Does SummaCare Cover Ozempic

Explore Ozempic coverage with SummaCare, reasons for denial, ways to get coverage, costs without insurance, and common FAQs.
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Coverage of Ozempic by SummaCare

 

  • Ozempic, a medication used to treat Type 2 diabetes, may be covered by SummaCare depending on specific health plans and medical necessity.
  •  

  • Coverage usually requires the prescription to be part of a comprehensive diabetes management plan provided by your healthcare provider.

 

Situations for Coverage

 

  • Ozempic is typically covered for individuals with a confirmed diagnosis of Type 2 diabetes who have not achieved sufficient glycemic control with alternative therapies.
  •  

  • The prescription must be deemed necessary by a licensed healthcare professional.

 

Basic Rules and Criteria

 

  • Pre-authorization might be needed, requiring documentation of previous treatment attempts and reasoning for Ozempic's necessity over other options.
  •  

  • Co-pays or deductibles may apply, depending on the specifics of your SummaCare health plan.
  •  

  • Patients might be required to adhere to a treatment plan or regular monitoring to ensure the medication's effectiveness.

 

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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.

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

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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 Ozempic Coverage with SummaCare

 

Determine Eligibility for Coverage

 

  • Review your current SummaCare prescription drug plan to check if Ozempic is included in the formulary. You can usually find this information in your plan materials or by logging into your account on the SummaCare website.
  •  

  • Contact SummaCare customer service for confirmation on whether Ozempic is covered under your specific plan. They can provide detailed coverage options and any applicable requirements.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Ozempic. Prepare to provide information about previous treatments and why Ozempic is necessary for your health condition.
  •  

  • Request that your healthcare provider submits a prior authorization request to SummaCare, if necessary. This process is important to confirm that Ozempic is clinically appropriate for your treatment.

 

Gather Documentation and Submit Claims

 

  • Collect any necessary documentation, such as your prescription and any relevant medical records, that might support your case for requiring Ozempic.
  •  

  • Submit a prescription claim to SummaCare through their prescription claims process. Ensure all information provided is accurate and complete to expedite the review process.

 

Follow Up on Your Claim

 

  • Keep in regular contact with SummaCare to monitor the status of your prescription claim. Make sure to address any additional information requests promptly.
  •  

  • If initial claims are denied, work with your healthcare provider to address any issues or appeal the decision using the proper SummaCare appeal process.

 

Understand Co-Pay Assistance Programs

 

  • Investigate if there are any manufacturer coupons or patient assistance programs available for Ozempic that might reduce your out-of-pocket costs, especially if some costs are not covered by SummaCare.
  •  

  • Discuss these options with your healthcare provider and pharmacist to maximize savings while ensuring proper medication management.

 

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FAQs

Does SummaCare Cover Ozempic

Explore Ozempic coverage with SummaCare, reasons for denial, ways to get coverage, costs without insurance, and common FAQs.
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Is Ozempic Covered by SummaCare

 

Coverage of Ozempic by SummaCare

 

  • Ozempic, a medication used to treat Type 2 diabetes, may be covered by SummaCare depending on specific health plans and medical necessity.
  •  

  • Coverage usually requires the prescription to be part of a comprehensive diabetes management plan provided by your healthcare provider.

 

Situations for Coverage

 

  • Ozempic is typically covered for individuals with a confirmed diagnosis of Type 2 diabetes who have not achieved sufficient glycemic control with alternative therapies.
  •  

  • The prescription must be deemed necessary by a licensed healthcare professional.

 

Basic Rules and Criteria

 

  • Pre-authorization might be needed, requiring documentation of previous treatment attempts and reasoning for Ozempic's necessity over other options.
  •  

  • Co-pays or deductibles may apply, depending on the specifics of your SummaCare health plan.
  •  

  • Patients might be required to adhere to a treatment plan or regular monitoring to ensure the medication's effectiveness.

 

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SummaCare's Approved Criteria for Ozempic Coverage

 

Eligibility Criteria for SummaCare Ozempic Coverage

 

  • Patients must have a confirmed diagnosis of Type 2 Diabetes Mellitus, signified in medical records.
  •  

  • Documentation of inadequate blood sugar control with lifestyle modifications and other antidiabetic agents, such as metformin, must be provided.
  •  

  • Body Mass Index (BMI) of 30 or greater, or BMI of 27 with obesity-related complications, is required for coverage.
  •  

  • The patient must have a documented history of trying and failing to achieve glycemic control with a minimum of two antihyperglycemic agents.
  •  

  • A recent A1C test result indicating levels above the targeted range conducive to diabetes management is required.
  •  

  • The prescribing healthcare professional must attest to the necessity of Ozempic for improving disease management.
  •  

  • Continuous medical supervision is required, with periodic follow-ups to assess Ozempic's efficacy and necessity.

 

Prescription and Supply Specifications

 

  • Ozempic must be prescribed by an endocrinologist, a diabetes specialist, or a healthcare professional with relevant experience in diabetes management.
  •  

  • Initial authorization will cover a supply period of three months, with subsequent renewals based on documented patient outcomes and clinical necessity.
  •  

  • Detailed dosage and administration instructions aligned with SummaCare’s pharmaceutical guidelines need to be reflected in the prescription.

 

Renewal and Continued Treatment Conditions

 

  • Approval for continuation of coverage requires proof of adherence to the treatment regimen and documentation of improved or stabilized A1C levels.
  •  

  • Annual renewal assessments must include a full review of the patient's diabetic management plan and evidence of ineffective alternative treatments if further usage of Ozempic is required.
  •  

  • The prescribing provider must submit a clinical assessment report supporting the need for ongoing Ozempic therapy aligned with SummaCare’s guidelines.

