Does SummaCare Cover Januvia

Explore SummaCare's Januvia coverage, denial reasons, costs without insurance, and FAQs. Learn how to secure coverage efficiently.
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Does SummaCare Cover Januvia?

 

  • SummaCare may cover Januvia, an oral diabetes medication, under its prescription drug plan. Coverage can vary based on the specific plan type.
  •  

  • Generally, to get Januvia covered, it must be medically necessary and prescribed by a healthcare provider as part of your diabetes treatment.
  •  

  • Ensure that Januvia is on your specific SummaCare plan's formulary, as coverage is often subject to formulary listings.
  •  

  • Members may need to meet certain criteria, such as prior authorization or step therapy requirements, which means trying other medications first.
  •  

  • Cost-sharing, such as copayments or coinsurance, may apply, depending on your plan's details.
  •  

  • It's advisable to contact SummaCare customer service or review the plan documents for the most accurate and personalized coverage information.

 

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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 Januvia Coverage with SummaCare

 

Check Your SummaCare Plan

 

  • Verify your current SummaCare insurance plan to ensure it offers prescription drug coverage.
  •  

  • Look for details in your policy documents or member portal to determine if Januvia or its therapeutic class is listed under covered medications.

 

Consult the SummaCare Formulary

 

  • Access the SummaCare drug formulary online or request a copy from customer service.
  •  

  • Search the formulary for Januvia to see if it is covered under your prescription plan. Note any requirements or conditions such as prior authorization or step therapy.

 

Contact SummaCare Customer Service

 

  • Reach out to SummaCare customer service for clarification about Januvia's coverage. Have your member ID ready for personalized assistance.
  •  

  • Inquire about any specific steps or documentations needed to obtain coverage for Januvia.

 

Speak with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the need for Januvia and any alternative medications that might be more easily covered.
  •  

  • Ask your provider to submit a prior authorization request to SummaCare if required for Januvia.

 

Submit Required Documentation

 

  • Provide any required documentation to SummaCare as instructed during your customer service call or in the formulary guidelines.
  •  

  • Ensure all forms are correctly filled out, signed, and submitted within any given deadlines.

 

Follow Up with SummaCare

 

  • Monitor the status of your coverage request for Januvia by contacting SummaCare directly or checking your member portal.
  •  

  • Respond promptly to any additional requests for information or clarification from SummaCare to avoid delays in processing your coverage approval.

 

Evaluate Your Coverage Options

 

  • If Januvia is not covered, speak with SummaCare about potential alternatives or generic options that may be available.
  •  

  • Consider discussing any financial assistance programs or discounts directly offered by the manufacturer if coverage for Januvia remains unobtainable.

 

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FAQs

Does SummaCare Cover Januvia

Explore SummaCare's Januvia coverage, denial reasons, costs without insurance, and FAQs. Learn how to secure coverage efficiently.
Curex allergy drops unboxing

Is Januvia Covered by SummaCare

 

Does SummaCare Cover Januvia?

 

  • SummaCare may cover Januvia, an oral diabetes medication, under its prescription drug plan. Coverage can vary based on the specific plan type.
  •  

  • Generally, to get Januvia covered, it must be medically necessary and prescribed by a healthcare provider as part of your diabetes treatment.
  •  

  • Ensure that Januvia is on your specific SummaCare plan's formulary, as coverage is often subject to formulary listings.
  •  

  • Members may need to meet certain criteria, such as prior authorization or step therapy requirements, which means trying other medications first.
  •  

  • Cost-sharing, such as copayments or coinsurance, may apply, depending on your plan's details.
  •  

  • It's advisable to contact SummaCare customer service or review the plan documents for the most accurate and personalized coverage information.

 

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SummaCare's Approved Criteria for Januvia Coverage

 

SummaCare's Approved Criteria for Januvia Coverage

 

  • Diagnosis of Type 2 Diabetes: Januvia is covered for individuals who have been diagnosed with Type 2 Diabetes Mellitus.
  •  

  • Requirement of Additional Glycemic Control: Coverage is available for patients who need supplementary glycemic control when diet and exercise are not enough in managing blood glucose levels.
  •  

  • Combination Therapy: Januvia is approved as a second or third-line therapy option and may be used in combination with other antidiabetic agents such as metformin, sulfonylureas, or insulin.
  •  

  • Intolerance or Contraindication to Alternatives: Patients who are intolerant or have contraindications to other options like metformin or sulfonylureas may be eligible for Januvia coverage.
  •  

  • Medical History Documentation: A comprehensive history that details previous and current pharmacological treatments related to diabetes management must be provided.
  •  

  • Compliance with Prescribed Regimen: Patients should exhibit a history of compliance with their treatment regimen, including lifestyle modifications.
  •  

  • Health Care Provider Supervision: Continued coverage requires periodic reassessment and monitoring of treatment efficacy by a healthcare professional.
  •  

  • Adherence to SummaCare's Formulary Guidelines: Eligibility must align with SummaCare’s formulary guidelines and prior authorization might be required.

