Does SummaCare Cover Lantus

Find out how to secure SummaCare coverage for Lantus, reasons for denial, costs without insurance, and get answers to frequently asked questions.
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SummaCare Coverage for Lantus

 

  • Check if Lantus is listed on the SummaCare formulary, as coverage may vary based on specific plan policies.
  •  

  • Lantus coverage typically applies to managing diabetes under conditions specified by your healthcare provider.
  •  

  • Prior authorization might be required, where medical necessity is verified before approving Lantus.
  •  

  • You may need to demonstrate continuous symptoms of diabetes or ineffective response to other insulin treatments.
  •  

  • A valid prescription from your healthcare provider is mandatory to obtain coverage for Lantus.
  •  

  • Co-pays or coinsurance may apply, which can differ based on your selected SummaCare plan.
  •  

  • Check for any step therapy rules, requiring you to try other medications before Lantus is approved.

 

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Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Lantus Coverage with SummaCare

 

Check Your SummaCare Plan's Formulary

 

  • Before initiating the process for Lantus coverage, first verify if Lantus is included in your specific SummaCare plan's formulary. The formulary is the list of drugs covered by your plan and is usually available on the SummaCare website.

 

Consult with Your Healthcare Provider

 

  • Discuss with your physician or endocrinologist about your need for Lantus and ask them to provide a prescription. Your healthcare provider can also suggest alternative medications if Lantus is not covered, or assist in providing necessary medical documentation to support why Lantus is essential for your treatment.

 

Contact SummaCare Customer Service

 

  • Reach out to SummaCare's customer service for detailed information on your coverage benefits regarding Lantus. They can elucidate the step-by-step process and any prerequisites that must be met for coverage, such as prior authorization requirements.

 

Obtain Prior Authorization if Required

 

  • If prior authorization is necessary, your healthcare provider will need to submit a request to SummaCare on your behalf, showcasing the necessity of Lantus for your condition. This process ensures that the prescribed treatment aligns with SummaCare’s medical guidelines.

 

Consider Generic Alternatives

 

  • Ask your pharmacist or healthcare provider if there are any generic alternatives or biosimilars of Lantus covered under your plan that can fulfill the same medical need.

 

Submit a Coverage Determination Request

 

  • If Lantus is not initially covered, you can file a coverage determination request or an appeal with SummaCare to review and potentially approve the medication based on your specific health needs. This requires submitting appropriate documentation and can lead to approval if justified.

 

Review Financial Assistance Programs

 

  • Investigate additional financial assistance programs available through the manufacturer or third-party organizations for Lantus. Even if your plan covers it partially, these programs can help reduce out-of-pocket costs further.

 

Follow-up and Stay Informed

 

  • After submitting any requests or documentation, regularly follow up with both SummaCare and your healthcare provider to ensure that all processes are progressing smoothly. Keep yourself updated about any changes in your plan that could affect your medication coverage.

 

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FAQs

Does SummaCare Cover Lantus

Find out how to secure SummaCare coverage for Lantus, reasons for denial, costs without insurance, and get answers to frequently asked questions.
Curex allergy drops unboxing

Is Lantus Covered by SummaCare

 

SummaCare Coverage for Lantus

 

  • Check if Lantus is listed on the SummaCare formulary, as coverage may vary based on specific plan policies.
  •  

  • Lantus coverage typically applies to managing diabetes under conditions specified by your healthcare provider.
  •  

  • Prior authorization might be required, where medical necessity is verified before approving Lantus.
  •  

  • You may need to demonstrate continuous symptoms of diabetes or ineffective response to other insulin treatments.
  •  

  • A valid prescription from your healthcare provider is mandatory to obtain coverage for Lantus.
  •  

  • Co-pays or coinsurance may apply, which can differ based on your selected SummaCare plan.
  •  

  • Check for any step therapy rules, requiring you to try other medications before Lantus is approved.

 

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SummaCare's Approved Criteria for Lantus Coverage

 

SummaCare's Approved Criteria for Lantus Coverage

 

  • **Diagnosis of Diabetes**: SummaCare covers Lantus for individuals with a confirmed diagnosis of diabetes mellitus, which includes both Type 1 and Type 2 diabetes.
  •  

  • **Age Requirement**: Patients of any age who require insulin to manage their diabetes are eligible for Lantus coverage.
  •  

  • **Prescription by Healthcare Provider**: Coverage is approved if Lantus is prescribed by a licensed healthcare provider, such as an endocrinologist, general practitioner, or pediatrician, as part of the patient's diabetes management plan.
  •  

  • **Documented Blood Sugar Control**: Patients must demonstrate the necessity for insulin therapy through records of blood sugar levels and A1C results that indicate uncontrolled diabetes despite the use of oral medications or other interventions.
  •  

  • **Prior Insulin Use**: SummaCare covers Lantus for patients who have previously used other insulin formulations and require a long-acting insulin to maintain optimal blood glucose levels.
  •  

  • **Utilization of Insulin Pumps**: Individuals utilizing insulin pumps that are compatible with long-acting insulins, including Lantus, may qualify for coverage as part of their overall diabetes management strategy.
  •  

  • **Compliance with Treatment Guidelines**: Coverage is contingent on the patient's adherence to recommended diabetes treatment guidelines, including lifestyle modifications and regular monitoring of blood glucose levels.
  •  

  • **Medical Necessity Documentation**: A documented medical necessity for Lantus, supported by clinical evidence and rationale provided by the prescribing healthcare provider, is required for approval.
  •  

  • **Regular Follow-ups**: Patients must engage in regular follow-ups with their healthcare provider to assess the effectiveness of Lantus in their diabetes management and make any necessary adjustments to the treatment plan.

