Does SelectHealth Cover Lyrica

Explore why SelectHealth might deny Lyrica coverage, how to secure it, cost details without insurance, and FAQs for informed healthcare decisions.
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Does SelectHealth Cover Lyrica?

 

  • SelectHealth may cover Lyrica if it is deemed medically necessary. Typically, this involves conditions like fibromyalgia, diabetic nerve damage, epilepsy, or spinal cord injury-related nerve pain.
  •  

  • Insurance coverage often requires prior authorization to confirm that treatments align with SelectHealth's medical policies.
  •  

  • An essential criterion is that Lyrica is prescribed for an FDA-approved indication and tried previous therapies were insufficient or failed.
  •  

  • Consult the SelectHealth formulary for any copayments, tier levels, or specific quantity limits related to Lyrica.
  •  

  • Make sure your prescription plan covers Lyrica by discussing with your healthcare provider and reviewing your policy documents for specifics.
  •  

 

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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.

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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.

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 Lyrica Coverage with SelectHealth

 

Start with Understanding Prescription Coverage

 

  • Visit the SelectHealth website to review their standard prescription drug coverage plans. This will provide insight into the formulary (list of covered drugs) and any associated requirements for coverage.
  •  

  • Check if Lyrica (pregabalin) is included in the formulary. You might find it listed under both brand name and generic options, so look carefully.

 

Contact SelectHealth Member Services

 

  • Reach out to SelectHealth Member Services by phone or through their secure messaging system available on their website.
  •  

  • Ask for detailed information regarding Lyrica coverage. Inquire if there are any specific steps, such as prior authorization, step therapy, or quantity limits that need to be met for coverage approval.

 

Consult with Your Healthcare Provider

 

  • Speak to your physician about your prescription needs. Inform them that you need Lyrica covered by SelectHealth and discuss any necessary documentation needed to support your medical need for Lyrica.
  •  

  • Ensure that your provider sends a prescription directly to your pharmacy and, if necessary, submits any required documents to SelectHealth.

 

Submit a Prior Authorization Request

 

  • If SelectHealth requires prior authorization for Lyrica, work with your healthcare provider to complete the necessary forms. This process involves demonstrating medical necessity for taking Lyrica instead of alternative treatments.
  •  

  • Once submitted, follow up with SelectHealth to check on the status of your prior authorization request. Ensure all necessary documentation has been received and processed.

 

Review Step Therapy Requirements

 

  • In some cases, SelectHealth may require step therapy, which means trying other medications before Lyrica. Check if these requirements apply to your plan.
  •  

  • If step therapy is necessary, discuss alternatives with your healthcare provider and follow the protocol specified by SelectHealth to proceed with Lyrica coverage.

 

Check for Financial Assistance Programs

 

  • If you're having difficulty obtaining coverage for Lyrica, explore financial assistance programs provided by the drug manufacturer or third-party organizations. These can help reduce out-of-pocket costs.
  •  

  • Consult SelectHealth's resources for any additional coverage options, such as discount programs or supplementary insurance plans that cover prescription medications more comprehensively.

 

Read Plan Documents Carefully

 

  • Thoroughly review any updates or changes to your plan documents regarding prescription drug coverage. Keep an eye out for annual changes that may affect Lyrica's coverage status.
  •  

  • Understand your appeal rights in case your coverage request is denied. Being informed will prepare you to take necessary action to obtain needed medication.

 

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FAQs

Does SelectHealth Cover Lyrica

Explore why SelectHealth might deny Lyrica coverage, how to secure it, cost details without insurance, and FAQs for informed healthcare decisions.
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Is Lyrica Covered by SelectHealth

 

Does SelectHealth Cover Lyrica?

