Does SummaCare Cover Jardiance

Explore Jardiance coverage with SummaCare, denial reasons, tips to secure coverage, costs without insurance, and answers to common questions.
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Coverage for Jardiance Under SummaCare

 

  • SummaCare may cover Jardiance, a medication used to manage type 2 diabetes, under its drug formulary. The extent of coverage depends on your specific health plan and its formulary tier structure.

 

Situations Where Coverage Applies

 

  • Certain SummaCare plans might cover Jardiance if it's prescribed by a healthcare provider to manage type 2 diabetes when other treatments haven't been effective or suitable.
  • Coverage may also depend on whether you've adhered to any step therapy processes required by SummaCare, which might necessitate trying other preferred medications first.

 

Basic Rules and Criteria

 

  • Plan members generally need prior authorization to receive coverage for Jardiance. This means your healthcare provider must demonstrate medical necessity.
  • Some health plans within SummaCare's network might require you to meet a deductible or co-payment for prescription drug benefits, including Jardiance.
  • Checking with SummaCare's customer support or your plan's Evidence of Coverage (EOC) document can clarify exact coverage details and individual responsibilities.

 

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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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 Jardiance Coverage with SummaCare

 

Check Your Current SummaCare Plan

 

  • Look over your existing SummaCare insurance plan documents to see if Jardiance is included in your medication coverage.
  •  

  • If you're unsure, contact SummaCare customer service for clarification regarding the inclusion of Jardiance.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Jardiance for your health condition.
  •  

  • Obtain a prescription indicating that Jardiance is medically necessary for your treatment plan.

 

Explore Formulary Lists and Tiers

 

  • Access SummaCare's drug formulary lists, which can typically be found on their website or by contacting their support team.
  •  

  • Identify the tier in which Jardiance is placed, as this will affect your co-pay or out-of-pocket expenses.

 

Understand SummaCare Requirements for Coverage

 

  • Check if SummaCare requires prior authorization for Jardiance, which is a common practice for covering specialty medications.
  •  

  • Make note of any required documentation or steps needed for obtaining prior authorization.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to complete and submit a prior authorization request form to SummaCare for Jardiance coverage.
  •  

  • Ensure all necessary medical information and justification for the prescription are included in the request.

 

Follow Up on Your Request

 

  • Contact SummaCare to confirm receipt of your prior authorization request and ask about the expected processing time.
  •  

  • If needed, be prepared to provide additional information or appeal a denial with supporting documentation from your healthcare provider.

 

Utilize SummaCare Customer Support

 

  • Use SummaCare's customer support services for any questions or assistance regarding the coverage process for Jardiance.
  •  

  • Maintain thorough records of all communications and documentation related to your Jardiance coverage request.

 

Consider Financial Assistance Programs

 

  • If you face difficulties in obtaining coverage, explore Jardiance manufacturer assistance programs or non-profit resources that may help reduce medication costs.
  •  

  • Discuss alternative options with your healthcare provider or SummaCare for managing treatment costs effectively.

 

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FAQs

Does SummaCare Cover Jardiance

Explore Jardiance coverage with SummaCare, denial reasons, tips to secure coverage, costs without insurance, and answers to common questions.
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Is Jardiance Covered by SummaCare

 

Coverage for Jardiance Under SummaCare

 

  • SummaCare may cover Jardiance, a medication used to manage type 2 diabetes, under its drug formulary. The extent of coverage depends on your specific health plan and its formulary tier structure.

 

Situations Where Coverage Applies

 

  • Certain SummaCare plans might cover Jardiance if it's prescribed by a healthcare provider to manage type 2 diabetes when other treatments haven't been effective or suitable.
  • Coverage may also depend on whether you've adhered to any step therapy processes required by SummaCare, which might necessitate trying other preferred medications first.

 

Basic Rules and Criteria

 

  • Plan members generally need prior authorization to receive coverage for Jardiance. This means your healthcare provider must demonstrate medical necessity.
  • Some health plans within SummaCare's network might require you to meet a deductible or co-payment for prescription drug benefits, including Jardiance.
  • Checking with SummaCare's customer support or your plan's Evidence of Coverage (EOC) document can clarify exact coverage details and individual responsibilities.

