Does SummaCare Cover Trelegy

Explore SummaCare's Trelegy coverage criteria, tips for approval, costs without insurance, and common questions answered in our comprehensive guide.
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Does SummaCare Cover Trelegy?

 

  • SummaCare covers Trelegy under its prescription drug benefits, which typically include coverage for a range of medications prescribed to manage chronic conditions like COPD and asthma.
  •  

  • Coverage may vary based on your specific plan and whether Trelegy is listed on SummaCare’s formulary. It is important to check the formulary or contact SummaCare directly for confirmation.

 

Basic Criteria for Coverage

 

  • To get Trelegy covered, it usually must be deemed medically necessary by your healthcare provider and prescribed for an FDA-approved indication.
  •  

  • Prior authorization may be required, meaning that your healthcare provider must justify the medical necessity to SummaCare before coverage is approved.
  •  

  • Be aware of co-pays or any applicable deductibles determined by your specific SummaCare plan. These costs can influence out-of-pocket expenses when obtaining Trelegy.

 

General Recommendations

 

  • Consult your healthcare provider to determine if Trelegy is suitable for your condition and to assist with the prior authorization process if needed.
  •  

  • Contact SummaCare member services or review their online resources for details on pharmacy networks and specific plan details regarding Trelegy coverage.
  •  

  • Stay informed about any changes to your insurance plan that might affect prescription drug coverage.

 

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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.

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 Trelegy Coverage with SummaCare

 

Check Your Current SummaCare Plan

 

  • Gather your SummaCare insurance documents, or log into your SummaCare member portal to review your current plan details.
  •  

  • Verify if your plan includes prescription drug coverage. Trelegy is typically covered under such plans.

 

Contact SummaCare Customer Service

 

  • Call SummaCare's customer service helpline, which you can find on your insurance card or the SummaCare website, to get detailed information about your plan's prescription drug benefits.
  •  

  • Ask specifically about Trelegy coverage under your plan or any prerequisites like prior authorization that's needed for coverage.

 

Consult Your Healthcare Provider

 

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

  • If required, request the healthcare provider to prepare any needed documentation or justification for why Trelegy is necessary for your treatment.

 

Submit Prior Authorization Request

 

  • If prior authorization is needed, work with your healthcare provider to submit the proper request to SummaCare.
  •  

  • Ensure all necessary forms and supporting documents are included when submitting the request to avoid any delays.

 

Monitor Claim Status

 

  • After the submission, regularly check the claim status through your SummaCare member portal or by contacting customer service.
  •  

  • If you face any issues or delays, follow up with both SummaCare and your healthcare provider for any additional information they may require.

 

Appeal If Necessary

 

  • If the initial request for Trelegy coverage is denied, thoroughly review the denial reason provided by SummaCare.
  •  

  • Work with your healthcare provider to gather additional documentation and potentially file an appeal to have the decision reconsidered.

 

Review Cost-Sharing Details

 

  • Once coverage is approved, check your plan’s cost-sharing details, such as co-pays or deductibles, for Trelegy.
  •  

  • Understand any additional costs you may be responsible for to enable proper financial planning.

 

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FAQs

Does SummaCare Cover Trelegy

Explore SummaCare's Trelegy coverage criteria, tips for approval, costs without insurance, and common questions answered in our comprehensive guide.
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Is Trelegy Covered by SummaCare

 

Does SummaCare Cover Trelegy?

 

  • SummaCare covers Trelegy under its prescription drug benefits, which typically include coverage for a range of medications prescribed to manage chronic conditions like COPD and asthma.
  •  

  • Coverage may vary based on your specific plan and whether Trelegy is listed on SummaCare’s formulary. It is important to check the formulary or contact SummaCare directly for confirmation.

