Does Aetna Cover Symbicort

Explore Aetna's Symbicort coverage, reasons for denial, alternatives for approval, costs without insurance, and answers to common questions.
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Symbicort Coverage with Aetna

 

  • Aetna typically covers Symbicort as part of its prescription drug benefits under certain health plans. However, coverage can vary based on plan type and state-specific policies.
  •  

  • Coverage is generally available for conditions like asthma and COPD as Symbicort is commonly prescribed for managing these diseases.
  •  

  • The medication may be listed on Aetna's formulary, but coverage might require a doctor's prescription, prior authorization, or a step therapy process where you try other medications first.
  •  

  • Check with Aetna to ensure that your specific plan covers Symbicort. You can do this via their online formulary or customer service.
  •  

  • For the most accurate information, consult your plan’s summary of benefits or directly contact Aetna for personalized advice based on your individual plan coverage.

 

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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.

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 Symbicort Coverage with Aetna

 

Verify Your Plan Details

 

  • Log in to your Aetna member portal using your account credentials to access your specific plan details.
  •  

  • Navigate to the benefits section and review the prescription drug coverage details. Confirm that your plan includes coverage for inhalers and, specifically, Symbicort if possible.
  •  

  • Locate Aetna's formulary list or drug coverage list on their website to check if Symbicort is covered and understand any specific requirements or restrictions.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your need for Symbicort and obtain a legitimate prescription tailored to your health requirements.
  •  

  • Request that your healthcare provider include diagnosis codes and notes that might be required by Aetna to justify the medical necessity for Symbicort.

 

Contact Aetna Member Services

 

  • Using the contact information provided on your insurance card or via their website, call Aetna member services for specific information about Symbicort coverage on your plan.
  •  

  • Ask if there are any prior authorization requirements or if you need a doctor's note to process the coverage for your Symbicort prescription.

 

Submit Prior Authorization (if necessary)

 

  • If Aetna requires prior authorization for Symbicort, work with your healthcare provider to gather necessary documents and forms.
  •  

  • Submit these documents via Aetna's preferred method, which may be through their online portal, fax, or mail.
  •  

  • Follow up with Aetna to ensure they received the documentation and inquire about expected processing times.

 

Fill Your Prescription

 

  • Once coverage has been confirmed, take your prescription for Symbicort to a participating pharmacy that accepts your Aetna plan.
  •  

  • Provide the pharmacy with your insurance details to process the coverage, ensuring that Symbicort is billed correctly under your plan.
  •  

  • Plan to pick up your medication once the pharmacist confirms your insurance coverage and medication cost, if applicable.

 

Appeal Denials, if Required

 

  • If your request for coverage is denied, review the explanation of benefits document provided by Aetna to understand the reason for denial.
  •  

  • Contact Aetna to verify the exact nature of the denial and inquire about the appeals process.
  •  

  • Prepare an appeal with the help of your healthcare provider, including any additional documentation or justifications that may support your need for Symbicort.
  •  

  • Submit the appeal according to Aetna's guidelines and follow up regularly until a decision is reached.

 

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FAQs

Does Aetna Cover Symbicort

Explore Aetna's Symbicort coverage, reasons for denial, alternatives for approval, costs without insurance, and answers to common questions.
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Is Symbicort Covered by Aetna

 

Symbicort Coverage with Aetna

 

  • Aetna typically covers Symbicort as part of its prescription drug benefits under certain health plans. However, coverage can vary based on plan type and state-specific policies.
  •  

  • Coverage is generally available for conditions like asthma and COPD as Symbicort is commonly prescribed for managing these diseases.
  •  

  • The medication may be listed on Aetna's formulary, but coverage might require a doctor's prescription, prior authorization, or a step therapy process where you try other medications first.
  •  

  • Check with Aetna to ensure that your specific plan covers Symbicort. You can do this via their online formulary or customer service.
  •  

  • For the most accurate information, consult your plan’s summary of benefits or directly contact Aetna for personalized advice based on your individual plan coverage.

