Does SelectHealth Cover Lexapro

Learn why SelectHealth may deny Lexapro coverage, how to secure it, cost implications without insurance, and find answers to common questions in our FAQ.
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Coverage for Lexapro

 

  • SelectHealth typically covers Lexapro under their prescription drug plans as it is a commonly prescribed antidepressant.
  • Coverage may vary depending on your specific plan type, such as employer-sponsored, individual, or Medicare Advantage plans.
  • Lexapro may be categorized under different tiers, which impacts the copayment or coinsurance amount. Lower-tier drugs often cost less.

 

Basic Rules and Criteria

 

  • A prescription must be provided by a licensed healthcare provider in order for Lexapro to be covered.
  • Prior authorization might be required; consult SelectHealth’s formulary or contact them directly to confirm coverage specifics.
  • A step therapy protocol might be in place, meaning other medications need to be tried first before Lexapro is covered.
  • Ensure your pharmacy is in-network to maximize your plan’s benefits and reduce out-of-pocket costs.

 

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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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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 Lexapro Coverage with SelectHealth

 

Contact SelectHealth Customer Service

 

  • Reach out to SelectHealth's customer service for tailored advice on prescription drug coverage. They can provide information specific to your plan regarding Lexapro.
  •  

  • Use the contact information on your SelectHealth insurance card or visit their official website for guidance.

 

Check Your Plan Details

 

  • Log into your SelectHealth account to review your current coverage plan. Look for information under the prescription drug coverage section.
  •  

  • Download the Summary of Benefits or Evidence of Coverage documents to verify if Lexapro is covered under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Lexapro with your healthcare provider. They might have insights into insurance coding that ensures coverage approval.
  •  

  • Ask your provider for a detailed prescription note specifying the medical necessity of Lexapro, which could support insurance claim approvals.

 

Understand Formulary and Preferred Drug List

 

  • Access SelectHealth’s drug formulary, a list of covered medications, to check if Lexapro is included.
  •  

  • If Lexapro isn't on the preferred list, consult your doctor about similar drugs that might have coverage or consider submitting a request for non-preferred drug coverage.

 

Submit a Coverage Request

 

  • If Lexapro is not initially covered, you might need to submit a coverage request or exception form, available through SelectHealth's customer service or website.
  •  

  • Your healthcare provider can often assist with this process, providing necessary medical information that supports the request.

 

Verify Pharmacy Choice

 

  • Ensure that your preferred pharmacy is in-network with SelectHealth to minimize out-of-pocket costs for prescriptions.
  •  

  • Some plans may require you to use specific pharmacies to receive full coverage benefits, so check beforehand to prevent unexpected expenses.

 

Stay Updated on Plan Changes

 

  • Insurance plans, including drug coverage policies, often update annually, so stay informed of any changes in your SelectHealth plan that may affect Lexapro coverage.
  •  

  • Make use of SelectHealth newsletters, emails, or member portals for timely updates and coverage modifications.

 

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FAQs

Does SelectHealth Cover Lexapro

Learn why SelectHealth may deny Lexapro coverage, how to secure it, cost implications without insurance, and find answers to common questions in our FAQ.
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Is Lexapro Covered by SelectHealth

 

Coverage for Lexapro

 

  • SelectHealth typically covers Lexapro under their prescription drug plans as it is a commonly prescribed antidepressant.
  • Coverage may vary depending on your specific plan type, such as employer-sponsored, individual, or Medicare Advantage plans.
  • Lexapro may be categorized under different tiers, which impacts the copayment or coinsurance amount. Lower-tier drugs often cost less.

 

Basic Rules and Criteria

 

  • A prescription must be provided by a licensed healthcare provider in order for Lexapro to be covered.
  • Prior authorization might be required; consult SelectHealth’s formulary or contact them directly to confirm coverage specifics.
  • A step therapy protocol might be in place, meaning other medications need to be tried first before Lexapro is covered.
  • Ensure your pharmacy is in-network to maximize your plan’s benefits and reduce out-of-pocket costs.

