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Does SelectHealth Cover Lantus

Explore Lantus coverage by SelectHealth, reasons for denial, steps to secure coverage, costs without insurance, and answers to common questions.
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Coverage Overview

 

  • SelectHealth generally covers Lantus under their prescription drug plans, which are subject to formulary inclusion.

    •  

  • Coverage can vary based on the specific health plan and benefit structure.

 

Situations and Criteria for Coverage

 

  • It is typically covered for patients who have been diagnosed with diabetes and require long-acting insulin.

    •  

  • A doctor’s prescription is necessary, and prior authorization may be required in some cases to ensure medical necessity.

 

General Rules and Tips

 

  • Patients might need to demonstrate that they've tried other treatment options, if outlined by the plan’s policy.

    •  

  • Formulary status of Lantus may require the patient to pay different out-of-pocket costs, so checking plan specifics is crucial.

    •  

  • Check with SelectHealth customer service or consult the plan's specific formulary document to confirm coverage details for Lantus.

 

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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 Lantus Coverage with SelectHealth

 

Getting Started with SelectHealth

 

  • Begin by visiting the SelectHealth website or contacting their customer service to learn about your current insurance plan and its coverage options.

    •  

  • Ensure that you have a current membership/ID card and all necessary personal details ready for inquiries.

    •  

  • Ask specifically about the prescription drug coverage and if Lantus (insulin glargine) is included in the formulary (list of covered drugs).

 

Consult with Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your need for Lantus and obtain a formal prescription.

    •  

  • Request any documentation or additional medical justification that may be required by SelectHealth to substantiate the medical necessity of Lantus.

 

Verify Pharmacy Benefits

 

  • Contact the pharmacy department of SelectHealth or visit their website to verify if Lantus requires prior authorization or has any step therapy protocols in place.

    •  

  • Make a note of any quantity limits or requirements for using specific pharmacy networks to fill your prescription.

 

Submit Required Documentation

 

  • Gather all pertinent documentation, which may include your prescription, justification from your healthcare provider, and any forms required by SelectHealth for prescription coverage authorization.

    •  

  • Submit these documents through the appropriate channels, such as online portals, fax, or mail as instructed by SelectHealth.

 

Follow Up on Authorization

 

  • Keep track of your submission and follow up with SelectHealth to confirm receipt and status of the authorization process.

    •  

  • Be proactive and ask for a timeline on when you can expect a decision regarding Lantus coverage. Additionally, inquire about the appeals process in case of initial denial.

 

Fill Your Prescription

 

  • Once authorization is approved, take your prescription to a participating pharmacy or use any mail-order services provided by SelectHealth.

    •  

  • Ensure that the pharmacist processes the prescription within the coverage terms provided by SelectHealth to avoid unexpected out-of-pocket costs.

 

Evaluate Ongoing Coverage

 

  • Regularly review your SelectHealth plan details and any notices that may affect your Lantus coverage to stay informed about any changes.

    •  

  • Engage with SelectHealth and your healthcare provider annually or as needed to discuss ongoing coverage needs and explore any additional financial assistance programs if necessary.

 

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

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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 SelectHealth Cover Lantus

Explore Lantus coverage by SelectHealth, reasons for denial, steps to secure coverage, costs without insurance, and answers to common questions.
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Is Lantus Covered by SelectHealth

 

Coverage Overview

 

  • SelectHealth generally covers Lantus under their prescription drug plans, which are subject to formulary inclusion.

    •  

  • Coverage can vary based on the specific health plan and benefit structure.

 

Situations and Criteria for Coverage

 

  • It is typically covered for patients who have been diagnosed with diabetes and require long-acting insulin.

    •  

  • A doctor’s prescription is necessary, and prior authorization may be required in some cases to ensure medical necessity.

 

General Rules and Tips

 

  • Patients might need to demonstrate that they've tried other treatment options, if outlined by the plan’s policy.

