Does UPMC Health Plan Cover Trulicity

Explore UPMC Health Plan's coverage for Trulicity, reasons for denial, costs without insurance, and FAQs. Get tips on securing coverage effectively.
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Coverage of Trulicity by UPMC Health Plan

 

  • UPMC Health Plan generally provides coverage for Trulicity, a medication used to improve blood sugar control in adults with type 2 diabetes.
  •  

  • Coverage is subject to the specific terms of your health plan, so reviewing your plan's formulary and benefits is essential.
  •  

  • Prior authorization may be required, meaning your healthcare provider must obtain approval from the plan to ensure medical necessity.
  •  

  • In some cases, patients must have tried and not sufficiently benefitted from alternative diabetes medications before Trulicity is approved.
  •  

  • Individuals should consult their healthcare provider and contact UPMC Health Plan's customer service for personalized advice and verification of benefits.

 

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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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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 Trulicity Coverage with UPMC Health Plan

 

Review Your Current Prescription Plan

 

  • Contact UPMC Health Plan customer service to understand your current prescription drug coverage.
  •  

  • Request a detailed list of your formulary to see if Trulicity is covered.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Trulicity for your condition.
  •  

  • Acquire any necessary medical documentation that demonstrates the need for Trulicity.

 

Check UPMC Health Plan Formulary

 

  • Visit the UPMC Health Plan website to access their formulary list online.
  •  

  • Type "Trulicity" in the search box to verify its coverage status.

 

Acquaint Yourself with Your Plan's Tier System

 

  • Find out whether Trulicity is placed in a tier requiring higher co-pays or prior authorization.
  •  

  • Contact UPMC Health Plan's pharmacy department for clarity on tier status specifics.

 

Request Prior Authorization If Necessary

 

  • If Trulicity requires prior authorization, obtain the necessary forms from UPMC Health Plan.
  •  

  • Work with your doctor to complete and submit these forms, including all required medical information.

 

Appeal If Coverage is Denied

 

  • If your request for Trulicity coverage is denied, obtain detailed reasons for this decision from UPMC Health Plan.
  •  

  • Gather additional supporting documents from your doctor and file an appeal with UPMC Health Plan.
  •  

  • Stay in contact with UPMC Health Plan representatives and follow through the appeals process diligently.

 

Explore Patient Assistance Programs

 

  • If coverage is unattainable or costs are prohibitive, consider reaching out to Eli Lilly's patient assistance programs for Trulicity.
  •  

  • Look into other potential pharmaceutical assistance programs or co-pay cards that may reduce costs.

 

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FAQs

Does UPMC Health Plan Cover Trulicity

Explore UPMC Health Plan's coverage for Trulicity, reasons for denial, costs without insurance, and FAQs. Get tips on securing coverage effectively.
Curex allergy drops unboxing

Is Trulicity Covered by UPMC Health Plan

 

Coverage of Trulicity by UPMC Health Plan

 

  • UPMC Health Plan generally provides coverage for Trulicity, a medication used to improve blood sugar control in adults with type 2 diabetes.
  •  

  • Coverage is subject to the specific terms of your health plan, so reviewing your plan's formulary and benefits is essential.
  •  

  • Prior authorization may be required, meaning your healthcare provider must obtain approval from the plan to ensure medical necessity.
  •  

  • In some cases, patients must have tried and not sufficiently benefitted from alternative diabetes medications before Trulicity is approved.
  •  

  • Individuals should consult their healthcare provider and contact UPMC Health Plan's customer service for personalized advice and verification of benefits.

 

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UPMC Health Plan's Approved Criteria for Trulicity Coverage

 

UPMC Health Plan Coverage Criteria for Trulicity

 

  • **Diagnosis Requirement**: The patient must have a confirmed diagnosis of type 2 diabetes mellitus. Documentation of this diagnosis is required for coverage consideration.
  •  

  • **Age Requirement**: Coverage is provided for adults aged 18 years and older. The patient's age must be verified through appropriate documentation.
  •  

  • **Treatment Indications**: Trulicity is covered when used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.
  •  

  • **Previous Treatment Failure**: The patient should have a documented history of inadequate control of blood glucose levels with lifestyle modifications and/or with previous non-insulin antidiabetic medications.
  •  

  • **Prescription by a Specialist**: The drug should be prescribed by, or in consultation with, a healthcare provider experienced in the management of diabetes, typically an endocrinologist or a primary care provider specializing in diabetes.
  •  

  • **Dosage and Administration**: Coverage is provided for Trulicity as per FDA-approved dosing regimens. Prescriptions must conform to labeling parameters for the drug, including dosage amount and frequency.
  •  

  • **Additional Health Conditions**: If the patient has a history of heart disease, evidence of potential benefit of Trulicity as a secondary prevention method may enhance coverage considerations.
  •  

 

Why UPMC Health Plan Might Deny Trulicity Coverage

 

Reasons for Denial of Trulicity Coverage by UPMC Health Plan

 

  • **Non-Medical Necessity**: The plan may deny coverage if Trulicity is deemed not medically necessary for the patient's treatment according to their health guidelines and criteria.
  •  

  • **Exclusion from Plan Benefits**: Trulicity might be specifically excluded from the patient's plan benefits, meaning it is not included in the list of covered drugs.
  •  

  • **Off-Label Prescription**: If Trulicity is prescribed for a condition that is not FDA-approved or recognized by UPMC Health Plan for that medication, coverage may be denied.
  •  

  • **Failure to Meet Step Therapy Requirements**: The patient may be required to try and fail on a different medication before Trulicity is approved, failing which coverage might be denied.
  •  

  • **Non-Formulary Status**: If Trulicity is not on the plan's formulary, or preferred drug list, it may result in denial unless an exception is made.
  •  

  • **Inadequate Documentation**: Lack of necessary documentation or medical records that justify the use of Trulicity can lead to denial.
  •  

  • **Policy Waiting Periods**: If the patient is within a waiting period or if coverage has not yet commenced, the claim for Trulicity might be denied.
  •  

  • **Prior Authorization Not Obtained**: Some plans require prior authorization before covering certain medications like Trulicity. Failure to obtain this beforehand can lead to denial.
  •  

 

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How Much Does Trulicity Cost without Insurance?

