How Does Fridays Handle Insurance for GLP-1 and Other Medications?
Fridays provides clarity and support around medication management, including GLP-1 medications, as well as processes for obtaining insurance coverage. Below is an overview of the key policies and procedures regarding insurance options and medication coverage with Fridays.
While Fridays simplifies the management of GLP-1 medications through transparent pricing and well-defined protocols, patients must manage separate costs for branded medications directly at their pharmacies based on their insurance coverage and pharmacy pricing.
GLP-1 Medications: Compounded vs. Branded
Compounded GLP-1 Medications: Insurance does not cover compounded medications, such as GLP-1 variants created specifically for Fridays' plans. These are classified as self-pay medication options. Patients can begin their weight management journey with these while insurance formalities for branded medications are processed.
Branded GLP-1 Medications: Medications like Wegovy and Ozempic are considered brand-name medications. While Fridays does not directly offer insurance coverage for them on their plans, patients can explore coverage via prior authorization procedures guided by Fridays.
Insurance Coverage Policies
Fridays does not accept insurance for compounded medications.
For branded medications, Fridays facilitates insurance engagement by: - Initiating Prior Authorization (PA) as part of their membership services. This incurs no extra cost to the patient.- Assisting with appeals if requested for denied prior authorizations. When reaching out to support about your PA please specify which medication you would like so that you have the best opportunity for approval.
As part of the PA services, Fridays ensures timely submission of requests, handles communication with insurance providers, and informs patients promptly of any documentation needs or updates during the PA process. Typically, prior authorizations take 7-10 business days to process, though this timeline can vary depending on your insurance company's responsiveness. Patients are advised to monitor their email for updates as email tracking is the best way to stay informed about the status of the prior authorization. The insurance team will contact them if further clarification or documents are required.
Steps for Insurance Coverage With Fridays
Begin With Self-Pay Plans: - All new patients are onboarded with self-pay compounded medication plans, which are independent of insurance coverage. This serves as the initial step while insurance paperwork for branded medications proceeds.
Prior Authorization (PA) Process: - Fridays will handle the prior authorization process for branded medications after the provider consultation. The Prior Authorization team will contact patients via email if additional information or documentation is required during the submission process.
Consultations for switching to specific medications, like Zepbound, can be booked directly through the portal under the "Consultations" tab.
Patients are advised to upload their insurance details through the Fridays patient portal before the consultation to ensure all necessary information is available for prior authorization.
Addressing Pending Claims: - If a claim shows as "pending" in your insurance or pharmacy system, the Prior Authorization (PA) team will follow up to complete the process. Any additional documentation required will be communicated to you via email.
Handling Denied Claims: - In case of claim denial, the PA team will review the case and ensure all necessary documents are submitted for reconsideration. If needed, they will help appeal the decision as a part of the service.
What to do if I'm Approved?
Switching to Branded Medications Like Zepbound: - To switch, patients need to complete a healthcare provider visit through Fridays.
Impact on Subscriptions: - Patients discussing a switch to a branded medication have to wait for the next billing cycle for their subscription to update to the cost of a branded subscription
Important Notes
Fridays only processes insurance-related documentation for branded medications.
Compounded medications, while an effective option for weight management, remain a self-pay service.
Benefits for branded medications depend on the insurance provider's approval of the PA submission.
Costs for branded medications such as Zepbound must be paid directly at the pharmacy, as prices depend on individual insurance coverage and pharmacy rates. Patients are encouraged to check with their pharmacies for up-to-date pricing.