    •  

  • Formulary status of Lantus may require the patient to pay different out-of-pocket costs, so checking plan specifics is crucial.

    •  

  • Check with SelectHealth customer service or consult the plan's specific formulary document to confirm coverage details for Lantus.

 

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SelectHealth's Approved Criteria for Lantus Coverage

 

SelectHealth's Approved Criteria for Lantus Coverage

 

  • Lantus is covered for individuals diagnosed with Type 1 Diabetes who require insulin therapy to manage blood glucose levels.

    •  

  • Coverage is available for patients who have Type 2 Diabetes and need basal insulin to achieve desired glycemic control when oral medications are insufficient.

    •  

  • Individuals with gestational diabetes who require insulin therapy to manage glucose levels may also receive coverage.

    •  

  • Patients transitioning from other insulin therapies for medical reasons, such as allergies or adverse reactions, might be eligible.

    •  

  • Coverage is typically approved when prescribed by an endocrinologist or diabetes specialist indicating the necessity of Lantus in the patient's treatment plan.

    •  

  • Consideration for coverage includes trials of other less expensive basal insulin options that were ineffective in managing the patient's condition.

    •  

  • Prior authorization requirements must be met along with submission of relevant medical documentation supporting the use of Lantus.

 

Why SelectHealth Might Deny Lantus Coverage

 

Situations Where SelectHealth Might Deny Lantus Coverage

 

  • **Non-Formulary Drug Status:** If Lantus is not included in SelectHealth's formulary list, it may not be covered unless an exception is granted.

    •  

  • **Lack of Prior Authorization:** Coverage may be denied if prior authorization is required and has not been obtained before the prescription is filled.

    •  

  • **Alternative Treatment Requirement:** SelectHealth might deny coverage if there is a requirement to try and fail on a preferred, or more cost-effective, alternative medication before approving Lantus.

    •  

  • **Off-Label Use:** If Lantus is prescribed for a condition not approved by the FDA or outside the scope of covered treatments defined by SelectHealth, coverage may be refused.

    •  

  • **Non-Compliance with Step Therapy Protocols:** SelectHealth might require patients to follow a step therapy protocol, whereby Lantus approval is contingent on trying other medications first, and failure to adhere to this procedure may lead to denial.

    •  

  • **Policy Limitations or Exclusions:** Specific plan provisions might exclude Lantus coverage, possibly based on plan type, such as high-deductible plans that have different pharmacy coverage parameters.

    •  

  • **Lack of Medical Necessity:** If SelectHealth determines that the use of Lantus is not medically necessary based on the member's health records or clinical guidelines, they might deny coverage.

    •  

  • **Non-Participation of Pharmacy or Prescriber:** If the pharmacy or prescriber does not participate with SelectHealth, prescriptions for Lantus might not be covered.

    •  

  • **Incomplete or Incorrect Documentation:** Submissions that lack proper documentation or contain errors in the explanation of benefits may lead to coverage denial.

 

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

  • The price of Lantus (insulin glargine) without insurance can vary based on factors such as the pharmacy, location, and available discounts. Typically, the retail price ranges between $250 and $350 for a 10ml vial at a retail pharmacy.

    •  

  • For the Lantus SoloStar pen, which is a more convenient option for some, the price is generally similar, ranging from $400 to $500 for a pack of five pens.

    •  

  • Prices can fluctuate slightly, so it is advisable to check with local pharmacies or online services for the most current prices and potential savings options.

    •  

  • Consider exploring patient assistance programs offered by the manufacturer or third-party organizations, which might offer Lantus at reduced prices or even for free if you qualify based on income.

 

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 Lantus Coverage with SelectHealth

 

Getting Started with SelectHealth

 

  • Begin by visiting the SelectHealth website or contacting their customer service to learn about your current insurance plan and its coverage options.

    •  

  • Ensure that you have a current membership/ID card and all necessary personal details ready for inquiries.