 

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SelectHealth's Approved Criteria for Lexapro Coverage

 

Eligible Diagnostic Criteria for Lexapro Coverage

 

  • Diagnosis of Major Depressive Disorder as confirmed by a licensed healthcare provider.
  •  

  • Diagnosis of Generalized Anxiety Disorder as documented and confirmed by a mental health professional.
  •  

  • Indication for treatment of Obsessive-Compulsive Disorder following an evaluation by a psychiatrist or qualified practitioner.
  •  

  • Achieving stabilization of symptoms in the context of Bipolar Disorder, when used alongside a mood stabilizer, as permitted by the treating psychiatrist.

 

Required Clinical Documentation

 

  • Comprehensive assessment and diagnosis from a licensed healthcare professional, including psychological evaluation or psychiatric report.
  •  

  • Evidence of previous medication trials, documenting the reason for discontinuation or inadequate response prior to Lexapro treatment.
  •  

  • Supporting documentation of ongoing psychotherapy or behavioral modification as part of an integrated treatment approach.

 

Conditions for Initial Prescription Approval

 

  • Documentation of Lexapro as part of a treatment plan developed and approved by a psychiatrist or qualified provider specializing in mental health.
  •  

  • Initiation dosage alignment with FDA-approved labeling guidelines and evidence of titration to avoid adverse effects.
  •  

  • Clear justification for Lexapro's selection, highlighting pharmacological factors relevant to patient’s unique clinical situation.

 

Criteria for Continuation of Coverage

 

  • Regular follow-up appointments with the prescribing healthcare provider to monitor progress, document symptom improvement, and adjust dosage as necessary.
  •  

  • Documented patient adherence to prescribed Lexapro regimen, validated through pharmacy records or practitioner notes.
  •  

  • Submission of periodic treatment evaluations, showcasing sustained symptom management, to authorize ongoing medication coverage.

 

Why SelectHealth Might Deny Lexapro Coverage

 

Reasons for Denial of Lexapro Coverage by SelectHealth

 

  • The prescription is for an off-label use that has not been approved by SelectHealth policy.
  •  

  • Lexapro is not included in the current formulary or is listed as a non-preferred medication.
  •  

  • The patient does not meet the specific age or condition criteria set in the policy for Lexapro coverage.
  •  

  • Failure to meet step therapy requirements, where more cost-effective or preferred alternatives must be tried first.
  •  

  • The required prior authorization was not obtained, or the authorization request was denied due to not meeting the clinical criteria.
  •  

  • The prescription exceeded the quantity limit established by the plan without an approved exception.
  •  

  • The patient has a history of non-compliance affecting medication coverage decisions.

 

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How Much Does Lexapro Cost without Insurance?

 

Approximate Cost of Lexapro Without Insurance

 

  • The cost of Lexapro, a commonly prescribed antidepressant, can vary based on dosage and location. Without insurance, patients might encounter prices that range from approximately $10 to $450 for a 30-day supply.
  •  

  • Different dosages available, such as 5 mg, 10 mg, 15 mg, and 20 mg, might influence the price. Higher dosages may often cost more than lower ones.
  •  

  • Prices may vary greatly between different pharmacies. It's advisable to compare costs at several locations or consider using prescription discount cards or online services to help reduce the expense.
  •  

  • Generic versions, known as escitalopram, can be significantly less expensive, offering more affordable options to those without insurance coverage.
  •  

  • Pharmacy discount programs or membership plans may be available and can help lower the cost further for those not utilizing insurance.

 

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 Lexapro Coverage with SelectHealth

 

Contact SelectHealth Customer Service

 

  • Reach out to SelectHealth's customer service for tailored advice on prescription drug coverage. They can provide information specific to your plan regarding Lexapro.
  •  

  • Use the contact information on your SelectHealth insurance card or visit their official website for guidance.