 

Why SummaCare Might Deny Januvia Coverage

 

Reasons for Coverage Denial for Januvia

 

  • Januvia might not be covered if it is not deemed medically necessary by SummaCare's assessment criteria.
  •  

  • The drug may be excluded if it is not the preferred medication for the specific medical condition, according to SummaCare's formulary guidelines.
  •  

  • SummaCare might deny coverage if the patient has not tried or failed other first-line treatments, as prior authorization may require evidence of alternative treatments being ineffective.
  •  

  • If Januvia is prescribed for an off-label use that is not supported by SummaCare’s guidelines, the coverage could be denied.
  •  

  • Coverage might be denied if the patient does not meet specific age or other demographic criteria set by SummaCare for Januvia usage.
  •  

  • SummaCare may deny coverage due to lack of enrollment in a qualifying plan that includes this medication in its benefits.
  •  

  • If the requested quantity exceeds what is usually prescribed for medical necessity or the dosage is not approved by SummaCare, coverage may be declined.

 

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How Much Does Januvia Cost without Insurance?

 

Cost of Januvia Without Insurance

 

  • The cost of Januvia (sitagliptin) without insurance can vary based on the pharmacy and location but is typically around $500 to $600 for a 30-day supply of 100 mg tablets.
  •  

  • Prices may differ based on various factors, including pharmacy location, any discount programs available, or changes in the drug market.
  •  

  • It's advisable to check different pharmacies or consider discount programs and prescription savings cards, which can sometimes offer reductions on the retail price.
  •  

  • For individuals paying out of pocket, some online tools or pharmacy networks provide price comparison services to find the best possible rate for Januvia.

 

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 Januvia Coverage with SummaCare

 

Check Your SummaCare Plan

 

  • Verify your current SummaCare insurance plan to ensure it offers prescription drug coverage.
  •  

  • Look for details in your policy documents or member portal to determine if Januvia or its therapeutic class is listed under covered medications.

 

Consult the SummaCare Formulary

 

  • Access the SummaCare drug formulary online or request a copy from customer service.
  •  

  • Search the formulary for Januvia to see if it is covered under your prescription plan. Note any requirements or conditions such as prior authorization or step therapy.

 

Contact SummaCare Customer Service

 

  • Reach out to SummaCare customer service for clarification about Januvia's coverage. Have your member ID ready for personalized assistance.
  •  

  • Inquire about any specific steps or documentations needed to obtain coverage for Januvia.

 

Speak with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the need for Januvia and any alternative medications that might be more easily covered.
  •  

  • Ask your provider to submit a prior authorization request to SummaCare if required for Januvia.

 

Submit Required Documentation

 

  • Provide any required documentation to SummaCare as instructed during your customer service call or in the formulary guidelines.
  •  

  • Ensure all forms are correctly filled out, signed, and submitted within any given deadlines.

 

Follow Up with SummaCare

 

  • Monitor the status of your coverage request for Januvia by contacting SummaCare directly or checking your member portal.
  •  

  • Respond promptly to any additional requests for information or clarification from SummaCare to avoid delays in processing your coverage approval.

 

Evaluate Your Coverage Options

 

  • If Januvia is not covered, speak with SummaCare about potential alternatives or generic options that may be available.
  •  

  • Consider discussing any financial assistance programs or discounts directly offered by the manufacturer if coverage for Januvia remains unobtainable.

 

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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.

Januvia FAQ

What are the common side effects of Januvia?

 

Common Side Effects of Januvia

 

  • **Headache**: Often reported and can range from mild to moderate.
  •  

  • **Upper respiratory tract infections**: Can include symptoms like nasal congestion, sore throat, and runny nose.
  •  

  • **Sore throat**: May occur alongside other symptoms such as cough.
  •  

  • **Diarrhea**: Typically mild but can be uncomfortable.
  •  

  • **Nausea**: Some patients experience this, usually transient.
  •  

  • **Abdominal pain**: Not very common but can occur.
  •  

  • **Joint pain**: Although less common, can be experienced by some individuals.

How does Januvia work to control blood sugar?

 

How Januvia Works

 

  • Januvia (sitagliptin) is a DPP-4 inhibitor that enhances the body's own ability to control blood sugar levels by increasing incretin levels, hormones that help regulate insulin production.
  •  

  • Incretins like GLP-1 function by promoting insulin secretion from the pancreas when blood sugar levels are high, and they reduce glucose production in the liver.

 

Benefits

 

  • Prevents rapid glucose level increases after meals while maintaining normal insulin activity during fasting states.
  •  

  • Has a low risk of causing hypoglycemia, a common concern with some other diabetes medications.

 

Considerations

 

  • Commonly prescribed for patients with type 2 diabetes as part of a comprehensive health plan, including diet and exercise.
  •  

  • Adjustments may be necessary for those with renal impairment.

 

Can Januvia be taken with other diabetes medications?

 

Can Januvia Be Combined with Other Diabetes Medications?

 

  • Januvia, a DPP-4 inhibitor, is commonly used with other oral diabetes medications like metformin, sulfonylureas, or thiazolidinediones to improve blood sugar control.
  •  

  • When combined, careful monitoring is essential to avoid hypoglycemia, especially when Januvia is used with insulin or sulfonylureas which can lower blood sugar too much.
  •  

  • Consult your healthcare provider before combining januvia with any other medication to tailor treatment to your specific needs and health status.
  •  

  • There generally aren’t major drug-drug interaction concerns with Januvia, but liver and kidney function should be regularly assessed as they might affect treatment.

 

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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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