$49$0.99

Does UPMC Health Plan Cover Orencia

Explore reasons for coverage denial, steps to secure coverage, out-of-pocket costs, and common questions about Orencia with UPMC Health Plan in this informative guide.

Treat your allergies with Curex

as seen on

“Curex is changing the landscape of allergies in 2024”

Coverage for Orencia

UPMC Health Plan covers Orencia when prescribed for FDA-approved conditions such as rheumatoid arthritis, psoriatic arthritis, or juvenile idiopathic arthritis.

Prior authorization is typically required, ensuring the medication is medically necessary and meets specific guideline criteria.

Certain policyholders might need to try other less expensive medications before Orencia is approved, following step therapy protocols.

Criteria for Approval

A confirmed diagnosis by a healthcare professional experienced in treating autoimmune conditions.

Evidence of inadequate response or intolerance to conventional disease-modifying antirheumatic drugs (DMARDs) or other biologics.

Current enrollment in a UPMC Health Plan that includes prescription drug benefits for Orencia.

Important Notes

Patients should consult their specific plan documents for detailed information on covered benefits.

Consult a healthcare provider or plan representative to assist with the authorization process and understand coverage limitations.

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49 $9.99

Review your allergy test results with a Curex allergist.

Start Now

Clinical Support

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 Orencia Coverage with UPMC Health Plan

Review Your Orencia Prescription

Consult your healthcare provider to confirm that Orencia is medically necessary for you and obtain a valid prescription.
Make sure all relevant information, such as dosage and duration of treatment, is included in the prescription.

Verify Your UPMC Health Plan Coverage

Check your current UPMC Health Plan to determine if Orencia is included under your coverage plan. You can do this by reviewing your policy documents or logging into the UPMC Health Plan member portal.
Contact UPMC Health Plan member services directly to ask if Orencia is covered and what documentation is required for coverage.

Get Prior Authorization

Some medications require prior authorization to ensure they are being used appropriately. Contact UPMC Health Plan to find out if Orencia requires prior authorization.
Work with your healthcare provider to submit a prior authorization request, accompanied by medical records and documentation supporting the medical necessity for Orencia.

Gather Necessary Documentation

Collect all necessary documents, such as doctor’s notes, lab results, and detailed medical history, that justify the need for Orencia.
Ensure you have the original prescription from your healthcare provider.

Submit a Coverage Request

Submit the coverage request to UPMC Health Plan along with all required documentation and your prescription.
Use the method specified by UPMC Health Plan, which could be online, by mail, or fax.

Follow Up with UPMC Health Plan

Regularly follow up with UPMC Health Plan once your coverage request is submitted to ensure it is being processed timely.
If the request is approved, confirm the details of your Orencia coverage, such as co-payments, and discuss any ongoing criteria or approvals needed.

Appeal a Denied Request

If your initial request is denied, review the reasons provided by UPMC Health Plan.
Work with your healthcare provider to address any issues or to gather additional evidence of medical necessity, and then submit an appeal to UPMC Health Plan.

Coordinate with Your Pharmacy

Contact your preferred pharmacy to inform them of your Orencia prescription and its coverage approval from UPMC Health Plan.
Ensure they have all necessary information to process your prescription under your insurance plan.

Happy Customers

We love helping people!

Allie, Nevada

"I have two cats I can finally cuddle!"
‍

Cat and dog allergies

Zachary, Texas

“I can breathe through my nose for the first time in like 20 years!"

Dust and mold allergies

Erika, New York

“I've noticed less sneezing and shortness of breath.”

Tree and grass allergies

Richard, Texas

I love the convenience!
‍

Tree and cat allergies

We Treat Allergies

Food Allergies

Weed Pollens

Cat Allergies

Dog Allergies

Dust Mites

Molds

Tree Pollens

curex user showing allergy treatment kit

a male patient showing allergy drops vial

50,000+ users have overcome their allergies

Am I eligible?

At-home Immunotherapy

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option

Treatment prescribed
by clinician

Clinicaly made allergen extracts are customized for your allergies

Your immune system gets desensitized to allergens, giving you long-term relief.

FAQs

Does UPMC Health Plan Cover Orencia

Explore reasons for coverage denial, steps to secure coverage, out-of-pocket costs, and common questions about Orencia with UPMC Health Plan in this informative guide.