 

Trulicity Cost Overview

 

  • Trulicity is a brand-name medication commonly used to treat type 2 diabetes. It's administered through a weekly injection.

 

Approximate Cost Without Insurance

 

  • The price of Trulicity can vary depending on the pharmacy or location, but the average cost for one pen of 1.5 mg/0.5 mL solution might run approximately $886 to $1,100.
  • Each box typically contains four pens, which is a month's supply, resulting in the total cost being roughly $3,544 to $4,400.

 

Factors Influencing Pricing

 

  • Pharmacy: Prices may differ from one pharmacy to another, so it’s beneficial to compare costs.
  • Location: Costs may vary based on geographic location due to regional pricing strategies and pharmacy benefits.
  • Discount Programs: Some pharmacies may offer savings programs or coupons that could lower the price.

 

Additional Cost-Saving Tips

 

  • Check for manufacturer discounts or patient assistance programs, which may offer significant savings or even free medication for qualified individuals.
  • Consider discussing alternative medications with your healthcare provider to find a more affordable option suitable for your needs.
  • Utilize pharmacy discount cards or look up savings programs online that specifically cater to diabetes medications.

 

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 Trulicity Coverage with UPMC Health Plan

 

Review Your Current Prescription Plan

 

  • Contact UPMC Health Plan customer service to understand your current prescription drug coverage.
  •  

  • Request a detailed list of your formulary to see if Trulicity is covered.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Trulicity for your condition.
  •  

  • Acquire any necessary medical documentation that demonstrates the need for Trulicity.

 

Check UPMC Health Plan Formulary

 

  • Visit the UPMC Health Plan website to access their formulary list online.
  •  

  • Type "Trulicity" in the search box to verify its coverage status.

 

Acquaint Yourself with Your Plan's Tier System

 

  • Find out whether Trulicity is placed in a tier requiring higher co-pays or prior authorization.
  •  

  • Contact UPMC Health Plan's pharmacy department for clarity on tier status specifics.

 

Request Prior Authorization If Necessary

 

  • If Trulicity requires prior authorization, obtain the necessary forms from UPMC Health Plan.
  •  

  • Work with your doctor to complete and submit these forms, including all required medical information.

 

Appeal If Coverage is Denied

 

  • If your request for Trulicity coverage is denied, obtain detailed reasons for this decision from UPMC Health Plan.
  •  

  • Gather additional supporting documents from your doctor and file an appeal with UPMC Health Plan.
  •  

  • Stay in contact with UPMC Health Plan representatives and follow through the appeals process diligently.

 

Explore Patient Assistance Programs

 

  • If coverage is unattainable or costs are prohibitive, consider reaching out to Eli Lilly's patient assistance programs for Trulicity.
  •  

  • Look into other potential pharmaceutical assistance programs or co-pay cards that may reduce costs.

 

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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.

Trulicity FAQ

What are the common side effects of Trulicity?

 

Common Side Effects of Trulicity

 

  • Nausea: Initially, many patients experience nausea, which often lessens over time as the body adjusts.
  •  

  • Vomiting: Some individuals may experience vomiting, particularly in the first few doses.
  •  

  • Diarrhea: Digestive disturbances such as diarrhea are commonly reported.
  •  

  • Abdominal Pain: Discomfort in the abdomen can occur, often subsiding with continued use.
  •  

  • Decreased Appetite: Patients often report a reduction in appetite.
  •  

  • Fatigue: Some individuals may feel unusually tired after starting treatment.
  •  

  • Reduced Blood Sugar: Blood sugar levels may become low, especially when used in conjunction with other diabetes medications.

 

How much weight can you lose on Trulicity?

 

Weight Loss with Trulicity

 

  • Trulicity (dulaglutide) is primarily prescribed for managing type 2 diabetes, but many patients also experience weight loss as an additional benefit.
  •  

  • Clinical trials indicate an average weight loss of around 2-6 pounds, but results differ based on individual factors such as diet, exercise, and adherence to the medication.
  •  

  • Some users report greater weight loss; however, it's important to accompany Trulicity with lifestyle changes for optimal results.
  •  

  • Consult with a healthcare provider to tailor a plan that maximizes benefits based on your health needs.

 

How does Trulicity work for type 2 diabetes?

 

How Trulicity Works

 

  • Trulicity is a GLP-1 receptor agonist, helping to regulate blood sugar levels.
  •  

  • It stimulates insulin release in response to high blood glucose.
  •  

  • It slows gastric emptying, which helps reduce post-meal glucose spikes.
  •  

  • Trulicity suppresses glucagon secretion, lowering glucose production by the liver.

 

Benefits

 

  • Easy-to-use once-weekly injection, improving adherence.
  •  

  • Not associated with causing weight gain; may even promote modest weight loss.
  •  

  • May reduce risk of cardiovascular events in patients with heart disease.

 

Considerations

 

  • May cause gastrointestinal side effects, often resolving over time.
  •  

  • Inform your doctor if you have a history of pancreatitis or gallbladder disease.
  •  

  • Monitor for signs of low blood sugar, especially if using other diabetes medications.

 

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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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