 

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SummaCare's Approved Criteria for Jardiance Coverage

 

Eligibility Criteria for Jardiance Coverage

 

  • The patient has a diagnosis of Type 2 Diabetes Mellitus (T2DM) and requires Jardiance as part of their treatment regimen.
  •  
  • The patient's current treatment includes lifestyle modifications such as diet and exercise.

 

Medical Necessity

 

  • Demonstrated need for Jardiance to improve glycemic control as evidenced by current A1C levels being above target, despite existing treatments.
  •  
  • The patient has been evaluated for alternative treatments and Jardiance has been deemed necessary based on medical history and clinical status.

 

Special Considerations

 

  • Jardiance may be approved for patients with established cardiovascular disease, where the use of Jardiance is indicated to reduce the risk of cardiovascular death in adult patients with T2DM.
  •  
  • Consideration for patients with established chronic kidney disease as Jardiance may slow the progression of this condition in T2DM patients.

 

Prescriber Requirements

 

  • Jardiance must be prescribed by an endocrinologist, a diabetologist, or another healthcare provider specialized in diabetes care.
  •  
  • The prescriber should provide thorough documentation including the patient’s current HbA1c level, history of previous diabetes medications tried, and the rationale for choosing Jardiance.

 

Renewal Criteria

 

  • Continued coverage for Jardiance requires evidence of clinical benefit, shown by improved or maintained glycemic control (reduction in A1C levels) since initiation of Jardiance.
  •  
  • Ongoing adherence to treatment and follow-up visits with the prescribing healthcare provider to assess efficacy and safety are required for renewal.

 

Why SummaCare Might Deny Jardiance Coverage

 

Reasons SummaCare Might Deny Jardiance Coverage

 

  • Failure to Meet Medical Necessity: If Jardiance is not deemed medically necessary for the patient's condition, SummaCare may deny the coverage. This judgment is often based on whether other medications are more suitable or if Jardiance is not considered the primary treatment option.
  •  

  • Non-Formulary Status: Jardiance may not be included in SummaCare's formulary or approved list of medications, leading to coverage denial. This occurs when the drug is either not listed or available through alternative preferred medications.
  •  

  • Lack of Prior Authorization: Jardiance coverage might require prior authorization, and failure to obtain this authorization before filling the prescription can result in denial. Prior authorization involves getting approval from SummaCare to ensure that the medication is necessary and covered.
  •  

  • Prescription Quantity Limits: SummaCare may impose quantity limits on prescriptions. If a Jardiance prescription exceeds these limits without justification, coverage can be denied. A physician may need to provide additional information to justify amounts exceeding standard limits.
  •  

  • Exclusion Due to Policy Limitations: Certain policies may specifically exclude coverage for certain drugs, including Jardiance, under their terms and limitations. This could be based on specific plan exclusions or restrictions that do not align with therapy involving Jardiance.
  •  

  • Missing or Incorrect Diagnosis Codes: If the claims for Jardiance lack necessary documentation or have inaccurate diagnosis codes that justify its use, the claim could be denied. Proper coding supporting the use of Jardiance is critical for coverage.

 

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How Much Does Jardiance Cost without Insurance?

 

Estimated Cost of Jardiance Without Insurance

 

  • The cost of Jardiance can vary depending on the pharmacy you visit, but as an oral medication used primarily to treat type 2 diabetes, it is often priced at a premium. Without insurance, the average monthly cost is approximately $550 to $650 for a 30-day supply of 10 mg or 25 mg tablets.
  •  

  • Prices can also vary based on location, pharmacy discounts, and available manufacturer coupons, so it's advisable to shop around or look for any available patient assistance programs to potentially lower the out-of-pocket cost.