Achieve Your Goals Faster with Curex

Is Orencia Covered by UPMC Health Plan

Coverage for Orencia

UPMC Health Plan covers Orencia when prescribed for FDA-approved conditions such as rheumatoid arthritis, psoriatic arthritis, or juvenile idiopathic arthritis.

Prior authorization is typically required, ensuring the medication is medically necessary and meets specific guideline criteria.

Certain policyholders might need to try other less expensive medications before Orencia is approved, following step therapy protocols.

Criteria for Approval

A confirmed diagnosis by a healthcare professional experienced in treating autoimmune conditions.

Evidence of inadequate response or intolerance to conventional disease-modifying antirheumatic drugs (DMARDs) or other biologics.

Current enrollment in a UPMC Health Plan that includes prescription drug benefits for Orencia.

Important Notes

Patients should consult their specific plan documents for detailed information on covered benefits.

Consult a healthcare provider or plan representative to assist with the authorization process and understand coverage limitations.

A weight management program tailored to you

Start with Curex

UPMC Health Plan's Approved Criteria for Orencia Coverage

Criteria for Orencia Coverage by UPMC Health Plan

Orencia may be covered when prescribed for the treatment of moderate to severe rheumatoid arthritis in adults, with inadequate response to one or more Disease Modifying Anti-Rheumatic Drugs (DMARDs).

Eligible coverage is provided for adult patients diagnosed with moderate to severe psoriatic arthritis, following the medical management criteria set by UPMC Health Plan.

Candidates for coverage must have attempted prior therapy with a TNF inhibitor, unless contraindicated or intolerant, and demonstrate ineffectiveness or adverse reaction towards such treatment.

Orencia may also be considered for children, aged six years and older, diagnosed with juvenile idiopathic arthritis, following the unsatisfactory response to at least one other DMARD.

Patients seeking coverage for Orencia must undergo and maintain regular follow-ups, with clinical documentation supporting continued benefit and stability with the drug therapy.

Coverage consideration requires detailed submission of prior medications tried, dosages, duration, and response outcomes as part of the medical documentation necessity.

UPMC Health Plan typically necessitates Orencia to be administered according to the recommended dosage schedule, ensuring appropriate use as determined by a healthcare professional.

Why UPMC Health Plan Might Deny Orencia Coverage

Situations Where UPMC Health Plan Does Not Cover Orencia

Off-Label Use: UPMC Health Plan denies coverage for Orencia when it is prescribed for uses not approved by the FDA or beyond its established and accepted indication.

Lack of Medical Necessity: Coverage is not provided if Orencia is determined not to be medically necessary, such as when the patient does not have a confirmed diagnosis aligning with the approved indications for the medication.

Failure to Meet Step Therapy Requirements: Members may be denied coverage if they have not tried and failed or have not shown an intolerance to previous therapies prescribed according to plan guidelines.

Incomplete Documentation: Claims for Orencia that lack the necessary clinical documentation to support its use can result in denial.

Non-Participating Providers: If Orencia is administered by a healthcare provider who is not part of the UPMC network, the coverage might be denied.

Non-Compliance with Plan Guidelines: If prescribing does not adhere to the specific guidelines set forth by UPMC, particularly regarding dosing and frequency, coverage may be denied.

Exceeding Quantity Limits: UPMC may deny claims if the prescribed quantity of Orencia exceeds the limits set by the health plan without an authorized exception.

Together with our partners we have changed the lives of over 300,000 patients.

Join Curex

How Much Does Orencia Cost without Insurance?

Cost of Orencia Without Insurance

The approximate cost for Orencia, when paying out of pocket without insurance, is between $4,500 to $5,000 per month. This cost can vary based on dosage, form (whether it's an IV infusion or subcutaneous injection), and the pharmacy or healthcare provider dispensing the medication.

Some patients may require different dosages which can further influence the cost, typically leading to higher expenses if more medication is required.

Patients without insurance may be eligible for manufacturer discounts or assistance programs, which can provide significant cost reductions. These programs often have specific eligibility requirements based on income and other factors.

Pharmacy discount cards or online services might offer slightly lower prices than traditional pharmacies.

Comparing costs between pharmacies and considering mail-order options can also help in reducing the overall expense.

Clinical Support

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

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

Kayla Mardaga, NP

How to Get Orencia Coverage with UPMC Health Plan

Review Your Orencia Prescription

Consult your healthcare provider to confirm that Orencia is medically necessary for you and obtain a valid prescription.
Make sure all relevant information, such as dosage and duration of treatment, is included in the prescription.

