Does Sharp Health Plan Cover Lantus

Explore Sharp Health Plan's Lantus coverage, reasons for denial, ways to secure it, cost insights without insurance, and FAQs in our comprehensive guide.
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Sharp Health Plan Coverage for Lantus

 

  • Sharp Health Plan typically covers Lantus, a long-acting insulin, for members with diabetes who demonstrate a medical need.
  •  

  • Coverage depends on the specific health plan and may require prior authorization, verifying Lantus is medically necessary for glucose management.
  •  

  • Members must consult their plan's formulary to confirm inclusion of Lantus and understand any potential out-of-pocket costs or co-payment requirements.
  •  

  • Sharp Health Plan may require clients to exhaust preferred alternatives or generic options before approving Lantus coverage.
  •  

  • Criteria for coverage approval often include documented medical history, treatment response, and a physician's recommendation through submitted medical records.

 

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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.

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 Sharp Health Plan

 

Start by Understanding Your Coverage

 

  • Review your current health plan benefits through the member portal or your insurance documents to understand what is covered.
  •  

  • Look for specific medications under the prescription drug coverage section, including information on any formulary or preferred drug list that includes Lantus.

 

Consult with Your Healthcare Provider

 

  • Schedule a visit with your healthcare provider to discuss your need for Lantus and to obtain a prescription if necessary.
  •  

  • Ask your provider if they can assist with prior authorization or provide any necessary paperwork to help secure coverage.

 

Contact Sharp Health Plan Member Services

 

  • Call Sharp Health Plan's member services or visit their website to confirm Lantus coverage details and any specific requirements.
  •  

  • Inquire about prior authorizations, step therapy, or any special coverage conditions for Lantus.

 

Submit a Prior Authorization Request

 

  • If required, work with your healthcare provider to submit a prior authorization request to Sharp Health Plan for Lantus.
  •  

  • Ensure that all relevant medical documentation and justifications for Lantus are included in the request to improve chances of approval.

 

Utilize Preferred Pharmacies

 

  • Check the Sharp Health Plan network to identify preferred pharmacies where Lantus might be covered more favorably.
  •  

  • Get your prescription filled at these designated pharmacies to potentially reduce out-of-pocket costs.

 

Explore Assistance Programs

 

  • Research patient assistance programs offered by the manufacturer of Lantus, which may help offset costs if coverage through Sharp Health Plan is limited.
  •  

  • Consider contacting national or local diabetes assistance organizations for any available resources or financial support.

 

Appeal Denied Claims

 

  • If your claim for Lantus coverage is denied, review the denial letter from Sharp Health Plan closely to understand the reason.
  •  

  • Work with your healthcare provider to gather additional documentation to support an appeal, and submit the appeal as directed in the denial letter.

 

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FAQs

Does Sharp Health Plan Cover Lantus

Explore Sharp Health Plan's Lantus coverage, reasons for denial, ways to secure it, cost insights without insurance, and FAQs in our comprehensive guide.
Curex allergy drops unboxing

Is Lantus Covered by Sharp Health Plan

 

Sharp Health Plan Coverage for Lantus

 

  • Sharp Health Plan typically covers Lantus, a long-acting insulin, for members with diabetes who demonstrate a medical need.
  •  

  • Coverage depends on the specific health plan and may require prior authorization, verifying Lantus is medically necessary for glucose management.
  •  

  • Members must consult their plan's formulary to confirm inclusion of Lantus and understand any potential out-of-pocket costs or co-payment requirements.
  •  

  • Sharp Health Plan may require clients to exhaust preferred alternatives or generic options before approving Lantus coverage.
  •  

  • Criteria for coverage approval often include documented medical history, treatment response, and a physician's recommendation through submitted medical records.

 

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Sharp Health Plan's Approved Criteria for Lantus Coverage

 

Eligibility for Lantus Coverage

 

  • Lantus is covered for patients with a documented diagnosis of diabetes mellitus, either Type 1 or Type 2.
  •  

  • Coverage is applicable if the patient is above 18 years and requires insulin therapy for blood sugar control.
  •  

  • For children and adolescents under 18 years, Lantus is covered when prescribed by an endocrinologist or a diabetes specialist.