 

Ways to Lower the Cost of Jardiance

 

  • **Pharmacy Discount Cards:** Utilizing pharmacy discount cards can sometimes provide substantial savings on your prescription, reducing the price by a notable percentage.
  •  

  • **Manufacturer Coupons and Programs:** Eli Lilly, the manufacturer of Jardiance, may offer savings cards or assistance programs to help eligible patients reduce their costs. It's worth checking through their official website or consulting with your healthcare provider.
  •  

  • **Generic Alternatives:** Although there may not be a generic version of Jardiance available currently, consulting with your healthcare provider about other generic medications for your condition may offer a more budget-friendly option.
  •  

  • **Bulk Purchasing Options:** Some pharmacies might offer discounts for purchasing a 90-day supply instead of a 30-day supply, which can lead to savings in the long term.

 

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 Jardiance Coverage with SummaCare

 

Check Your Current SummaCare Plan

 

  • Look over your existing SummaCare insurance plan documents to see if Jardiance is included in your medication coverage.
  •  

  • If you're unsure, contact SummaCare customer service for clarification regarding the inclusion of Jardiance.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Jardiance for your health condition.
  •  

  • Obtain a prescription indicating that Jardiance is medically necessary for your treatment plan.

 

Explore Formulary Lists and Tiers

 

  • Access SummaCare's drug formulary lists, which can typically be found on their website or by contacting their support team.
  •  

  • Identify the tier in which Jardiance is placed, as this will affect your co-pay or out-of-pocket expenses.

 

Understand SummaCare Requirements for Coverage

 

  • Check if SummaCare requires prior authorization for Jardiance, which is a common practice for covering specialty medications.
  •  

  • Make note of any required documentation or steps needed for obtaining prior authorization.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to complete and submit a prior authorization request form to SummaCare for Jardiance coverage.
  •  

  • Ensure all necessary medical information and justification for the prescription are included in the request.

 

Follow Up on Your Request

 

  • Contact SummaCare to confirm receipt of your prior authorization request and ask about the expected processing time.
  •  

  • If needed, be prepared to provide additional information or appeal a denial with supporting documentation from your healthcare provider.

 

Utilize SummaCare Customer Support

 

  • Use SummaCare's customer support services for any questions or assistance regarding the coverage process for Jardiance.
  •  

  • Maintain thorough records of all communications and documentation related to your Jardiance coverage request.

 

Consider Financial Assistance Programs

 

  • If you face difficulties in obtaining coverage, explore Jardiance manufacturer assistance programs or non-profit resources that may help reduce medication costs.
  •  

  • Discuss alternative options with your healthcare provider or SummaCare for managing treatment costs effectively.

 

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Jardiance FAQ

What is Jardiance used for?

 

What is Jardiance Used For?

 

  • Jardiance is primarily used to manage type 2 diabetes by helping to lower blood sugar levels in adults.
  •  

  • It works by promoting the excretion of excess glucose through urine, thus reducing the amount of sugar the body absorbs.
  •  

  • In addition to blood sugar management, Jardiance is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.
  •  

  • Patients with heart failure may benefit from Jardiance as it helps in reducing the risk of hospitalization due to heart failure.

 

What are the side effects of Jardiance?

 

Common Side Effects of Jardiance

 

  • Urinary tract infections: Symptoms may include burning sensation while urinating and frequent urges.
  • Increased urination: This is due to Jardiance's mechanism of removing excess glucose via urine.

 

Serious Side Effects

 

  • Ketoacidosis: This rare condition might present as difficulty breathing, nausea, or confusion.
  • Dehydration: Symptoms can be dizziness or light-headedness, especially upon standing.

 

Allergic Reactions

 

  • Rash or hives can occur, requiring immediate medical attention.

 

Precautions

 

  • Consult your healthcare provider before starting if you have kidney issues or are on diuretics.

 

Can Jardiance cause weight loss?

 

Can Jardiance Cause Weight Loss?

 

  • Yes, Jardiance (empagliflozin) can lead to weight loss. This medication is primarily used to treat type 2 diabetes.
  •  

  • It works by preventing glucose reabsorption in the kidneys, leading to glucose excretion through urine, which may also result in calorie loss.
  •  

  • Clinical trials have shown weight reduction as a common side effect, often averaging 2-3 kg.
  •  

  • This loss can differ among individuals; factors like diet and exercise may influence the extent of weight change.
  •  

  • Always consult with healthcare professionals to understand the benefits and risks associated with your specific health condition.

 

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Titration

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

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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.

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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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