 

Why SummaCare Might Deny Lantus Coverage

 

Reasons for Denial of Lantus Coverage by SummaCare

 

  • Lantus is being requested for an off-label use that is not approved under SummaCare guidelines.
  •  

  • The patient does not meet the specific age-related criteria set by SummaCare for Lantus coverage.
  •  

  • An alternative and less expensive treatment option is available and preferred according to SummaCare's formulary.
  •  

  • The prescribed dosage of Lantus exceeds the maximum allowable limit stated in SummaCare’s policy.
  •  

  • Coverage for Lantus is denied if the patient has a history of non-compliance with SummaCare's step therapy requirements.
  •  

  • Lantus is not covered if the patient fails to provide sufficient medical documentation justifying the need for this specific insulin.
  •  

  • Requests for Lantus are not covered if prior authorization is not obtained or is denied based on SummaCare’s assessment.

 

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How Much Does Lantus Cost without Insurance?

 

Cost of Lantus Without Insurance

 

  • The price of Lantus (insulin glargine) without insurance can vary based on factors such as the pharmacy, location, and available discounts. Typically, the retail price ranges between $250 and $350 for a 10ml vial at a retail pharmacy.
  •  

  • For the Lantus SoloStar pen, which is a more convenient option for some, the price is generally similar, ranging from $400 to $500 for a pack of five pens.
  •  

  • Prices can fluctuate slightly, so it is advisable to check with local pharmacies or online services for the most current prices and potential savings options.
  •  

  • Consider exploring patient assistance programs offered by the manufacturer or third-party organizations, which might offer Lantus at reduced prices or even for free if you qualify based on income.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Lantus Coverage with SummaCare

 

Check Your SummaCare Plan's Formulary

 

  • Before initiating the process for Lantus coverage, first verify if Lantus is included in your specific SummaCare plan's formulary. The formulary is the list of drugs covered by your plan and is usually available on the SummaCare website.

 

Consult with Your Healthcare Provider

 

  • Discuss with your physician or endocrinologist about your need for Lantus and ask them to provide a prescription. Your healthcare provider can also suggest alternative medications if Lantus is not covered, or assist in providing necessary medical documentation to support why Lantus is essential for your treatment.

 

Contact SummaCare Customer Service

 

  • Reach out to SummaCare's customer service for detailed information on your coverage benefits regarding Lantus. They can elucidate the step-by-step process and any prerequisites that must be met for coverage, such as prior authorization requirements.

 

Obtain Prior Authorization if Required

 

  • If prior authorization is necessary, your healthcare provider will need to submit a request to SummaCare on your behalf, showcasing the necessity of Lantus for your condition. This process ensures that the prescribed treatment aligns with SummaCare’s medical guidelines.

 

Consider Generic Alternatives

 

  • Ask your pharmacist or healthcare provider if there are any generic alternatives or biosimilars of Lantus covered under your plan that can fulfill the same medical need.

 

Submit a Coverage Determination Request

 

  • If Lantus is not initially covered, you can file a coverage determination request or an appeal with SummaCare to review and potentially approve the medication based on your specific health needs. This requires submitting appropriate documentation and can lead to approval if justified.

 

Review Financial Assistance Programs

 

  • Investigate additional financial assistance programs available through the manufacturer or third-party organizations for Lantus. Even if your plan covers it partially, these programs can help reduce out-of-pocket costs further.

 

Follow-up and Stay Informed

 

  • After submitting any requests or documentation, regularly follow up with both SummaCare and your healthcare provider to ensure that all processes are progressing smoothly. Keep yourself updated about any changes in your plan that could affect your medication coverage.

 

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Lantus FAQ

What is Lantus used for?

 

What is Lantus Used For?

 

  • Lantus is primarily used to manage blood sugar levels in individuals with type 1 and type 2 diabetes.
  •  

  • It is a long-acting insulin, providing a steady release of insulin over a 24-hour period with no pronounced peak, mimicking natural insulin secretion.
  •  

  • It's taken once daily, often at the same time each day, helping to maintain consistent blood glucose control.
  •  

  • Beneficial for patients requiring basal insulin to prevent hyperglycemia between meals and overnight.
  •  

  • Alongside diet and exercise, Lantus is vital for comprehensive diabetes management.

 

How does Lantus work in the body?

 

How Lantus Works

 

  • Lantus is a long-acting insulin, also known as insulin glargine. It provides a stable and continuous release of insulin to control blood sugar levels.
  •  

  • The formulation of Lantus enables it to dissolve slowly upon injection, creating a slow and steady insulin level that lasts up to 24 hours.
  •  

  • This minimizes the risk of blood sugar peaks and troughs, providing more consistent blood glucose management.
  •  

  • Lantus mimics the basal level of insulin production in the pancreas, thus helping to maintain glucose balance between meals and overnight.
  •  

  • It binds to insulin receptors, facilitating glucose uptake into muscle and fat tissues, while inhibiting hepatic glucose production.

 

What are the side effects of Lantus?

 

Common Side Effects

 

  • Injection site reactions such as redness, swelling, or itching can occur.
  • Hypoglycemia, or low blood sugar, is a frequent side effect.
  • Weight gain may happen due to improved glucose utilization.

 

Less Common Side Effects

 

  • Allergic reactions like rash or itching may occur but are rare.
  • Systemic reactions such as swelling of hands/feet can occur.
  • Visual changes might be experienced during initial treatment.

 

Serious Side Effects

 

  • Severe hypoglycemia requiring intervention.
  • Signs of allergic reactions like difficulty breathing, require immediate attention.
  • Hypokalemia may develop, leading to muscle weakness or cramps.

 

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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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