 

  • SelectHealth may cover Lyrica if it is deemed medically necessary. Typically, this involves conditions like fibromyalgia, diabetic nerve damage, epilepsy, or spinal cord injury-related nerve pain.
  •  

  • Insurance coverage often requires prior authorization to confirm that treatments align with SelectHealth's medical policies.
  •  

  • An essential criterion is that Lyrica is prescribed for an FDA-approved indication and tried previous therapies were insufficient or failed.
  •  

  • Consult the SelectHealth formulary for any copayments, tier levels, or specific quantity limits related to Lyrica.
  •  

  • Make sure your prescription plan covers Lyrica by discussing with your healthcare provider and reviewing your policy documents for specifics.
  •  

 

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SelectHealth's Approved Criteria for Lyrica Coverage

 

SelectHealth Coverage Criteria for Lyrica

 

  • Lyrica is approved for members diagnosed with neuropathic pain associated with diabetic peripheral neuropathy (DPN), confirmed by clinical documentation from the healthcare provider.
  •  

  • Coverage is available for members who have fibromyalgia as an ongoing condition, substantiated by submission of a record of diagnosis and previous treatment attempts.
  •  

  • Patients with postherpetic neuralgia (PHN) may be eligible for Lyrica if there is documentation of continuous pain following herpes zoster infection.
  •  

  • Individuals experiencing nerve pain due to spinal cord injury can have Lyrica coverage if the condition is verified by a healthcare provider with supporting medical records.
  •  

  • Off-label use of Lyrica, such as for restless legs syndrome (RLS), might be covered if standard treatment protocols have failed and appropriate justification is provided, including a letter from a consulting physician.
  •  

  • For members with epilepsy and partial onset seizures, Lyrica may be covered as adjunctive therapy if other anticonvulsant treatments have been inadequate, subject to documentation and clinical rationale.

 

Why SelectHealth Might Deny Lyrica Coverage

 

Reasons for Denial of Lyrica Coverage by SelectHealth

 

  • Lyrica may not be covered if the medication is not deemed medically necessary based on patient's current diagnosis and treatment plan.
  •  

  • SelectHealth might deny coverage if Lyrica is used for a condition not listed within their approved uses for the drug.
  •  

  • Coverage could be denied if there is a lack of documented treatment failure, intolerance, or contraindication with alternative medications.
  •  

  • If there is an absence of prior authorization where it is required, SelectHealth may deny coverage for Lyrica.
  •  

  • If the prescribed dosage exceeds the limitation set by SelectHealth, they might not cover the medication.
  •  

  • Denial might occur if Lyrica is considered a non-preferred drug in cases where more cost-effective alternatives are available and preferred by the insurance plan.
  •  

  • Coverage can be denied if the patient's plan does not include prescription drug benefits or specifically excludes Lyrica from covered medications.
  •  

  • Lyrica may not be covered if SelectHealth determines that the use of the drug is experimental or investigational for the patient's condition.

 

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How Much Does Lyrica Cost without Insurance?

 

Cost of Lyrica Without Insurance

 

  • The price of Lyrica without insurance can vary significantly depending on the pharmacy, geographic location, dosage, and quantity. On average, the cost can range between $460 to $720 for a 30-day supply when filling a common dosage such as 150 mg capsules.
  •  

  • Generic versions of Lyrica, known as pregabalin, are often significantly cheaper. The average cost for the generic version might be closer to $30 to $70 for a similar quantity and dosage.
  •  

  • Prices may also vary due to manufacturer's discounts, pharmacy membership programs, or coupon usage, which can help reduce the overall cost.
  •  

  • Comparing prices between local pharmacies or using online price comparison tools can help find the most affordable option.

 

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 Lyrica Coverage with SelectHealth

 

Start with Understanding Prescription Coverage

 

  • Visit the SelectHealth website to review their standard prescription drug coverage plans. This will provide insight into the formulary (list of covered drugs) and any associated requirements for coverage.
  •  

  • Check if Lyrica (pregabalin) is included in the formulary. You might find it listed under both brand name and generic options, so look carefully.

 

Contact SelectHealth Member Services

 

  • Reach out to SelectHealth Member Services by phone or through their secure messaging system available on their website.
  •  

  • Ask for detailed information regarding Lyrica coverage. Inquire if there are any specific steps, such as prior authorization, step therapy, or quantity limits that need to be met for coverage approval.

