequate Medical Necessity Documentation:** If insufficient evidence is provided to show that Jardiance is medically necessary for the patient, SelectHealth may deny the claim.

**Out-of-Network Prescriber:** If Jardiance is prescribed by a healthcare provider who is out-of-network, SelectHealth may not cover the prescription.

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How Much Does Jardiance Cost without Insurance?

Estimated Cost of Jardiance Without Insurance

The cost of Jardiance can vary depending on the pharmacy you visit, but as an oral medication used primarily to treat type 2 diabetes, it is often priced at a premium. Without insurance, the average monthly cost is approximately $550 to $650 for a 30-day supply of 10 mg or 25 mg tablets.

Prices can also vary based on location, pharmacy discounts, and available manufacturer coupons, so it's advisable to shop around or look for any available patient assistance programs to potentially lower the out-of-pocket cost.

Ways to Lower the Cost of Jardiance

**Pharmacy Discount Cards:** Utilizing pharmacy discount cards can sometimes provide substantial savings on your prescription, reducing the price by a notable percentage.

**Manufacturer Coupons and Programs:** Eli Lilly, the manufacturer of Jardiance, may offer savings cards or assistance programs to help eligible patients reduce their costs. It's worth checking through their official website or consulting with your healthcare provider.

**Generic Alternatives:** Although there may not be a generic version of Jardiance available currently, consulting with your healthcare provider about other generic medications for your condition may offer a more budget-friendly option.

**Bulk Purchasing Options:** Some pharmacies might offer discounts for purchasing a 90-day supply instead of a 30-day supply, which can lead to savings in the long term.

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 Jardiance Coverage with SelectHealth

Understand Your SelectHealth Insurance Plan

Review your policy documents or log in to your online SelectHealth account to understand what is covered under your plan. Look for information regarding prescription drug coverage.

Determine if your plan includes a formulary, which is a list of medications covered by your insurance. Check if Jardiance is listed in the formulary.

Consult with Your Healthcare Provider

Discuss with your doctor about your need for Jardiance. Your healthcare provider can help justify the necessity of Jardiance for your treatment.

Ensure that your doctor provides necessary documentation, such as a prescription and any other supporting medical records that explain why Jardiance is needed for your health condition.

Contact SelectHealth for Benefits Details

Call the customer service number on your SelectHealth insurance card to inquire about Jardiance coverage specifics under your plan.

Ask about any requirements, such as prior authorization or step therapy, that might apply to get coverage for Jardiance.

Obtain Prior Authorization if Required

If SelectHealth requires prior authorization for Jardiance, ask your healthcare provider to submit the necessary request. This typically involves filling out a form and providing documentation of medical necessity.

Monitor the status of your prior authorization by checking with both your healthcare provider and SelectHealth to ensure timely processing.

Use In-Network Pharmacies

To maximize your benefits and reduce out-of-pocket costs, fill your Jardiance prescription at a pharmacy that is part of the SelectHealth network.

Verify with the pharmacy that they accept your SelectHealth insurance and check if they have Jardiance in stock.

Appeal If Necessary

If your claim for Jardiance coverage is denied, you can appeal the decision. Start by requesting an explanation of the denial from SelectHealth.

Prepare any additional documentation or justification needed to support your appeal. Work with your healthcare provider to strengthen your case, if required.

Evaluate Financial Assistance Programs

If you face challenges in obtaining coverage or affording Jardiance, consider exploring manufacturer assistance programs or non-profit programs that provide financial aid for prescription medications.

Contact Jardiance’s manufacturer for information on assistance programs they might offer directly to patients.

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Jardiance FAQ

What is Jardiance used for?

What is Jardiance Used For?

Jardiance is primarily used to manage type 2 diabetes by helping to lower blood sugar levels in adults.

It works by promoting the excretion of excess glucose through urine, thus reducing the amount of sugar the body absorbs.

In addition to blood sugar management, Jardiance is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.

Patients with heart failure may benefit from Jardiance as it helps in reducing the risk of hospitalization due to heart failure.

What are the side effects of Jardiance?

Common Side Effects of Jardiance

Urinary tract infections: Symptoms may include burning sensation while urinating and frequent urges.
Increased urination: This is due to Jardiance's mechanism of removing excess glucose via urine.

Serious Side Effects

Ketoacidosis: This rare condition might present as difficulty breathing, nausea, or confusion.
Dehydration: Symptoms can be dizziness or light-headedness, especially upon standing.

Allergic Reactions

Rash or hives can occur, requiring immediate medical attention.

Precautions

Consult your healthcare provider before starting if you have kidney issues or are on diuretics.

Can Jardiance cause weight loss?

Can Jardiance Cause Weight Loss?

Yes, Jardiance (empagliflozin) can lead to weight loss. This medication is primarily used to treat type 2 diabetes.

It works by preventing glucose reabsorption in the kidneys, leading to glucose excretion through urine, which may also result in calorie loss.

Clinical trials have shown weight reduction as a common side effect, often averaging 2-3 kg.

This loss can differ among individuals; factors like diet and exercise may influence the extent of weight change.

Always consult with healthcare professionals to understand the benefits and risks associated with your specific health condition.

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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 SelectHealth Cover Jardiance

Explore SelectHealth Jardiance coverage, reasons for denial, ways to secure coverage, costs without insurance, and answers to common questions.

Achieve Your Goals Faster with Curex