Does SummaCare Cover Chantix

Explore why SummaCare may deny Chantix, steps to gain coverage, costs without insurance, and FAQs in this comprehensive guide on Chantix and SummaCare.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Does SummaCare Cover Chantix

 

  • **Coverage**: SummaCare typically covers Chantix under its prescription drug plan. Coverage specifics can vary based on the policy, so verify with SummaCare for precise details.
  •  

  • **Eligibility**: Coverage may require a doctor's prescription. Prescription may need to indicate it's part of a smoking cessation program.
  •  

  • **Prior Authorization**: Some plans might require prior authorization. Check with SummaCare to see if Chantix requires additional approval before coverage.
  •  

  • **Tiered Formularies**: Chantix placement in SummaCare's formulary tiers can affect copayment costs. Higher-tier placement often leads to higher out-of-pocket costs.
  •  

  • **Step Therapy**: There may be a requirement to try and fail other smoking cessation methods before Chantix is covered.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

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 Chantix Coverage with SummaCare

 

Review Your SummaCare Plan

 

  • Access your SummaCare policy documents or online portal to understand your prescription drug benefits.
  •  

  • Check if Chantix (varenicline) is listed under your plan's covered medications. You might find this under the formulary section.

 

Consult with Your Healthcare Provider

 

  • Discuss your intention to quit smoking and your interest in using Chantix as an aid with your healthcare provider.
  •  

  • Your doctor can prescribe Chantix and might need to provide justification for its use if required by SummaCare.

 

Contact SummaCare Customer Service

 

  • Reach out to SummaCare's customer service for clarification on Chantix coverage under your specific plan.
  •  

  • Ask about any necessary pre-authorizations or documents needed to ensure coverage for Chantix.

 

Submit Any Required Documentation

 

  • If pre-authorization is required, ensure that your healthcare provider submits all necessary paperwork to SummaCare.
  •  

  • Keep a copy of all submitted documents for your records. This can be useful if there are any disputes later on.

 

Visit the Pharmacy

 

  • Once the prescription is ready, present it to a pharmacy that is in-network with SummaCare.
  •  

  • Ask the pharmacist to confirm whether Chantix is covered under your plan before you make a payment.

 

Appeal If Necessary

 

  • If your claim is denied, check the denial notice for the reason and immediately contact SummaCare to understand the denial's basis.
  •  

  • Prepare to file an appeal with the help of your healthcare provider, providing any necessary documentation or explanations.

 

Understand Your Cost-Sharing Details

 

  • Be aware of any co-pays, deductibles, or co-insurance components that apply to the prescription of Chantix under your plan.
  •  

  • Review your benefits summary to ensure there are no surprises in cost-sharing and budget accordingly.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

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
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does SummaCare Cover Chantix

Explore why SummaCare may deny Chantix, steps to gain coverage, costs without insurance, and FAQs in this comprehensive guide on Chantix and SummaCare.
Curex allergy drops unboxing

Is Chantix Covered by SummaCare

 

Does SummaCare Cover Chantix

 

  • **Coverage**: SummaCare typically covers Chantix under its prescription drug plan. Coverage specifics can vary based on the policy, so verify with SummaCare for precise details.
  •  

  • **Eligibility**: Coverage may require a doctor's prescription. Prescription may need to indicate it's part of a smoking cessation program.
  •  

  • **Prior Authorization**: Some plans might require prior authorization. Check with SummaCare to see if Chantix requires additional approval before coverage.
  •  

  • **Tiered Formularies**: Chantix placement in SummaCare's formulary tiers can affect copayment costs. Higher-tier placement often leads to higher out-of-pocket costs.
  •  

  • **Step Therapy**: There may be a requirement to try and fail other smoking cessation methods before Chantix is covered.

 

A weight management program tailored to you

Start with Curex

SummaCare's Approved Criteria for Chantix Coverage

 

Chantix Coverage Criteria by SummaCare

 

  • The patient must demonstrate a willingness to quit smoking, as evidenced by enrollment in a smoking cessation program or participation in a structured counseling group focused on smoking cessation.
  •  

  • Candidates must provide documentation or a prescription request from a healthcare provider that explicitly indicates the need for Chantix (varenicline) as part of the patient's smoking cessation plan.
  •  

  • The patient should have tried at least one other form of nicotine replacement therapy (e.g., nicotine patches, gum, lozenges), or alternative pharmacotherapy (e.g., bupropion SR), and have documented evidence indicating that these methods were insufficient or produced adverse reactions.
  •  

  • SummaCare may require proof of a comprehensive health evaluation conducted by a healthcare provider prior to recommending Chantix, ensuring that it is an appropriate treatment given the patient's medical history.
  •  

  • The initial prescription of Chantix is typically covered for a duration specified by medical guidelines or the prescribing policy of SummaCare, highlighting the requirement of an evaluation for continuing therapy.

 

Required Documentation

 

  • Complete patient history that includes past attempts to quit smoking and attempted therapies.
  •  

  • Current enrollment proof in a smoking cessation program or schedule of counseling sessions.
  •  

  • A written recommendation from a healthcare provider that includes a rationale for choosing Chantix as the primary pharmacotherapy for smoking cessation.

 

Additional Considerations

 

  • Coverage for Chantix may include restrictions based on patient age, requiring that beneficiaries meet predefined age criteria set forth by SummaCare policies.
  •  

  • Ongoing therapy may necessitate follow-up visits with the prescribing healthcare provider to ensure successful cessation attempts and to monitor for any side effects associated with Chantix.

