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Does Sharp Health Plan Cover Prozac

Explore Prozac coverage under Sharp Health Plan, reasons for denial, ways to secure coverage, costs without insurance, and FAQs.
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Coverage for Prozac

 

  • Sharp Health Plan covers Prozac (Fluoxetine) under its prescription drug benefit. Coverage can vary based on your specific plan type and policy details.

    •  

  • Typically, the drug is covered when prescribed by a healthcare provider for approved mental health conditions such as depression or anxiety.

    •  

  • Coverage is subject to formulary guidelines, which may require prior authorization, a generic substitution, or step therapy.

 

Getting Prozac Covered

 

  • Ensure that the prescription aligns with FDA-approved indications and plan guidelines.

    •  

  • A healthcare provider must submit any necessary prior authorization forms to Sharp Health Plan, if required.

    •  

  • Check your plan’s formulary to confirm Prozac’s tier placement and understand any copay or coinsurance obligations.

    •  

  • Utilize Sharp Health Plan's customer service for any assistance or clarification needed regarding your prescription coverage.

 

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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 Prozac Coverage with Sharp Health Plan

 

Check Your Current Plan Coverage

 

  • Log into your Sharp Health Plan member account online or review your plan documents to determine if prescription medications like Prozac are covered under your current plan. This information is usually available under the ‘Pharmacy’ or ‘Prescription’ section.

    •  

  • Consult your plan’s formulary, which is a list of covered medications. Check whether Prozac (fluoxetine) is listed and see the tier level it’s placed in, as this affects your copay or coinsurance.

 

Contact Sharp Health Plan Customer Service

 

  • If you’re unsure about your coverage, contact Sharp Health Plan’s customer service. You can find the number on your insurance card or the plan’s website. Ask them about Prozac’s coverage and what steps you need to take to ensure it’s covered.

    •  

  • Inquire whether any prior authorization is required for Prozac and the process involved if it is. They may require documentation from your healthcare provider to approve coverage.

 

Consult With Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Prozac. Ensure they are aware of your insurance plan and can provide any necessary information, such as medical necessity, to support your prescription.

    •  

  • Request your healthcare provider to send any necessary documentation to Sharp Health Plan if a prior authorization is required to cover Prozac.

 

Visit Your Preferred Pharmacy

 

  • Choose a pharmacy that is in-network with Sharp Health Plan to avoid unnecessary expenses. In-network pharmacies are preferred providers and will generally have lower costs.

    •  

  • Have your healthcare provider send your Prozac prescription directly to the pharmacy. When you pick up your medication, provide your Sharp Health Plan insurance card to ensure the coverage is applied correctly.

    •  

  • If there are any issues, the pharmacist can often clarify what the problem is or contact the insurance provider for further information.

 

File Any Additional Claims or Appeals

 

  • If Prozac is not initially covered, you can file a claim or an appeal with Sharp Health Plan. Gather supporting documents such as a letter of medical necessity from your healthcare provider and any other relevant information that demonstrates the importance of Prozac to your treatment.

    •  

  • Submit the claim or appeal through the Sharp Health Plan’s website or by mail. Follow up with a call to confirm receipt and inquire about the expected timeline for a decision.

 

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Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

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

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
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Your immune system gets desensitized to allergens, giving you long-term relief.

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FAQs

Does Sharp Health Plan Cover Prozac

Explore Prozac coverage under Sharp Health Plan, reasons for denial, ways to secure coverage, costs without insurance, and FAQs.
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Is Prozac Covered by Sharp Health Plan

 

Coverage for Prozac

 

  • Sharp Health Plan covers Prozac (Fluoxetine) under its prescription drug benefit. Coverage can vary based on your specific plan type and policy details.

    •  

  • Typically, the drug is covered when prescribed by a healthcare provider for approved mental health conditions such as depression or anxiety.

    •  

  • Coverage is subject to formulary guidelines, which may require prior authorization, a generic substitution, or step therapy.

 

Getting Prozac Covered

 

  • Ensure that the prescription aligns with FDA-approved indications and plan guidelines.

    •  

  • A healthcare provider must submit any necessary prior authorization forms to Sharp Health Plan, if required.

    •  

  • Check your plan’s formulary to confirm Prozac’s tier placement and understand any copay or coinsurance obligations.

    •  

  • Utilize Sharp Health Plan's customer service for any assistance or clarification needed regarding your prescription coverage.

 

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Sharp Health Plan's Approved Criteria for Prozac Coverage

 

Criteria for Prozac Coverage under Sharp Health Plan

 

  • Prozac must be prescribed by a licensed healthcare provider acting within their scope of practice.

    •  

  • Member must have a documented diagnosis of major depressive disorder, obsessive-compulsive disorder, bulimia nervosa, panic disorder, or premenstrual dysphoric disorder where Prozac is indicated as appropriate treatment.

    •  

  • Clinical documentation showing that non-pharmacological treatment options have been considered or attempted without adequate symptom relief.

    •  

  • The member has a history of therapeutic failure or intolerance to another selective serotonin reuptake inhibitor (SSRI) when appropriate, unless Prozac is preferred due to clinical considerations.

    •  

  • Continued coverage requires evidence of symptom improvement, and the member must have regular follow-ups with the prescribing provider to assess effectiveness and side effects.

    •  

  • Coverage is contingent upon the medication being utilized according to approved dosing guidelines for the specified indication.

    •  

 

Why Sharp Health Plan Might Deny Prozac Coverage

 

Exclusions and Non-Coverage Criteria for Prozac

 

  • The prescription is for an off-label use not approved by the FDA and not deemed medically necessary according to Sharp Health Plan's guidelines.

    •  

  • Prozac is prescribed for a condition that is explicitly excluded from coverage under the member's specific plan documents.

