Does Tufts Health Plan Cover Lantus

Explore Tufts Health Plan's Lantus coverage, reasons for denial, cost without insurance, and tips to secure coverage. Get answers to key questions in our comprehensive FAQ.
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Lantus Coverage by Tufts Health Plan

 

  • Tufts Health Plan generally covers Lantus for patients with diabetes who require insulin therapy to manage their blood sugar levels.
  •  

  • Coverage is dependent on the specific plan and may require prior authorization from a healthcare provider.
  •  

  • Patients must demonstrate medical necessity, usually proven by a physician's prescription and diagnosis of diabetes.
  •  

  • Some plans may have quantity limits and require patients to try other forms of insulin before approving Lantus.
  •  

  • Co-pays and out-of-pocket costs can vary, so it is advisable to review the specific plan details or contact the Tufts Health Plan customer service for exact coverage information.

 

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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.

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.

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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 Lantus Coverage with Tufts Health Plan

 

Check Your Plan Details

 

  • Log in to your Tufts Health Plan member account on their official website to understand your specific coverage details.
  •  

  • Review the summary of benefits and coverage (SBC) document to determine if Lantus, a prescription medication, is covered under your plan.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your doctor to evaluate the medical necessity of Lantus for your condition.
  •  

  • Your healthcare provider can help justify the need for Lantus, which may be required for coverage approval.

 

Get Prior Authorization

 

  • Check if Lantus requires prior authorization through a call to Tufts Health Plan’s customer service or via their website.
  •  

  • If needed, have your healthcare provider submit a prior authorization request on your behalf, including documentation supporting the necessity of Lantus.

 

Submit a Prescription

 

  • Once any necessary prior authorization is obtained, have your prescription for Lantus sent to a pharmacy that is in-network for Tufts Health Plan.
  •  

  • Ensure the pharmacy is aware of any prior approval so they can process the prescription correctly under your insurance plan.

 

Check Formulary Status

 

  • Look up the formulary status for Lantus on Tufts Health Plan's website to see if it is included and what tier it falls under.
  •  

  • Understand how the formulary status might affect your co-payment and out-of-pocket costs for the medication.

 

Contact Customer Service

 

  • If you have any questions or difficulties, directly contact Tufts Health Plan customer service for assistance with Lantus coverage.
  •  

  • Customer service can also provide clarification and guidance through the steps if any issues arise.

 

Explore Financial Assistance Programs

 

  • If Lantus is not fully covered or you face high out-of-pocket costs, inquire about financial assistance programs either through Tufts or Sanofi, the manufacturer of Lantus.
  •  

  • These programs may offer discounts or co-pay assistance to reduce the financial burden.

 

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FAQs

Does Tufts Health Plan Cover Lantus

Explore Tufts Health Plan's Lantus coverage, reasons for denial, cost without insurance, and tips to secure coverage. Get answers to key questions in our comprehensive FAQ.
Curex allergy drops unboxing

Is Lantus Covered by Tufts Health Plan

 

Lantus Coverage by Tufts Health Plan

 

  • Tufts Health Plan generally covers Lantus for patients with diabetes who require insulin therapy to manage their blood sugar levels.
  •  

  • Coverage is dependent on the specific plan and may require prior authorization from a healthcare provider.
  •  

  • Patients must demonstrate medical necessity, usually proven by a physician's prescription and diagnosis of diabetes.
  •  

  • Some plans may have quantity limits and require patients to try other forms of insulin before approving Lantus.
  •  

  • Co-pays and out-of-pocket costs can vary, so it is advisable to review the specific plan details or contact the Tufts Health Plan customer service for exact coverage information.

 

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Tufts Health Plan's Approved Criteria for Lantus Coverage

 

Criteria for Lantus Coverage

 

  • **Lantus Coverage for Diabetes Management**: Tufts Health Plan covers Lantus for individuals diagnosed with diabetes requiring insulin therapy. Patients must have documentation supporting the need for a long-acting insulin to achieve glycemic control.
  •  

  • **Prior Insulin Therapy Documentation**: Patients must provide evidence of inadequate control with other forms of insulin, necessitating a change to or addition of a long-acting basal insulin like Lantus.
  •  

  • **Treatment Plan Approval**: A documented treatment plan from the prescribing healthcare professional must be submitted, indicating the expected benefits of Lantus as part of a comprehensive diabetes management strategy.
  •  

  • **Age Appropriateness**: Lantus is covered for patients who meet the age criterion that aligns with its FDA approval for use in both adult and pediatric diabetic patients aged six years and older.
  •  

  • **Specialist Consultation**: Documentation of a specialist, such as an endocrinologist, overseeing or consulting on the treatment plan may enhance coverage approvability under Tufts Health Plan.
  •  

  • **Compliance with Treatment Guidelines**: The prescribing physician must show adherence to established diabetes treatment guidelines, justifying the necessity of using Lantus.
  •  

  • **Continued Coverage**: For continued Lantus coverage, patients may need to submit evidence of efficacy and adherence after an initial period, often through medical review by the health plan.

 

Why Tufts Health Plan Might Deny Lantus Coverage

 

When Coverage Might be Denied

 

  • Tufts Health Plan may deny Lantus coverage if the prescribed use does not align with its approved medical guidelines and policies.
  •  

  • If sufficient documentation supporting medical necessity for Lantus is not provided, Tufts Health Plan might not approve coverage.
  •  

  • Coverage may be denied if there are available and medically appropriate alternatives to Lantus that are more cost-effective according to Tufts Health Plan's formulary policies.
  •  

  • Requests not in compliance with Tufts Health Plan's prior authorization and step therapy requirements could lead to denial of Lantus coverage.
  •  

  • Lantus may not be covered if the request does not meet the clinical criteria established by Tufts Health Plan for insulin treatments.
  •  

  • If the prescribed dosage exceeds the maximum amount without a justified medical rationale, Tufts Health Plan might deny coverage.

 

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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 Tufts Health Plan

 

Check Your Plan Details

 

  • Log in to your Tufts Health Plan member account on their official website to understand your specific coverage details.
  •  

  • Review the summary of benefits and coverage (SBC) document to determine if Lantus, a prescription medication, is covered under your plan.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your doctor to evaluate the medical necessity of Lantus for your condition.
  •  

  • Your healthcare provider can help justify the need for Lantus, which may be required for coverage approval.

 

Get Prior Authorization

 

  • Check if Lantus requires prior authorization through a call to Tufts Health Plan’s customer service or via their website.
  •  

  • If needed, have your healthcare provider submit a prior authorization request on your behalf, including documentation supporting the necessity of Lantus.

 

Submit a Prescription

 

  • Once any necessary prior authorization is obtained, have your prescription for Lantus sent to a pharmacy that is in-network for Tufts Health Plan.
  •  

  • Ensure the pharmacy is aware of any prior approval so they can process the prescription correctly under your insurance plan.

 

Check Formulary Status

 

  • Look up the formulary status for Lantus on Tufts Health Plan's website to see if it is included and what tier it falls under.
  •  

  • Understand how the formulary status might affect your co-payment and out-of-pocket costs for the medication.

 

Contact Customer Service

 

  • If you have any questions or difficulties, directly contact Tufts Health Plan customer service for assistance with Lantus coverage.
  •  

  • Customer service can also provide clarification and guidance through the steps if any issues arise.

 

Explore Financial Assistance Programs

 

  • If Lantus is not fully covered or you face high out-of-pocket costs, inquire about financial assistance programs either through Tufts or Sanofi, the manufacturer of Lantus.
  •  

  • These programs may offer discounts or co-pay assistance to reduce the financial burden.

 

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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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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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