Does WellCare Cover Orencia

Explore WellCare's coverage for Orencia. Learn about denial reasons, obtaining coverage, costs without insurance, and answers to common Orencia questions.
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“Curex is changing the landscape of allergies in 2024”
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Coverage of Orencia by WellCare

 

  • WellCare generally provides coverage for Orencia, specifically for conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, and psoriatic arthritis.
  •  

  • Orencia coverage usually requires prior authorization, meaning your healthcare provider will need to justify the medical necessity of the treatment.
  •  

  • To be eligible, the patient often must have tried and not responded adequately to other treatments, like non-biologic DMARDs.
  •  

  • Review your specific plan details as coverage may vary depending on the policy and geographical location.
  •  

  • Contact WellCare directly or consult with your healthcare provider for personalized advice and assistance with approval processes.

 

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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 WellCare

 

Initial Research and Documentation Preparation

 

  • Gather all relevant personal and financial information such as your Social Security Number, income details, and existing insurance coverage.
  •  

  • Compile your medical history and any documentation from your healthcare provider that supports the necessity for Orencia.

 

Review Your WellCare Benefits

 

  • Access your WellCare insurance policy documents or the WellCare website to determine whether Orencia is included in your formulary and what the specific coverage conditions are.
  •  

  • Look out for any requirements related to prior authorization, step therapy, or tier placement that might affect coverage.

 

Contact WellCare Customer Service

 

  • Reach out to WellCare customer support through their helpline or member services portal for clarification on Orencia coverage and any necessary pre-authorization requirements.
  •  

  • Request detailed information regarding in-network pharmacies and providers authorized to dispense Orencia.

 

Provider Authorization

 

  • If pre-authorization is required, coordinate with your healthcare provider to submit the necessary paperwork to WellCare, highlighting the medical necessity for Orencia.
  •  

  • Follow up with both your provider and WellCare to ensure that the pre-authorization request is processed swiftly.

 

Prescription Fulfillment

 

  • Once approval is confirmed, work with an in-network pharmacy to fill your Orencia prescription, ensuring that any copayment or coinsurance responsibilities are understood.
  •  

  • Keep accurate records of all transactions and communications related to the prescription for future reference and in case of disputes.

 

Appeal Denials (if necessary)

 

  • If your initial coverage request is denied, promptly review the denial letter from WellCare for specific reasons and the steps to appeal the decision.
  •  

  • Prepare a comprehensive appeal that includes additional supporting documents from your healthcare provider and any required forms specified by WellCare.

 

Maintain Regular Communication

 

  • Continue to maintain communication with WellCare and your healthcare provider throughout this process to avoid any lapses in medication availability.
  •  

  • Regularly review your policy updates to stay informed about any changes to your coverage that may affect long-term Orencia use.

 

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Does WellCare Cover Orencia

Explore WellCare's coverage for Orencia. Learn about denial reasons, obtaining coverage, costs without insurance, and answers to common Orencia questions.
Curex allergy drops unboxing

Is Orencia Covered by WellCare

 

Coverage of Orencia by WellCare

 

  • WellCare generally provides coverage for Orencia, specifically for conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, and psoriatic arthritis.
  •  

  • Orencia coverage usually requires prior authorization, meaning your healthcare provider will need to justify the medical necessity of the treatment.
  •  

  • To be eligible, the patient often must have tried and not responded adequately to other treatments, like non-biologic DMARDs.
  •  

  • Review your specific plan details as coverage may vary depending on the policy and geographical location.
  •  

  • Contact WellCare directly or consult with your healthcare provider for personalized advice and assistance with approval processes.

 

A weight management program tailored to you

Start with Curex

WellCare's Approved Criteria for Orencia Coverage

 

General Criteria for Orencia Coverage

 

  • Orencia is covered for patients who have been diagnosed with rheumatoid arthritis, juvenile idiopathic arthritis, or psoriatic arthritis.
  •  

  • Patients must have had an inadequate response to one or more disease-modifying antirheumatic drugs (DMARDs).
  •  

  • Orencia may be prescribed for patients who have experienced intolerance to other DMARDs.

