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Does WellCare Cover Forteo

Explore Forteo coverage by WellCare, understand denial reasons, learn how to secure coverage, find Forteo costs without insurance, and get answers to FAQs.

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Does WellCare Cover Forteo?

WellCare may cover Forteo under its Medicare Part D plans, but coverage depends on the specific plan and its formulary.

Coverage is typically provided for patients with severe osteoporosis, particularly those who have had multiple fractures or are at high risk for fractures.

Criteria for Coverage

The patient must meet specific medical criteria, usually evidenced by a diagnosis of osteoporosis with a high risk for fracture.

The prescribing physician needs to provide documentation supporting the need for Forteo as part of the treatment plan.

Additional Rules

A prior authorization process might be required to demonstrate medical necessity and ensure prescription coverage.

Patients may have to try and fail other osteoporosis treatments before getting approval for Forteo coverage.

Copayments, coinsurance, or deductibles may apply based on the specific WellCare plan.

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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.

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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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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 Forteo Coverage with WellCare

Initial Steps with WellCare

First, verify if you are currently enrolled in a WellCare plan. Access your details by logging into your WellCare account online or contacting their customer service.

If you are not enrolled yet, research the available WellCare plans in your area. Make sure to choose a plan that potentially covers Forteo by reviewing plan details or contacting WellCare representatives.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Forteo. Your provider can offer medical documentation that supports your need for this medication, which is crucial for insurance approval.

Ask your healthcare provider to write a prescription for Forteo, emphasizing the necessity of this medication for your specific condition.

Check Coverage Options

Review your WellCare benefits summary to see if Forteo is listed under covered medications. This information is often found in the formulary section of your plan documents.

If Forteo is not listed, contact WellCare’s customer service to inquire about possible exceptions, such as prior authorization or step therapy requirements that might allow Forteo to be covered.

Request Prior Authorization

If required, ask your healthcare provider to submit a prior authorization request to WellCare. This often includes medical records, the prescription, and a letter of necessity.

Ensure that all supporting documentation is comprehensive and specifically highlights why Forteo is critical for your treatment.

Utilize WellCare's Coverage Determination Process

If initial requests are denied, utilize WellCare’s coverage determination process to make a formal appeal. Gather additional documentation if necessary to support your case.

Contact WellCare for detailed guidance on how to submit an appeal and any additional information they might require.

Explore Additional Financial Assistance

Consider seeking additional financial help if coverage is denied. Contact the manufacturer of Forteo for patient assistance programs that may offer the medication at a reduced cost or even free of charge to qualified patients.

Check with non-profit organizations that may provide grants or financial aid for medications not covered by insurance.

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FAQs

Does WellCare Cover Forteo

Explore Forteo coverage by WellCare, understand denial reasons, learn how to secure coverage, find Forteo costs without insurance, and get answers to FAQs.

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Is Forteo Covered by WellCare

Does WellCare Cover Forteo?

WellCare may cover Forteo under its Medicare Part D plans, but coverage depends on the specific plan and its formulary.

Coverage is typically provided for patients with severe osteoporosis, particularly those who have had multiple fractures or are at high risk for fractures.

Criteria for Coverage

The patient must meet specific medical criteria, usually evidenced by a diagnosis of osteoporosis with a high risk for fracture.

The prescribing physician needs to provide documentation supporting the need for Forteo as part of the treatment plan.

Additional Rules

A prior authorization process might be required to demonstrate medical necessity and ensure prescription coverage.

Patients may have to try and fail other osteoporosis treatments before getting approval for Forteo coverage.

Copayments, coinsurance, or deductibles may apply based on the specific WellCare plan.

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WellCare's Approved Criteria for Forteo Coverage

Criteria for Forteo Coverage by WellCare

**Diagnosis Requirement:** Must have a documented diagnosis of osteoporosis. Osteoporosis should be confirmed by a bone mineral density test (DEXA scan) indicating a T-score of -2.5 or lower, or by the presence of a fragility fracture.

**Previous Treatment:** The patient should have a history of inadequate response or contraindication to other osteoporosis therapies. This includes bisphosphonates, selective estrogen receptor modulators, or calcitonin.

**Age Consideration:** Typically, WellCare covers patients who are postmenopausal women or men aged 50 years or older. Exceptions may require additional documentation from a healthcare provider.

**Risk of Fracture:** Patients considered at a high risk for fracture are eligible. This can include those with multiple risk factors for fracture, as well as those with a history of osteoporotic fracture.

**Physician Confirmation:** A licensed healthcare provider must confirm the necessity of Forteo, documenting its medical necessity and anticipated benefits over other treatments.

**Treatment Duration:** The intended treatment duration should comply with the safety guidelines associated with Forteo, often not exceeding two years of cumulative use due to safety concerns linked to long-term usage.

**Special Populations:** Pre-approval might be needed for individuals under certain circumstances, such as those with a history of cancer affecting bones, pending an analysis of potential benefits and risks by WellCare.

Why WellCare Might Deny Forteo Coverage

Situations Where WellCare Might Deny Forteo Coverage

Forteo use doesn't align with FDA-approved indications: WellCare may deny coverage if Forteo is prescribed for conditions that are not approved by the FDA, such as cases outside of severe osteoporosis in postmenopausal women, men at high risk of fracture, or individuals with glucocorticoid-induced osteoporosis.