    •  

  • Ask specifically about the prescription drug coverage and if Lantus (insulin glargine) is included in the formulary (list of covered drugs).

 

Consult with Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your need for Lantus and obtain a formal prescription.

    •  

  • Request any documentation or additional medical justification that may be required by SelectHealth to substantiate the medical necessity of Lantus.

 

Verify Pharmacy Benefits

 

  • Contact the pharmacy department of SelectHealth or visit their website to verify if Lantus requires prior authorization or has any step therapy protocols in place.

    •  

  • Make a note of any quantity limits or requirements for using specific pharmacy networks to fill your prescription.

 

Submit Required Documentation

 

  • Gather all pertinent documentation, which may include your prescription, justification from your healthcare provider, and any forms required by SelectHealth for prescription coverage authorization.

    •  

  • Submit these documents through the appropriate channels, such as online portals, fax, or mail as instructed by SelectHealth.

 

Follow Up on Authorization

 

  • Keep track of your submission and follow up with SelectHealth to confirm receipt and status of the authorization process.

    •  

  • Be proactive and ask for a timeline on when you can expect a decision regarding Lantus coverage. Additionally, inquire about the appeals process in case of initial denial.

 

Fill Your Prescription

 

  • Once authorization is approved, take your prescription to a participating pharmacy or use any mail-order services provided by SelectHealth.

    •  

  • Ensure that the pharmacist processes the prescription within the coverage terms provided by SelectHealth to avoid unexpected out-of-pocket costs.

 

Evaluate Ongoing Coverage

 

  • Regularly review your SelectHealth plan details and any notices that may affect your Lantus coverage to stay informed about any changes.

    •  

  • Engage with SelectHealth and your healthcare provider annually or as needed to discuss ongoing coverage needs and explore any additional financial assistance programs if necessary.

 

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Lantus FAQ

What is Lantus used for?

 

What is Lantus Used For?

 

  • Lantus is primarily used to manage blood sugar levels in individuals with type 1 and type 2 diabetes.

    •  

  • It is a long-acting insulin, providing a steady release of insulin over a 24-hour period with no pronounced peak, mimicking natural insulin secretion.

    •  

  • It's taken once daily, often at the same time each day, helping to maintain consistent blood glucose control.

    •  

  • Beneficial for patients requiring basal insulin to prevent hyperglycemia between meals and overnight.

    •  

  • Alongside diet and exercise, Lantus is vital for comprehensive diabetes management.

 

How does Lantus work in the body?

 

How Lantus Works

 

  • Lantus is a long-acting insulin, also known as insulin glargine. It provides a stable and continuous release of insulin to control blood sugar levels.

    •  

  • The formulation of Lantus enables it to dissolve slowly upon injection, creating a slow and steady insulin level that lasts up to 24 hours.

    •  

  • This minimizes the risk of blood sugar peaks and troughs, providing more consistent blood glucose management.

    •  

  • Lantus mimics the basal level of insulin production in the pancreas, thus helping to maintain glucose balance between meals and overnight.

    •  

  • It binds to insulin receptors, facilitating glucose uptake into muscle and fat tissues, while inhibiting hepatic glucose production.

 

What are the side effects of Lantus?

 

Common Side Effects

 

  • Injection site reactions such as redness, swelling, or itching can occur.
  • Hypoglycemia, or low blood sugar, is a frequent side effect.
  • Weight gain may happen due to improved glucose utilization.

 

Less Common Side Effects

 

  • Allergic reactions like rash or itching may occur but are rare.
  • Systemic reactions such as swelling of hands/feet can occur.
  • Visual changes might be experienced during initial treatment.

 

Serious Side Effects

 

  • Severe hypoglycemia requiring intervention.
  • Signs of allergic reactions like difficulty breathing, require immediate attention.
  • Hypokalemia may develop, leading to muscle weakness or cramps.

 

Have questions left?

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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.

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