 

Rheumatoid Arthritis

 

  • Patients must be adults aged 18 or older.
  •  

  • A diagnosis of moderate to severe rheumatoid arthritis is necessary.
  •  

  • Prior treatment with at least two DMARDs, including methotrexate, with an inadequate response is required.

 

Juvenile Idiopathic Arthritis

 

  • Coverage is available for patients aged 2 years and older.
  •  

  • Diagnosis must be moderate to severe polyarticular juvenile idiopathic arthritis.
  •  

  • Patients must have failed to adequately respond to one or more DMARDs.

 

Psoriatic Arthritis

 

  • Patients must be adults diagnosed with active psoriatic arthritis.
  •  

  • An inadequate response to prior DMARD therapy is required for coverage.
  •  

  • Intolerance to alternative DMARD therapy options is also considered for coverage.

 

Additional Guidelines

 

  • Orencia therapy must be prescribed by or in consultation with a rheumatologist.
  •  

  • Patients are required to follow a regular monitoring schedule as recommended by their healthcare provider.
  •  

  • Combination use of Orencia with other biologic DMARDs is generally not covered.

 

Why WellCare Might Deny Orencia Coverage

 

Situations Where WellCare Might Deny Orencia Coverage

 

  • Orencia is prescribed for a condition that is not approved by the FDA or is considered experimental or investigational.
  •  

  • The patient does not meet the medical necessity criteria, such as having an incomplete or non-severe diagnosis of rheumatoid arthritis, juvenile idiopathic arthritis, or psoriatic arthritis.
  •  

  • Failure to comply with prior authorization requirements, where the necessary documentation and rationale for Orencia treatment have not been adequately provided.
  •  

  • Orencia is being prescribed in combination with other biologic disease-modifying antirheumatic drugs (DMARDs), contrary to WellCare's policy, unless specifically noted in the patient's plan.
  •  

  • The patient is non-compliant with previous treatments or has not tried alternative, less costly therapies that are usually required before Orencia is considered.
  •  

  • Orencia is requested for an off-label use that has not been evaluated and approved for coverage by the WellCare policy criteria.
  •  

  • The request does not align with the established quantity limits or dosing requirements set by WellCare, potentially indicating over-prescription or inappropriate dosage.
  •  

 

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

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.

 

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 WellCare

 

Initial Research and Documentation Preparation

 

  • Gather all relevant personal and financial information such as your Social Security Number, income details, and existing insurance coverage.
  •  

  • Compile your medical history and any documentation from your healthcare provider that supports the necessity for Orencia.

 

Review Your WellCare Benefits

 

  • Access your WellCare insurance policy documents or the WellCare website to determine whether Orencia is included in your formulary and what the specific coverage conditions are.
  •  

  • Look out for any requirements related to prior authorization, step therapy, or tier placement that might affect coverage.

 

Contact WellCare Customer Service

 

  • Reach out to WellCare customer support through their helpline or member services portal for clarification on Orencia coverage and any necessary pre-authorization requirements.
  •  

  • Request detailed information regarding in-network pharmacies and providers authorized to dispense Orencia.

 

Provider Authorization

 

  • If pre-authorization is required, coordinate with your healthcare provider to submit the necessary paperwork to WellCare, highlighting the medical necessity for Orencia.
  •  

  • Follow up with both your provider and WellCare to ensure that the pre-authorization request is processed swiftly.

 

Prescription Fulfillment

 

  • Once approval is confirmed, work with an in-network pharmacy to fill your Orencia prescription, ensuring that any copayment or coinsurance responsibilities are understood.
  •  

  • Keep accurate records of all transactions and communications related to the prescription for future reference and in case of disputes.

 

Appeal Denials (if necessary)

 

  • If your initial coverage request is denied, promptly review the denial letter from WellCare for specific reasons and the steps to appeal the decision.
  •  

  • Prepare a comprehensive appeal that includes additional supporting documents from your healthcare provider and any required forms specified by WellCare.