Off-label prescription: If Forteo is prescribed for an off-label condition, which isn't supported by strong clinical evidence, WellCare might refuse coverage.

Lack of prior authorization or documentation: WellCare often requires detailed documentation and prior authorization. If paperwork is missing or incomplete, they might deny the claim.

Non-compliance with step therapy protocols: WellCare might have step therapy requirements, which mandate trying and failing other osteoporosis treatments before Forteo is approved. Non-compliance with such protocols could result in denial.

Exceeding approved duration of treatment: Forteo is typically approved for a limited duration (generally 24 months throughout a patient's lifetime), and use beyond this may not be covered.

Absence of necessary clinical criteria: Forteo's coverage might be refused if the patient's clinical profile does not meet stringent conditions, such as demonstrating a high risk of fracture or failure on previous osteoporosis therapies.

Duplicate therapy: If a patient is simultaneously being treated with another parathyroid hormone analog, WellCare might deny coverage for Forteo.

Insurance plan limitations: Specific WellCare plans may have limitations or exclusions for biologic agents like Forteo, based on coverage policies or plan-specific formularies.

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How Much Does Forteo Cost without Insurance?

Cost of Forteo Without Insurance

The price of Forteo (teriparatide injection) without insurance is quite substantial, typically ranging between $3,500 and $4,000 for a 28-day supply, which is a 2.4 mL pen of 600 mcg per 2.4 mL strength.

Keep in mind that pharmaceutical prices can vary based on the pharmacy, geographical location, and any available discounts or pharmacy-specific savings programs.

Patients can check with specific pharmacies for the most accurate pricing and inquire about any potential savings programs or discounts.

Consider contacting the manufacturer or exploring patient assistance programs, as they sometimes offer help to reduce costs for those without insurance coverage.

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 Forteo Coverage with WellCare

Initial Steps with WellCare

First, verify if you are currently enrolled in a WellCare plan. Access your details by logging into your WellCare account online or contacting their customer service.

If you are not enrolled yet, research the available WellCare plans in your area. Make sure to choose a plan that potentially covers Forteo by reviewing plan details or contacting WellCare representatives.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Forteo. Your provider can offer medical documentation that supports your need for this medication, which is crucial for insurance approval.

Ask your healthcare provider to write a prescription for Forteo, emphasizing the necessity of this medication for your specific condition.

Check Coverage Options

Review your WellCare benefits summary to see if Forteo is listed under covered medications. This information is often found in the formulary section of your plan documents.

If Forteo is not listed, contact WellCare’s customer service to inquire about possible exceptions, such as prior authorization or step therapy requirements that might allow Forteo to be covered.

Request Prior Authorization

If required, ask your healthcare provider to submit a prior authorization request to WellCare. This often includes medical records, the prescription, and a letter of necessity.

Ensure that all supporting documentation is comprehensive and specifically highlights why Forteo is critical for your treatment.

Utilize WellCare's Coverage Determination Process

If initial requests are denied, utilize WellCare’s coverage determination process to make a formal appeal. Gather additional documentation if necessary to support your case.

Contact WellCare for detailed guidance on how to submit an appeal and any additional information they might require.

Explore Additional Financial Assistance

Consider seeking additional financial help if coverage is denied. Contact the manufacturer of Forteo for patient assistance programs that may offer the medication at a reduced cost or even free of charge to qualified patients.

Check with non-profit organizations that may provide grants or financial aid for medications not covered by insurance.

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Forteo FAQ

What are the common side effects of Forteo?

Common Side Effects of Forteo

Nausea: A frequent complaint among users, often resolves as your body adjusts to the medication.

Dizziness: Usually occurs after an injection, so sitting or lying down shortly afterward can help.

Leg Cramps: Regular stretching exercises may alleviate this discomfort.

Joint Pain: May be managed by over-the-counter painkillers, but consult your doctor first.

Injection Site Reactions: Mild redness or itching at the injection site is common, often soothed by cold compresses.

How does Forteo work for osteoporosis?

How Forteo Works

Forteo, or teriparatide, is a form of parathyroid hormone that helps stimulate new bone formation.

It works by increasing bone remodeling, which is crucial for improving bone density.

Osteoporosis Effectiveness

Used primarily for osteoporosis patients who have a high risk of fractures.

Improves bone microarchitecture, which enhances bone strength.

Administration

Administered via daily subcutaneous injection for up to 2 years.

Patients should follow their doctor’s instructions for the correct administration.

How long can you safely take Forteo?

Duration of Forteo Use

Forteo (teriparatide) is recommended for a maximum duration of 2 years over a patient's lifetime.

This limitation is based on studies that show an increased risk of osteosarcoma in rats. Though this risk hasn't been confirmed in humans, the duration is restricted for safety.

Considerations and Monitoring

During treatment, regular bone density scans and evaluations for potential side effects are necessary.

Patients should ensure they are not taking medications or have conditions that could further exacerbate potential risks.

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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 WellCare Cover Forteo

Explore Forteo coverage by WellCare, understand denial reasons, learn how to secure coverage, find Forteo costs without insurance, and get answers to FAQs.

Achieve Your Goals Faster with Curex