 

Basic Criteria for Coverage

 

  • To get Trelegy covered, it usually must be deemed medically necessary by your healthcare provider and prescribed for an FDA-approved indication.
  •  

  • Prior authorization may be required, meaning that your healthcare provider must justify the medical necessity to SummaCare before coverage is approved.
  •  

  • Be aware of co-pays or any applicable deductibles determined by your specific SummaCare plan. These costs can influence out-of-pocket expenses when obtaining Trelegy.

 

General Recommendations

 

  • Consult your healthcare provider to determine if Trelegy is suitable for your condition and to assist with the prior authorization process if needed.
  •  

  • Contact SummaCare member services or review their online resources for details on pharmacy networks and specific plan details regarding Trelegy coverage.
  •  

  • Stay informed about any changes to your insurance plan that might affect prescription drug coverage.

 

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SummaCare's Approved Criteria for Trelegy Coverage

 

Eligibility Criteria for Trelegy Coverage

 

  • Member must be diagnosed with Chronic Obstructive Pulmonary Disease (COPD), including chronic bronchitis and emphysema, or asthma as confirmed by pulmonary function tests.
  •  

  • The member should have had adequate trials of other inhalers or medications that are generally prescribed before Trelegy, but which were not effective or caused significant side effects.
  •  

  • Documented evidence of an exacerbation in the past year despite current therapy is required.
  •  

  • Treatment plan should include the use of Trelegy as a maintenance therapy to improve lung capacity and reduce COPD exacerbations or asthma attacks.

 

Prescription Requirements

 

  • The prescription for Trelegy must be written by a pulmonologist or a qualified specialist experienced in treating chronic lung diseases.
  •  

  • The member must be 18 years of age or older for COPD or asthma-related prescriptions of Trelegy. Adherence to age-specific guidelines is necessary.

 

Documentation and Review Considerations

 

  • Physician documentation must include a detailed account of previous therapies attempted, including dosages and duration, and the clinical reason for any discontinuation.
  •  

  • A recent spirometry report indicating airflow limitations consistent with COPD or asthma must be present in the patient's medical records.
  •  

  • Submission of a treatment plan that outlines expected clinical outcomes from the use of Trelegy.

 

Renewal Criteria

 

  • Renewal approvals will be based on evidence of improved lung function, reduced frequency of exacerbations, and enhanced quality of life as per the physician's evaluation.
  •  

  • The member must demonstrate adherence to the prescribed Trelegy regimen and follow-up visits to assess efficacy and monitor for adverse effects.

 

Why SummaCare Might Deny Trelegy Coverage

 

Situations Where SummaCare Might Deny Trelegy Coverage

 

  • **Non-Formulary Drug:** Trelegy may not be included in SummaCare's formulary, which could lead to a denial of coverage.
  •  

  • **Lack of Medical Necessity:** Coverage may be denied if SummaCare determines that Trelegy is not medically necessary for the patient's condition.
  •  

  • **Prior Authorization Not Obtained:** If prior authorization is required but not obtained before purchasing Trelegy, coverage may be denied.
  •  

  • **Step Therapy Requirements:** SummaCare might deny coverage if step therapy protocols are not followed, such as trying and failing other medications first.
  •  

  • **Out of Network Provider:** Obtaining Trelegy from an out-of-network pharmacy or provider without a valid exception request can lead to a denial of coverage.
  •  

  • **Policy Exclusions:** If Trelegy is specifically excluded under the individual's plan policy, SummaCare might deny coverage.
  •  

  • **Quantity Limits Exceeded:** Coverage may be denied if the prescription exceeds the quantity limits set by SummaCare for Trelegy.

 

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How Much Does Trelegy Cost without Insurance?

 

Approximate Cost of Trelegy Without Insurance

 

  • The cost of Trelegy Ellipta, without insurance, can vary significantly based on several factors like the pharmacy, geographical location, or available discounts. On average, patients can expect to pay between $550 to $650 for a 30-day supply.
  •  

  • Prices may also fluctuate depending on ongoing promotions or pharmacy memberships that can provide additional savings.
  •  

  • It’s advisable for patients to use discount cards, check for manufacturer coupons, or explore patient assistance programs to lower the out-of-pocket expense.
  •  

  • Shopping around, comparing prices at different pharmacies, or using online price comparison tools can also result in significant cost savings for Trelegy.