 

Maintain Regular Communication

 

  • Continue to maintain communication with WellCare and your healthcare provider throughout this process to avoid any lapses in medication availability.
  •  

  • Regularly review your policy updates to stay informed about any changes to your coverage that may affect long-term Orencia use.

 

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

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

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 WellCare Cover Orencia

Explore WellCare's coverage for Orencia. Learn about denial reasons, obtaining coverage, costs without insurance, and answers to common Orencia questions.
Curex allergy drops unboxing

Does WellCare Cover Orencia

 

Coverage of Orencia by WellCare

 

  • WellCare generally provides coverage for Orencia, specifically for conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, and psoriatic arthritis.
  •  

  • Orencia coverage usually requires prior authorization, meaning your healthcare provider will need to justify the medical necessity of the treatment.
  •  

  • To be eligible, the patient often must have tried and not responded adequately to other treatments, like non-biologic DMARDs.
  •  

  • Review your specific plan details as coverage may vary depending on the policy and geographical location.
  •  

  • Contact WellCare directly or consult with your healthcare provider for personalized advice and assistance with approval processes.

 

A weight management program tailored to you

Start with Curex

Why WellCare Might Deny Orencia Coverage

 

General Criteria for Orencia Coverage

 

  • Orencia is covered for patients who have been diagnosed with rheumatoid arthritis, juvenile idiopathic arthritis, or psoriatic arthritis.
  •  

  • Patients must have had an inadequate response to one or more disease-modifying antirheumatic drugs (DMARDs).
  •  

  • Orencia may be prescribed for patients who have experienced intolerance to other DMARDs.

 

Rheumatoid Arthritis

 

  • Patients must be adults aged 18 or older.
  •  

  • A diagnosis of moderate to severe rheumatoid arthritis is necessary.
  •  

  • Prior treatment with at least two DMARDs, including methotrexate, with an inadequate response is required.

 

Juvenile Idiopathic Arthritis

 

  • Coverage is available for patients aged 2 years and older.
  •  

  • Diagnosis must be moderate to severe polyarticular juvenile idiopathic arthritis.
  •  

  • Patients must have failed to adequately respond to one or more DMARDs.

 

Psoriatic Arthritis

 

  • Patients must be adults diagnosed with active psoriatic arthritis.
  •  

  • An inadequate response to prior DMARD therapy is required for coverage.
  •  

  • Intolerance to alternative DMARD therapy options is also considered for coverage.

 

Additional Guidelines

 

  • Orencia therapy must be prescribed by or in consultation with a rheumatologist.
  •  

  • Patients are required to follow a regular monitoring schedule as recommended by their healthcare provider.
  •  

  • Combination use of Orencia with other biologic DMARDs is generally not covered.

 

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

Orencia FAQ

 

Situations Where WellCare Might Deny Orencia Coverage

 

  • Orencia is prescribed for a condition that is not approved by the FDA or is considered experimental or investigational.
  •  

  • The patient does not meet the medical necessity criteria, such as having an incomplete or non-severe diagnosis of rheumatoid arthritis, juvenile idiopathic arthritis, or psoriatic arthritis.
  •  

  • Failure to comply with prior authorization requirements, where the necessary documentation and rationale for Orencia treatment have not been adequately provided.
  •  

  • Orencia is being prescribed in combination with other biologic disease-modifying antirheumatic drugs (DMARDs), contrary to WellCare's policy, unless specifically noted in the patient's plan.
  •  

  • The patient is non-compliant with previous treatments or has not tried alternative, less costly therapies that are usually required before Orencia is considered.
  •  

  • Orencia is requested for an off-label use that has not been evaluated and approved for coverage by the WellCare policy criteria.
  •  

  • The request does not align with the established quantity limits or dosing requirements set by WellCare, potentially indicating over-prescription or inappropriate dosage.
  •  

 

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 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.

 

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.

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

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.