    •  

  • The medication is not prescribed by a healthcare provider that is recognized within the network of Sharp Health Plan.

    •  

  • The member has reached maximum benefit limits for medications in the same therapeutic class as Prozac within the plan year.

    •  

  • A generic equivalent, deemed therapeutically equivalent, is mandated by the plan's policy and a prior authorization for using branded Prozac has been denied.

    •  

  • Prozac is being used as part of a treatment plan that requires step therapy and alternative medications have not been tried as required by the plan.

    •  

  • The prescribed dosage exceeds the FDA-approved and plan-authorized limits without sufficient medical justification for higher dosing.

    •  

  • The request for coverage cannot provide the necessary clinical justification that aligns with Sharp Health Plan's criteria for approval.

    •  

 

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How Much Does Prozac Cost without Insurance?

 

Approximate Cost of Prozac Without Insurance

 

  • The cost of Prozac (fluoxetine), a medication commonly used to treat depression and anxiety disorders, can vary based on the dosage, quantity, and location.

    •  

  • For a 30-day supply of generic fluoxetine, the average cost can range from $4 to $20 for the commonly prescribed dosages like 10mg, 20mg, or 40mg.

    •  

  • The branded version, Prozac, can be more expensive, with prices ranging from $120 to $150 or more without insurance for a similar 30-day supply.

    •  

  • Prices may vary between different pharmacies, and discount programs or pharmacy membership plans can potentially reduce the out-of-pocket cost.

 

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 Prozac Coverage with Sharp Health Plan

 

Check Your Current Plan Coverage

 

  • Log into your Sharp Health Plan member account online or review your plan documents to determine if prescription medications like Prozac are covered under your current plan. This information is usually available under the ‘Pharmacy’ or ‘Prescription’ section.

    •  

  • Consult your plan’s formulary, which is a list of covered medications. Check whether Prozac (fluoxetine) is listed and see the tier level it’s placed in, as this affects your copay or coinsurance.

 

Contact Sharp Health Plan Customer Service

 

  • If you’re unsure about your coverage, contact Sharp Health Plan’s customer service. You can find the number on your insurance card or the plan’s website. Ask them about Prozac’s coverage and what steps you need to take to ensure it’s covered.

    •  

  • Inquire whether any prior authorization is required for Prozac and the process involved if it is. They may require documentation from your healthcare provider to approve coverage.

 

Consult With Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Prozac. Ensure they are aware of your insurance plan and can provide any necessary information, such as medical necessity, to support your prescription.

    •  

  • Request your healthcare provider to send any necessary documentation to Sharp Health Plan if a prior authorization is required to cover Prozac.

 

Visit Your Preferred Pharmacy

 

  • Choose a pharmacy that is in-network with Sharp Health Plan to avoid unnecessary expenses. In-network pharmacies are preferred providers and will generally have lower costs.

    •  

  • Have your healthcare provider send your Prozac prescription directly to the pharmacy. When you pick up your medication, provide your Sharp Health Plan insurance card to ensure the coverage is applied correctly.

    •  

  • If there are any issues, the pharmacist can often clarify what the problem is or contact the insurance provider for further information.

 

File Any Additional Claims or Appeals

 

  • If Prozac is not initially covered, you can file a claim or an appeal with Sharp Health Plan. Gather supporting documents such as a letter of medical necessity from your healthcare provider and any other relevant information that demonstrates the importance of Prozac to your treatment.

    •  

  • Submit the claim or appeal through the Sharp Health Plan’s website or by mail. Follow up with a call to confirm receipt and inquire about the expected timeline for a decision.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Prozac FAQ

1. What are the common side effects of Prozac?

 

Common Side Effects of Prozac

 

  • Nausea: Often occurs during initial treatment or after dose increases.

    •  

  • Headache: Can vary in intensity and duration among users.

    •  

  • Sleep disturbances: Includes insomnia or unusual dreams.

    •  

  • Sexual dysfunction: Includes decreased libido, delayed ejaculation, or orgasmic issues.

    •  

  • Dry mouth: May lead to increased thirst or discomfort.

    •  

  • Drowsiness: Some users experience fatigue or lethargy.

    •  

  • Anxiety: Agitation or nervousness may occur, especially early in treatment.

    •  

  • Diarrhea: Varying consistency and frequency may be noted.

2. How long does it take for Prozac to start working?

 

How Prozac Works

 

  • Prozac, an SSRI, increases serotonin levels in the brain by inhibiting reuptake. Improved serotonin availability helps stabilize mood.

 

Onset of Effects

 

  • Initial physical effects, such as improved energy, may be noted within 1-2 weeks.

    •  

  • Significant mood improvement typically requires 4-6 weeks, varying between individuals.

 

Factors Influencing Efficacy

 

  • Dosage and individual metabolism play crucial roles in response time.

    •  

  • Concurrent medication and underlying health conditions can influence onset and effectiveness.

    •  

  • Adherence to prescribed dosing schedule is essential for optimal results.

3. Can Prozac cause weight gain or loss?

 

Prozac and Weight Changes

 

  • **Weight Gain**: Some users may experience weight gain. This can be due to changes in metabolism, increased appetite, or changes in energy levels. It's important to monitor your weight and discuss changes with your doctor.

    •  

  • **Weight Loss**: Others might experience weight loss, possibly due to decreased appetite or improved mood leading to more physical activity. Again, tracking weight changes and discussing them with your healthcare provider is essential.

    •  

  • **Individual Response**: Weight changes are often individual. Some people might not experience any change. Knowing your body’s response and maintaining a balanced diet and exercise routine is crucial.

 

Have questions left?

‍

Get a personalized online consultation with a doctor at Curex

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Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
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"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“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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Call/text us at:

(857) 240-1080

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Miami, FL 33131

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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.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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