Does WellCare Cover Vyvanse

Explore WellCare's coverage for Vyvanse, overcoming coverage denials, costs without insurance, and common questions answered in this comprehensive guide.
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Vyvanse Coverage by WellCare

 

  • **Prior Authorization:** To get Vyvanse covered, you typically need prior authorization. Ensure your healthcare provider submits necessary documentation proving medical necessity.
  •  

  • **Plan Specifics:** Coverage can vary based on the specific Medicare or Medicaid plan you have with WellCare. Consult your plan's formulary or contact WellCare for details.
  •  

  • **Medical Use Justification:** Vyvanse is often covered for conditions like ADHD or binge eating disorder. Your provider must justify its use for the coverage.
  •  

  • **Generic Alternatives:** If a generic or alternative medication is available and effective, WellCare might prefer these options. Discuss with your doctor whether Vyvanse is essential.
  •  

  • **Appeals Process:** If coverage is initially denied, you have the right to appeal the decision, provided you gather supporting evidence from your healthcare provider.

 

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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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Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

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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 Vyvanse Coverage with WellCare

 

Verify Your WellCare Plan Coverage

 

  • Contact WellCare customer service using the phone number on the back of your insurance card to ask if Vyvanse is covered under your current plan.
  •  

  • Review your benefits booklet or online member portal to identify whether Vyvanse is listed as a covered medication.

 

Consult Your Healthcare Provider

 

  • Speak with your doctor about the necessity of Vyvanse for your condition. They might provide additional documentation or justification needed for insurance approval.
  •  

  • Ensure that your prescription is written correctly as per your plan’s requirements, including dosage and frequency.

 

Check Prior Authorization Requirements

 

  • Determine if Vyvanse requires prior authorization by contacting WellCare or reviewing your plan documentation.
  •  

  • Work with your healthcare provider to complete any necessary prior authorization forms, providing detailed medical necessity for Vyvanse use.

 

Explore Tier and Formulary Options

 

  • Check which formulary tier Vyvanse falls under in your WellCare plan, as this affects cost and approval.
  •  

  • Ask WellCare if there's a preferred alternative for Vyvanse that might be on a lower tier and ensure it's appropriate for your treatment plan with your doctor.

 

File an Appeal or Exception

 

  • If your initial request for Vyvanse is denied, consult WellCare’s appeals process outlined in your coverage materials.
  •  

  • Gather any necessary supporting documents, including a letter from your healthcare provider, before filing the appeal.

 

Establish a WellCare Online Account

 

  • Create an account on the WellCare member portal to monitor your coverage status and track any changes to your plan that might affect Vyvanse.
  •  

  • Use the portal to access any updates regarding prescription drug coverage and any changes to formulary or tier placements.
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FAQs

Does WellCare Cover Vyvanse

Explore WellCare's coverage for Vyvanse, overcoming coverage denials, costs without insurance, and common questions answered in this comprehensive guide.
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Is Vyvanse Covered by WellCare

 

Vyvanse Coverage by WellCare

 

  • **Prior Authorization:** To get Vyvanse covered, you typically need prior authorization. Ensure your healthcare provider submits necessary documentation proving medical necessity.
  •  

  • **Plan Specifics:** Coverage can vary based on the specific Medicare or Medicaid plan you have with WellCare. Consult your plan's formulary or contact WellCare for details.
  •  

  • **Medical Use Justification:** Vyvanse is often covered for conditions like ADHD or binge eating disorder. Your provider must justify its use for the coverage.
  •  

  • **Generic Alternatives:** If a generic or alternative medication is available and effective, WellCare might prefer these options. Discuss with your doctor whether Vyvanse is essential.
  •  

  • **Appeals Process:** If coverage is initially denied, you have the right to appeal the decision, provided you gather supporting evidence from your healthcare provider.

