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.
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.
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.
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.
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.