 

Required Documentation

 

  • A prescription from a licensed healthcare provider stating the medical necessity of Lantus.
  •  

  • Medical records documenting previous insulin use and showing that the patient requires long-acting insulin therapy to maintain glycemic control.
  •  

  • Proof of diagnosis, including laboratory test results such as A1C levels, that supports the need for insulin therapy.

 

Specific Conditions for Coverage

 

  • Patients should have a history of failure, intolerance, or contraindication to other formulary long-acting insulins before Lantus is approved.
  •  

  • Lantus will be covered if it is used as part of a comprehensive diabetes management plan, including lifestyle modifications and regular monitoring of blood glucose.
  •  

  • Continuation of Lantus therapy requires periodic evaluation and documentation by the healthcare provider to confirm ongoing medical necessity.

 

Why Sharp Health Plan Might Deny Lantus Coverage

 

Reasons for Denial of Lantus Coverage by Sharp Health Plan

 

  • **Non-Formulary Medication**: Lantus may not be included in the plan's formulary list, which dictates what medications are covered under the insurance policy.
  •  

  • **Prior Authorization Requirement Not Met**: Coverage could be denied if prior authorization protocols are not followed, meaning the prescriber must obtain authorization before the plan covers the medication.
  •  

  • **Step Therapy Requirements**: Lantus might be subject to step therapy, needing the patient to try and fail other treatments first. Failing to meet these requirements can lead to a denial.
  •  

  • **Lack of Medical Necessity**: If it is determined that Lantus is not medically necessary for your condition, coverage may be denied. The decision can be based on medical guidelines set by the insurance plan.
  •  

  • **Plan Benefits Exclusion**: The specific health plan may exclude coverage for certain types of medications, including insulin like Lantus, due to plan descriptions and the outlined benefits.
  •  

  • **Expired or Incorrect Prescriptions**: Coverage can be denied if the prescription for Lantus is expired, not properly documented, or contains errors in dosage or patient information.

 

Together with our partners we have changed the lives of over 300,000 patients.

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.

 

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 Sharp Health Plan

 

Start by Understanding Your Coverage

 

  • Review your current health plan benefits through the member portal or your insurance documents to understand what is covered.
  •  

  • Look for specific medications under the prescription drug coverage section, including information on any formulary or preferred drug list that includes Lantus.

 

Consult with Your Healthcare Provider

 

  • Schedule a visit with your healthcare provider to discuss your need for Lantus and to obtain a prescription if necessary.
  •  

  • Ask your provider if they can assist with prior authorization or provide any necessary paperwork to help secure coverage.

 

Contact Sharp Health Plan Member Services

 

  • Call Sharp Health Plan's member services or visit their website to confirm Lantus coverage details and any specific requirements.
  •  

  • Inquire about prior authorizations, step therapy, or any special coverage conditions for Lantus.

 

Submit a Prior Authorization Request

 

  • If required, work with your healthcare provider to submit a prior authorization request to Sharp Health Plan for Lantus.
  •  

  • Ensure that all relevant medical documentation and justifications for Lantus are included in the request to improve chances of approval.

 

Utilize Preferred Pharmacies

 

  • Check the Sharp Health Plan network to identify preferred pharmacies where Lantus might be covered more favorably.
  •  

  • Get your prescription filled at these designated pharmacies to potentially reduce out-of-pocket costs.

 

Explore Assistance Programs

 

  • Research patient assistance programs offered by the manufacturer of Lantus, which may help offset costs if coverage through Sharp Health Plan is limited.
  •  

  • Consider contacting national or local diabetes assistance organizations for any available resources or financial support.

 

Appeal Denied Claims

 

  • If your claim for Lantus coverage is denied, review the denial letter from Sharp Health Plan closely to understand the reason.
  •  

  • Work with your healthcare provider to gather additional documentation to support an appeal, and submit the appeal as directed in the denial letter.

 

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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.

 

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (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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