 

Why SummaCare Might Deny Chantix Coverage

 

Reasons for Denial of Chantix Coverage by SummaCare

 

  • Chantix is not covered if it is prescribed for conditions other than smoking cessation. SummaCare only approves Chantix for its FDA-approved indication related to quitting smoking.
  •  

  • If the prescribed Chantix does not align with the formulary guidelines set by SummaCare, the medication may be denied. This includes situations where Chantix is not listed in their current formulary.
  •  

  • Coverage may be denied if there is insufficient documentation demonstrating medical necessity as per SummaCare's policy requirements.
  •  

  • SummaCare could deny coverage if prior authorization requirements are not met, meaning the necessary documentation or approvals were not obtained before acquiring the medication.
  •  

  • Members who do not meet the established age criteria or have not fulfilled the required treatment history may be denied coverage. This refers to any mandated attempts with other cessation therapies as a prerequisite.
  •  

  • If the prescribed dosage of Chantix exceeds the recommended levels without proper justification, SummaCare might refuse to cover the medication.
  •  

  • In cases where the patient continues to use Chantix beyond the approved duration specified by their plan without reevaluation and approval, SummaCare may deny further coverage.

 

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

How Much Does Chantix Cost without Insurance?

 

Chantix Cost without Insurance

 

  • The cost of Chantix, a medication used to help adults stop smoking, can vary depending on the pharmacy and location. However, without insurance, the average price for a month's supply of Chantix is typically between $400 to $500.
  •  

  • Discounts or coupons may be available through certain pharmacies or websites, which can lower the out-of-pocket cost for those without insurance.
  •  

  • It's important to check with individual pharmacies for the most accurate pricing, as costs can differ significantly. Consider asking if they offer any in-house saving programs or discounts for cash payments.

 

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 Chantix Coverage with SummaCare

 

Review Your SummaCare Plan

 

  • Access your SummaCare policy documents or online portal to understand your prescription drug benefits.
  •  

  • Check if Chantix (varenicline) is listed under your plan's covered medications. You might find this under the formulary section.

 

Consult with Your Healthcare Provider

 

  • Discuss your intention to quit smoking and your interest in using Chantix as an aid with your healthcare provider.
  •  

  • Your doctor can prescribe Chantix and might need to provide justification for its use if required by SummaCare.

 

Contact SummaCare Customer Service

 

  • Reach out to SummaCare's customer service for clarification on Chantix coverage under your specific plan.
  •  

  • Ask about any necessary pre-authorizations or documents needed to ensure coverage for Chantix.

 

Submit Any Required Documentation

 

  • If pre-authorization is required, ensure that your healthcare provider submits all necessary paperwork to SummaCare.
  •  

  • Keep a copy of all submitted documents for your records. This can be useful if there are any disputes later on.

 

Visit the Pharmacy

 

  • Once the prescription is ready, present it to a pharmacy that is in-network with SummaCare.
  •  

  • Ask the pharmacist to confirm whether Chantix is covered under your plan before you make a payment.

 

Appeal If Necessary

 

  • If your claim is denied, check the denial notice for the reason and immediately contact SummaCare to understand the denial's basis.
  •  

  • Prepare to file an appeal with the help of your healthcare provider, providing any necessary documentation or explanations.

 

Understand Your Cost-Sharing Details

 

  • Be aware of any co-pays, deductibles, or co-insurance components that apply to the prescription of Chantix under your plan.
  •  

  • Review your benefits summary to ensure there are no surprises in cost-sharing and budget accordingly.

 

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.

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.

Chantix FAQ

What are the side effects of Chantix?

 

Common Side Effects of Chantix

 

  • Nausea, which is often dose-related and may decrease over time.
  • Insomnia or abnormal dreams, such as vivid or unusual dreams.
  • Constipation and gas due to changes in the digestive process.
  • Headaches, a frequent but generally mild occurrence.

 

Less Frequent but Serious Side Effects

 

  • Mood changes like depression or anxiety, warranting immediate medical attention.
  • Seizures, although rare, can occur and should be immediately addressed.
  • Heart issues, including an increased risk of cardiovascular events.

 

Additional Precautions

 

  • Monitor for allergic reactions, such as rash, itching, or swelling.
  • Use caution when consuming alcohol, as interactions might increase intoxication.
  • Consult a healthcare provider before use if there is a history of mental health issues.

 

How does Chantix help you quit smoking?

 

How Chantix Works

 

  • Chantix (varenicline) binds to nicotine receptors, reducing cravings by partially stimulating dopamine release to lessen withdrawal symptoms.
  •  

  • It acts as a partial agonist and antagonist, effectively blocking nicotine receptors; hence, smoking provides less pleasure.

 

Effective Usage

 

  • Start Chantix a week before quitting smoking to allow it to build up in your system.
  •  

  • Follow the prescribed plan: typically 0.5 mg once daily for three days, then twice daily, increasing to 1 mg twice daily.

 

Combine with Support

 

  • Chantix is more effective when used alongside behavioral support and counseling.
  •  

  • Seek support from healthcare providers or quit lines to enhance success rates.

 

Is Chantix available over the counter?

 

Is Chantix Available Over the Counter?

 

  • Chantix, known generically as varenicline, is a prescription medication. It is not available over-the-counter (OTC) in the United States. You will need a prescription from a healthcare provider to obtain it.
  •  

  • This medication is primarily used to help people quit smoking by reducing withdrawal symptoms and cigarette cravings.
  •  

  • Availability can vary by country, so it’s important to check local regulations regarding prescription requirements.
  •  

  • Always consult a healthcare professional before starting Chantix to understand potential side effects and interactions with other medications you may be taking.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

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.”
Becky D.
"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.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

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.

Made in Webflow