 

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WellCare's Approved Criteria for Vyvanse Coverage

 

Covered Indications for Vyvanse

 

  • Vyvanse may be covered for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients six years of age and older as part of a comprehensive treatment plan.
  •  

  • Vyvanse may be covered for the treatment of moderate to severe Binge Eating Disorder (BED) in adults aged 18 and older.

 

Required Documentation

 

  • A formal diagnosis from a qualified healthcare provider confirming ADHD or BED as per current diagnostic criteria is required.
  •  

  • Documentation of previous medical therapies attempted that demonstrate, through medical records, either an inadequate response or intolerable side effects must be submitted.

 

Trial and Failure of Alternatives

 

  • For ADHD, evidence must be presented that the patient has tried and failed to respond to or tolerate other stimulant medications, such as methylphenidate or amphetamine-based therapies, unless contraindicated or inappropriate based on medical and clinical circumstances.
  •  

  • For BED, documentation should show trial and failure of other therapeutic interventions such as nutritional counseling or psychotherapy unless these were deemed unsuitable for the patient.

 

Age and Dosage Requirements

 

  • Coverage is typically considered for patients who meet the FDA-approved age criteria for Vyvanse usage, specifically children from the age of six years for ADHD, and adults for BED.
  •  

  • The prescribed dosage should align with FDA guidelines; any deviations need substantial justification regarding the clinical need.

 

Monitoring and Follow-up

 

  • Regular follow-up appointments with the prescribing healthcare provider must be documented to assess the efficacy of the therapy and to monitor for any potential side effects or misuse.
  •  

  • Evidence of ongoing behavioral therapies or interventions as part of a comprehensive treatment program should also be documented for ADHD patients.

 

Why WellCare Might Deny Vyvanse Coverage

 

When WellCare Might Deny Vyvanse Coverage

 

  • **Non-Formulary Status:** Vyvanse may not be listed on WellCare's formulary, the list of prescription drugs covered by the plan. If Vyvanse is not included, coverage can be denied.
  •  

  • **Prior Authorization Not Obtained:** Coverage might be declined if the required prior authorization process has not been completed. WellCare often requires physicians to obtain prior authorization to justify the medical necessity of Vyvanse.
  •  

  • **Step Therapy Requirements:** If WellCare requires step therapy, and a patient hasn't tried and failed other preferred medications first, coverage for Vyvanse may be denied.
  •  

  • **Dosage Limit Exceeded:** WellCare may cover Vyvanse up to a certain dosage limit. If a prescription exceeds this limit, the claim could be denied unless special authorization is obtained.
  •  

  • **Non-Approved Usage:** Vyvanse may be denied if prescribed for non-approved medical conditions or off-label uses that are not recognized as standard care by WellCare's policies.
  •  

  • **Lack of Medical Necessity:** If WellCare does not find sufficient justification for the prescription of Vyvanse, deeming it not medically necessary, coverage may be denied.
  •  

  • **Non-Compliance with Plan Requirements:** Any non-compliance with other specific WellCare plan requirements for medication use, such as age restrictions or failure to adhere to treatment plans, can also result in denial of coverage.

 

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How Much Does Vyvanse Cost without Insurance?

 

Understanding the Cost of Vyvanse Without Insurance

 

  • Purchase prices for Vyvanse can vary depending on factors such as the dosage and the location of purchase. Typically, a 30-day supply of Vyvanse can price approximately between $350 and $500.
  •  

  • Costs might differ by pharmacy, with some options offering discounts or savings programs for those paying out-of-pocket.
  •  

  • It’s advisable to explore pharmacy discount cards or manufacturer copay assistance programs, as they can sometimes reduce the retail price.
  •  

  • Online pharmacy services may also present more competitive pricing, but always ensure they are reputable and that prescriptions are valid and properly filled.

 

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 Vyvanse Coverage with WellCare

 

Verify Your WellCare Plan Coverage

 

  • Contact WellCare customer service using the phone number on the back of your insurance card to ask if Vyvanse is covered under your current plan.
  •  

  • Review your benefits booklet or online member portal to identify whether Vyvanse is listed as a covered medication.