 

Check Your Plan Details

 

  • Log into your SelectHealth account to review your current coverage plan. Look for information under the prescription drug coverage section.
  •  

  • Download the Summary of Benefits or Evidence of Coverage documents to verify if Lexapro is covered under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Lexapro with your healthcare provider. They might have insights into insurance coding that ensures coverage approval.
  •  

  • Ask your provider for a detailed prescription note specifying the medical necessity of Lexapro, which could support insurance claim approvals.

 

Understand Formulary and Preferred Drug List

 

  • Access SelectHealth’s drug formulary, a list of covered medications, to check if Lexapro is included.
  •  

  • If Lexapro isn't on the preferred list, consult your doctor about similar drugs that might have coverage or consider submitting a request for non-preferred drug coverage.

 

Submit a Coverage Request

 

  • If Lexapro is not initially covered, you might need to submit a coverage request or exception form, available through SelectHealth's customer service or website.
  •  

  • Your healthcare provider can often assist with this process, providing necessary medical information that supports the request.

 

Verify Pharmacy Choice

 

  • Ensure that your preferred pharmacy is in-network with SelectHealth to minimize out-of-pocket costs for prescriptions.
  •  

  • Some plans may require you to use specific pharmacies to receive full coverage benefits, so check beforehand to prevent unexpected expenses.

 

Stay Updated on Plan Changes

 

  • Insurance plans, including drug coverage policies, often update annually, so stay informed of any changes in your SelectHealth plan that may affect Lexapro coverage.
  •  

  • Make use of SelectHealth newsletters, emails, or member portals for timely updates and coverage modifications.

 

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Lexapro FAQ

What are the common side effects of Lexapro?

 

Common Side Effects of Lexapro

 

  • Gastrointestinal Issues: Nausea, diarrhea, and constipation are frequently reported.
  •  

  • Sleep Disturbances: Insomnia or drowsiness can occur, affecting one's sleep patterns.
  •  

  • CNS Effects: Dizziness, headache, and increased sweating are common central nervous system-related effects.
  •  

  • Sexual Dysfunction: Decreased libido, delayed ejaculation, and anorgasmia may occur.
  •  

  • Weight Changes: Some individuals might experience weight gain or loss.
  •  

  • Emotional Effects: Anxiety and some degree of nervousness might manifest, especially during initial weeks.

 

How long does it take for Lexapro to start working?

 

When Lexapro Starts Working

 

  • Initial effects might be felt in 1-2 weeks, but these are often minor changes.
  •  

  • For full therapeutic effects, it commonly takes 4-6 weeks.
  •  

  • Some people may experience relief sooner, while others might need up to 8 weeks.

 

Factors Influencing Timeframe

 

  • Dosage level and adherence to prescribed regimen influence the response.
  •  

  • Individual differences in metabolism and genetics play a role.
  •  

  • Concurrent medications or health conditions can affect efficacy.

 

What to Do if Improvement is Slow

 

  • Consult your doctor if no improvement is seen after several weeks.
  •  

  • Do not adjust the dosage without medical advice.
  •  

  • Consider discussing therapy as a complementary treatment with your healthcare provider.

 

Can Lexapro cause weight gain?

 

Lexapro and Weight Gain

 

  • Lexapro (escitalopram) is commonly prescribed for depression and anxiety. Some patients report weight changes while using it.
  •  

  • **Possible Causes**: Increased appetite, metabolic changes, or decreased physical activity often cause weight gain.
  •  

  • **Individual Variability**: Not everyone experiences weight gain, and some might even lose weight. Individual metabolic responses can vary due to genetics and lifestyle.
  •  

  • **Monitoring Changes**: Regular weight monitoring and lifestyle adjustments, like balanced diet and exercise, can help manage potential weight changes.
  •  

  • **Consult Your Doctor**: Always discuss concerns with your healthcare provider, who can recommend personalized strategies or adjust medication if necessary.

 

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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 (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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