 

Consult with Your Healthcare Provider

 

  • Speak to your physician about your prescription needs. Inform them that you need Lyrica covered by SelectHealth and discuss any necessary documentation needed to support your medical need for Lyrica.
  •  

  • Ensure that your provider sends a prescription directly to your pharmacy and, if necessary, submits any required documents to SelectHealth.

 

Submit a Prior Authorization Request

 

  • If SelectHealth requires prior authorization for Lyrica, work with your healthcare provider to complete the necessary forms. This process involves demonstrating medical necessity for taking Lyrica instead of alternative treatments.
  •  

  • Once submitted, follow up with SelectHealth to check on the status of your prior authorization request. Ensure all necessary documentation has been received and processed.

 

Review Step Therapy Requirements

 

  • In some cases, SelectHealth may require step therapy, which means trying other medications before Lyrica. Check if these requirements apply to your plan.
  •  

  • If step therapy is necessary, discuss alternatives with your healthcare provider and follow the protocol specified by SelectHealth to proceed with Lyrica coverage.

 

Check for Financial Assistance Programs

 

  • If you're having difficulty obtaining coverage for Lyrica, explore financial assistance programs provided by the drug manufacturer or third-party organizations. These can help reduce out-of-pocket costs.
  •  

  • Consult SelectHealth's resources for any additional coverage options, such as discount programs or supplementary insurance plans that cover prescription medications more comprehensively.

 

Read Plan Documents Carefully

 

  • Thoroughly review any updates or changes to your plan documents regarding prescription drug coverage. Keep an eye out for annual changes that may affect Lyrica's coverage status.
  •  

  • Understand your appeal rights in case your coverage request is denied. Being informed will prepare you to take necessary action to obtain needed medication.

 

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Lyrica FAQ

What are the common side effects of Lyrica?

 

Common Side Effects of Lyrica

 

  • Dizziness: Frequently reported, often occurring shortly after starting treatment.
  • Sleepiness: Commonly affects daily activities due to its sedative effects.
  • Weight Gain: Notable for some, monitoring weight is advised.
  • Swelling: Particularly in hands and feet; may require medical attention if severe.
  • Blurred Vision: Usually temporary but should be reported if persistent.
  • Dry Mouth: Sometimes improved with increased fluid intake.
  • Difficulty concentrating: Can affect mental clarity and focus.

 

Is Lyrica the same as gabapentin?

 

Differences Between Lyrica and Gabapentin

 

  • Classification: Both are anticonvulsants but with different active ingredients. Lyrica contains pregabalin, while gabapentin itself is the active substance in gabapentin medications.
  •  

  • FDA Approval: Lyrica is approved for treating fibromyalgia, neuropathic pain, seizures, and generalized anxiety disorder in certain regions. Gabapentin's primary uses are for seizures and nerve pain.
  •  

  • Potency and Dosing: Lyrica is often considered more potent, requiring lower doses to achieve similar effects compared to gabapentin.
  •  

  • Side Effects: Both can cause dizziness and fatigue, but the severity and other side effects can vary between individuals.

 

Can Lyrica help with anxiety?

 

Understanding Lyrica and Anxiety

 

  • Lyrica (pregabalin) is primarily approved for treating nerve pain, fibromyalgia, and seizures.
  •  

  • Although not FDA-approved for anxiety, it has been used off-label to help some patients manage anxiety symptoms, especially in generalized anxiety disorder (GAD).

 

Mechanism and Effectiveness

 

  • Lyrica works by calming hyper-excited nerves, which may reduce anxiety symptoms by stabilizing neuronal activity.
  •  

  • Clinical studies suggest it can reduce anxiety more effectively than a placebo and comparable to some anxiety medications.

 

Considerations and Side Effects

 

  • Possible side effects include dizziness, sleepiness, and weight gain, which should be considered before off-label use.
  •  

  • Consult your doctor to assess if Lyrica aligns with your specific health needs and to discuss alternate anxiety treatments.

 

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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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