 

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 Trelegy Coverage with SummaCare

 

Check Your Current SummaCare Plan

 

  • Gather your SummaCare insurance documents, or log into your SummaCare member portal to review your current plan details.
  •  

  • Verify if your plan includes prescription drug coverage. Trelegy is typically covered under such plans.

 

Contact SummaCare Customer Service

 

  • Call SummaCare's customer service helpline, which you can find on your insurance card or the SummaCare website, to get detailed information about your plan's prescription drug benefits.
  •  

  • Ask specifically about Trelegy coverage under your plan or any prerequisites like prior authorization that's needed for coverage.

 

Consult Your Healthcare Provider

 

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

  • If required, request the healthcare provider to prepare any needed documentation or justification for why Trelegy is necessary for your treatment.

 

Submit Prior Authorization Request

 

  • If prior authorization is needed, work with your healthcare provider to submit the proper request to SummaCare.
  •  

  • Ensure all necessary forms and supporting documents are included when submitting the request to avoid any delays.

 

Monitor Claim Status

 

  • After the submission, regularly check the claim status through your SummaCare member portal or by contacting customer service.
  •  

  • If you face any issues or delays, follow up with both SummaCare and your healthcare provider for any additional information they may require.

 

Appeal If Necessary

 

  • If the initial request for Trelegy coverage is denied, thoroughly review the denial reason provided by SummaCare.
  •  

  • Work with your healthcare provider to gather additional documentation and potentially file an appeal to have the decision reconsidered.

 

Review Cost-Sharing Details

 

  • Once coverage is approved, check your plan’s cost-sharing details, such as co-pays or deductibles, for Trelegy.
  •  

  • Understand any additional costs you may be responsible for to enable proper financial planning.

 

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Trelegy FAQ

1. What are the side effects of Trelegy?

 

Common Side Effects of Trelegy

 

  • Headaches
  • Back pain
  • Hoarseness
  • Oral thrush

 

Serious Side Effects

 

  • Increased heart rate
  • Chest pain
  • High blood pressure
  • Pneumonia in COPD patients

 

Less Common Side Effects

 

  • Diarrhea
  • Cough
  • Sore throat
  • Gastrointestinal discomfort

 

Precautions

 

  • Monitor for worsening symptoms.
  • Consult a doctor for persistent side effects.

 

2. How does Trelegy compare to Breo?

 

Comparison of Trelegy and Breo

 

  • Trelegy combines three active ingredients: fluticasone furoate (a corticosteroid), umeclidinium (a long-acting muscarinic antagonist), and vilanterol (a long-acting beta2-agonist). Breo contains only two: fluticasone furoate and vilanterol.
  •  

  • This combination in Trelegy allows for better control of symptoms for COPD patients requiring more comprehensive therapy, whereas Breo is more suitable for those requiring less intensive treatment.
  •  

  • Both medications are administered once daily via inhalation, but Trelegy’s triple therapy provides a broader mechanism of action.
  •  

  • Side effects are generally similar, though patients transitioning from Breo to Trelegy may experience different responses due to the added component.

 

3. Is Trelegy a steroid?

 

Is Trelegy a Steroid?

 

  • Components: Trelegy contains three active ingredients: fluticasone furoate, umeclidinium, and vilanterol. Fluticasone furoate is a corticosteroid.
  •  

  • Steroid Role: The corticosteroid in Trelegy helps reduce inflammation in the airways, which is crucial for treating conditions like COPD and asthma.
  •  

  • Multi-Action: In addition to the steroid, umeclidinium (an anticholinergic) and vilanterol (a long-acting beta-agonist) work to relax and open the airways.
  •  

  • Usage: Trelegy is inhaled, delivering these components directly to the lungs for targeted action, minimizing systemic steroid exposure.

 

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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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