 

Why SummaCare Might Deny Ozempic Coverage

 

Situations When SummaCare Might Deny Ozempic Coverage

 

  • Ozempic prescribed for weight loss without a diabetes diagnosis. SummaCare may not cover Ozempic when it is prescribed solely for weight management or obesity treatment unless explicitly stated in the plan.
  •  

  • Use of Ozempic outside of FDA-approved indications. If Ozempic is being used for conditions that are not approved by the FDA or not covered under the specific terms of the policy, SummaCare might deny coverage.
  •  

  • Lack of prior authorization. If SummaCare requires prior authorization for Ozempic and it was not obtained before the prescription, coverage may be denied.
  •  

  • Failure to meet medical necessity criteria. If the prescribing physician cannot demonstrate that Ozempic is medically necessary according to SummaCare's guidelines, the claim for coverage might be denied.
  •  

  • Non-compliance with treatment plan. If there is evidence that the patient has not adhered to the prescribed treatment regimen, SummaCare may deny ongoing coverage for Ozempic.
  •  

  • Exceeding prescribed dosage limits. Coverage may be denied if the dosage prescribed exceeds the limits set by the SummaCare policy.
  •  

  • Prescription by an out-of-network provider without referrals or exceptions in place. If the prescribing physician is not within the SummaCare network and no referral or exception has been granted, coverage might be denied.
  •  

 

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How Much Does Ozempic Cost without Insurance?

 

Cost of Ozempic Without Insurance

 

  • The approximate cost of Ozempic without insurance is between $800 and $900 for a month's supply. This price can vary based on the pharmacy location and any available manufacturer discounts or special pharmacy promotions.
  •  

  • It's important to note that prices can fluctuate, so checking with multiple pharmacies or online services could provide more precise current pricing.
  •  

  • Patients may also consider enrolling in patient assistance programs offered by the manufacturer, Novo Nordisk, which may provide discounts or support for eligible individuals.

 

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 Ozempic Coverage with SummaCare

 

Determine Eligibility for Coverage

 

  • Review your current SummaCare prescription drug plan to check if Ozempic is included in the formulary. You can usually find this information in your plan materials or by logging into your account on the SummaCare website.
  •  

  • Contact SummaCare customer service for confirmation on whether Ozempic is covered under your specific plan. They can provide detailed coverage options and any applicable requirements.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Ozempic. Prepare to provide information about previous treatments and why Ozempic is necessary for your health condition.
  •  

  • Request that your healthcare provider submits a prior authorization request to SummaCare, if necessary. This process is important to confirm that Ozempic is clinically appropriate for your treatment.

 

Gather Documentation and Submit Claims

 

  • Collect any necessary documentation, such as your prescription and any relevant medical records, that might support your case for requiring Ozempic.
  •  

  • Submit a prescription claim to SummaCare through their prescription claims process. Ensure all information provided is accurate and complete to expedite the review process.

 

Follow Up on Your Claim

 

  • Keep in regular contact with SummaCare to monitor the status of your prescription claim. Make sure to address any additional information requests promptly.
  •  

  • If initial claims are denied, work with your healthcare provider to address any issues or appeal the decision using the proper SummaCare appeal process.

 

Understand Co-Pay Assistance Programs

 

  • Investigate if there are any manufacturer coupons or patient assistance programs available for Ozempic that might reduce your out-of-pocket costs, especially if some costs are not covered by SummaCare.
  •  

  • Discuss these options with your healthcare provider and pharmacist to maximize savings while ensuring proper medication management.

 

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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.

Ozempic FAQ

What are the common side effects of Ozempic?

 

Common Side Effects of Ozempic

 

  • Nausea: The most common side effect, often decreasing over time.
  •  

  • Vomiting: Can occur, especially at higher doses.
  •  

  • Diarrhea: May lead to dehydration; ensure adequate fluid intake.
  •  

  • Stomach (Abdominal) Pain: Often mild but can be bothersome.
  •  

  • Constipation: Can occur; manage with diet and hydration.
  •  

  • Reduced Appetite: May assist in weight loss but monitor nutritional intake.
  •  

  • Fatigue: Generally mild; ensure rest and hydration.
  •  

  • Dizziness: Monitor blood pressure and hydration levels.
  •  

  • Injection Site Reactions: Such as redness or irritation, usually temporary.

 

Ensure to discuss persistent or severe side effects with a healthcare provider.

Can Ozempic help with weight loss?

 

How Ozempic Aids Weight Loss

 

  • Ozempic contains semaglutide, a GLP-1 receptor agonist which enhances insulin release and suppresses appetite, facilitating weight loss.
  •  

  • The medication slows gastric emptying, increasing feelings of fullness and reducing calorie intake.

 

Considerations and Benefits

 

  • Clinical studies demonstrate significant weight reduction in people taking Ozempic, often used adjunctly with diet and exercise.
  •  

  • It can also help manage blood sugar levels, making it beneficial for individuals with type 2 diabetes.

 

Potential Side Effects

 

  • Common side effects include nausea, diarrhea, and vomiting, often decreasing over time.
  •  

  • Discuss with your healthcare provider to determine suitability, considering any existing conditions.

 

How does Ozempic work for diabetes?

 

How Ozempic Works for Diabetes

 

  • **Mechanism of Action:** Ozempic is a GLP-1 receptor agonist that mimics the incretin hormone, which decreases blood sugar levels by enhancing insulin secretion.
  •  

  • **Reducing Glucagon Levels:** It lowers glucagon release when blood glucose levels are high, which helps to reduce glucose production by the liver.
  •  

  • **Slows Gastric Emptying:** By delaying stomach emptying, it reduces the rapid spikes in blood glucose after meals.
  •  

  • **Increases Satiety:** It can suppress appetite, leading to possible weight loss, which is beneficial for type 2 diabetes management.

 

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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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