Verify Your UPMC Health Plan Coverage

Check your current UPMC Health Plan to determine if Orencia is included under your coverage plan. You can do this by reviewing your policy documents or logging into the UPMC Health Plan member portal.
Contact UPMC Health Plan member services directly to ask if Orencia is covered and what documentation is required for coverage.

Get Prior Authorization

Some medications require prior authorization to ensure they are being used appropriately. Contact UPMC Health Plan to find out if Orencia requires prior authorization.
Work with your healthcare provider to submit a prior authorization request, accompanied by medical records and documentation supporting the medical necessity for Orencia.

Gather Necessary Documentation

Collect all necessary documents, such as doctor’s notes, lab results, and detailed medical history, that justify the need for Orencia.
Ensure you have the original prescription from your healthcare provider.

Submit a Coverage Request

Submit the coverage request to UPMC Health Plan along with all required documentation and your prescription.
Use the method specified by UPMC Health Plan, which could be online, by mail, or fax.

Follow Up with UPMC Health Plan

Regularly follow up with UPMC Health Plan once your coverage request is submitted to ensure it is being processed timely.
If the request is approved, confirm the details of your Orencia coverage, such as co-payments, and discuss any ongoing criteria or approvals needed.

Appeal a Denied Request

If your initial request is denied, review the reasons provided by UPMC Health Plan.
Work with your healthcare provider to address any issues or to gather additional evidence of medical necessity, and then submit an appeal to UPMC Health Plan.

Coordinate with Your Pharmacy

Contact your preferred pharmacy to inform them of your Orencia prescription and its coverage approval from UPMC Health Plan.
Ensure they have all necessary information to process your prescription under your insurance plan.

Premium Medication you can trust

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.

Orencia FAQ

What are the common side effects of Orencia?

Common Side Effects of Orencia

**Infections:** Increased risk of upper respiratory infections, such as colds or sinus infections.

**Headache:** Mild to moderate headaches are commonly reported.

**Nausea:** Some patients may experience feelings of nausea.

**Fatigue:** Feeling unusually tired or weak can occur as well.

**Cough:** A persistent cough may develop during treatment.

**Pain:** Injection site reactions like redness or discomfort are possible.

How does Orencia work in treating rheumatoid arthritis?

How Orencia Works

Orencia is a biologic medication that targets specific components of the immune system to reduce inflammation in rheumatoid arthritis.

It works by binding to CD80/CD86 receptors on antigen-presenting cells, preventing the activation of T-cells, which play a critical role in the autoimmune response.

By inhibiting T-cell activation, Orencia helps decrease the inflammation and joint damage caused by rheumatoid arthritis.

Orencia is administered through injection, and its efficacy may take several weeks to become noticeable.

Benefits of Orencia

Reduces pain and swelling in affected joints, improving physical function.
Lowers the progression of joint damage over time.
Improves overall quality of life for patients with rheumatoid arthritis.

Is Orencia considered a biologic medication?

Orencia Overview

Orencia (abatacept) is classified as a biologic medication, used primarily to treat autoimmune conditions like rheumatoid arthritis.

Biologic Nature

It is a fusion protein that inhibits T-cell activation, an essential part of the immune response, thereby reducing inflammation.

Mechanism of Action

By blocking the co-stimulatory signal required for full T-cell activation, Orencia helps decrease abnormal immune responses involved in autoimmune diseases.

Administration and Use

Orencia is administered via intravenous infusion or subcutaneous injection, typically in a clinical setting.

Considerations

Patients should discuss potential benefits and risks with a healthcare professional, as Orencia may affect the immune system and increase the risk of infections.

Have questions left?

‍

Get a personalized online consultation with a doctor at Curex

Learn More

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”

Becky D.

"If I could give 6 stars, I would. BEST... BEST… BEST… service.”

Ferdian K.

“The Curex staff has been professional, efficient, and really focused on my individual needs.”

Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

Button Text

A weight management program tailored to you

Initial Dosage

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. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does UPMC Health Plan Cover Orencia

Explore reasons for coverage denial, steps to secure coverage, out-of-pocket costs, and common questions about Orencia with UPMC Health Plan in this informative guide.

Achieve Your Goals Faster with Curex