 

Consult Your Healthcare Provider

 

  • Speak with your doctor about the necessity of Vyvanse for your condition. They might provide additional documentation or justification needed for insurance approval.
  •  

  • Ensure that your prescription is written correctly as per your plan’s requirements, including dosage and frequency.

 

Check Prior Authorization Requirements

 

  • Determine if Vyvanse requires prior authorization by contacting WellCare or reviewing your plan documentation.
  •  

  • Work with your healthcare provider to complete any necessary prior authorization forms, providing detailed medical necessity for Vyvanse use.

 

Explore Tier and Formulary Options

 

  • Check which formulary tier Vyvanse falls under in your WellCare plan, as this affects cost and approval.
  •  

  • Ask WellCare if there's a preferred alternative for Vyvanse that might be on a lower tier and ensure it's appropriate for your treatment plan with your doctor.

 

File an Appeal or Exception

 

  • If your initial request for Vyvanse is denied, consult WellCare’s appeals process outlined in your coverage materials.
  •  

  • Gather any necessary supporting documents, including a letter from your healthcare provider, before filing the appeal.

 

Establish a WellCare Online Account

 

  • Create an account on the WellCare member portal to monitor your coverage status and track any changes to your plan that might affect Vyvanse.
  •  

  • Use the portal to access any updates regarding prescription drug coverage and any changes to formulary or tier placements.

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Vyvanse FAQ

What are the side effects of Vyvanse?

 

Common Side Effects

 

  • Loss of appetite
  • Insomnia
  • Dry mouth
  • Anxiety
  • Weight loss
  • Increased heart rate

 

Less Common Side Effects

 

  • Dizziness
  • Diarrhea
  • Rash
  • Blurred vision
  • Irritability

 

Serious Side Effects

 

  • Chest pain
  • Shortness of breath
  • Hallucinations
  • Severe anxiety or panic attacks
  • Swelling of extremities
  • Uncontrolled movements or vocal outbursts

 

Recommendations

 

  • Consult with a healthcare provider if side effects persist or worsen.
  • Monitor heart rate and blood pressure regularly.
  • Inform your doctor of any other medications being taken.

 

How long does Vyvanse stay in your system?

 

How Vyvanse Functions

 

  • Vyvanse is a prodrug, meaning it's inactive until metabolized in the body, which affects its duration.

 

Duration in the System

 

  • Vyvanse typically lasts 10-12 hours for therapeutic effects due to its extended-release formulation.
  • The half-life is around 10-13 hours, meaning it takes this time for half of the drug to be eliminated.

 

Detection Window

 

  • Blood: Detectable for up to 8 hours after ingestion.
  • Urine: Can be detected for up to 3 days, depending on metabolism and dosage.
  • Hair: May remain detectable for up to a month or longer.

 

Factors Influencing Duration

 

  • Metabolic rate, age, organ function, and dosage can alter the duration.
  • Chronic use may lead to accumulation, slightly extending the detectable period.

 

Is Vyvanse the same as Adderall?

 

Difference Between Vyvanse and Adderall

 

  • Composition: Vyvanse contains lisdexamfetamine, a prodrug requiring conversion in the body, while Adderall contains mixed amphetamine salts.
  •  

  • Onset: Vyvanse typically takes longer to start acting due to its prodrug nature, whereas Adderall provides quicker results.
  •  

  • Duration: Vyvanse lasts about 10-14 hours, while Adderall's duration varies based on the formulation: instant-release lasts 4-6 hours, extended-release lasts up to 12 hours.
  •  

  • Use: Both treat ADHD, but Vyvanse is also approved for binge eating disorder.
  •  

  • Abuse Potential: Vyvanse's requirement for metabolic activation reduces its immediate abuse risk compared to Adderall.

 

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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.

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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.

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Can I pay with an FSA or HSA card?

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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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