 

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Aetna's Approved Criteria for Symbicort Coverage

 

Approved Criteria for Symbicort Coverage

 

  • Symbicort is covered for individuals diagnosed with asthma who are 12 years of age or older. Eligibility requires documentation showing inadequate control by standard asthmatic therapies or use as a maintenance therapy for asthma.
  •  
    
    <li>For individuals diagnosed with chronic obstructive pulmonary disease (COPD), Symbicort is approved as a maintenance treatment to reduce exacerbations and hospitalizations related to COPD, supported by clinical history and necessity.</li>
    
    &nbsp;
    
    <li>Candidates must have shown a need for dual therapy, indicating insufficient control by inhaled corticosteroids alone or other bronchodilator regimens.</li>
    
    &nbsp;
    
    <li>Use of Symbicort should be supported by a medical professional's recommendation, with necessary documentation outlining the clinical rationale.</li>
    
    &nbsp;
    
    <li>Aetna requires that the prescribed dosage aligns with FDA-approved guidelines, ensuring dosage appropriateness in line with medical necessity and established clinical protocols.</li>
    

 

Additional Considerations

 

  • Symbicort coverage might extend to persons displaying symptoms indicating a higher risk of severe asthma attacks, guided by a physician's detailed assessment and evidence-based intervention.
  • &nbsp;
    
    <li>Approval for pediatric use (ages as designated by Aetna when policy applies) will require full documentation detailing previous treatment failures and current therapeutic needs.</li>
    

 

Why Aetna Might Deny Symbicort Coverage

 

Reasons Aetna Might Deny Symbicort Coverage

 

  • Symbicort does not meet the plan's formulary requirements, meaning it's not included in the preferred list of medications covered by Aetna.
  •  

  • The medication is deemed not medically necessary based on the patient's health plan guidelines or compared to other treatment options.
  •  

  • The prescribed dosage or frequency does not align with FDA-approved labeling or clinical guidelines, resulting in denial for off-label use.
  •  

  • There is no documented trial or failure of less expensive or alternative therapies that are typically required prior to approving Symbicort.
  •  

  • The patient's condition does not fall within the specified criteria for asthma or chronic obstructive pulmonary disease (COPD) as covered by the plan.
  •  

  • Aetna’s prior authorization requirements have not been met, which usually necessitates additional documentation and approval before covering the medication.
  •  

  • The prescription was filled at a pharmacy that is not within the Aetna preferred or in-network pharmacy list, which can affect coverage eligibility.

 

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How Much Does Symbicort Cost without Insurance?

 

Cost of Symbicort without Insurance

 

  • Symbicort is a prescription medication commonly used to treat asthma and chronic obstructive pulmonary disease (COPD). Without insurance, its cost can be quite high, varying largely due to factors such as dosage, pharmacy, and location. On average, the out-of-pocket cost for a 30-day supply of Symbicort (160/4.5 mcg) inhaler is around $250 to $350.
  •  

  • Prices can vary significantly from one pharmacy to another. Some big-box or discount pharmacies might offer slightly lower prices, while smaller local pharmacies may have higher rates without insurance discounts.
  •  

  • Patients can also explore manufacturer coupons or patient assistance programs, which might help reduce the overall cost. Additionally, online resources and discount cards may offer ways to slightly lower the cash price at participating pharmacies.
  •  

  • It's advisable for patients to check various pharmacies to ensure they are getting the best possible price. Comparing online pharmacy prices and visiting discount retailers could help mitigate high costs when paying out-of-pocket.

 

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 Symbicort Coverage with Aetna

 

Verify Your Plan Details

 

  • Log in to your Aetna member portal using your account credentials to access your specific plan details.
  •  

  • Navigate to the benefits section and review the prescription drug coverage details. Confirm that your plan includes coverage for inhalers and, specifically, Symbicort if possible.
  •  

  • Locate Aetna's formulary list or drug coverage list on their website to check if Symbicort is covered and understand any specific requirements or restrictions.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your need for Symbicort and obtain a legitimate prescription tailored to your health requirements.
  •  

  • Request that your healthcare provider include diagnosis codes and notes that might be required by Aetna to justify the medical necessity for Symbicort.

 

Contact Aetna Member Services

 

  • Using the contact information provided on your insurance card or via their website, call Aetna member services for specific information about Symbicort coverage on your plan.
  •  

  • Ask if there are any prior authorization requirements or if you need a doctor's note to process the coverage for your Symbicort prescription.

 

Submit Prior Authorization (if necessary)

 

  • If Aetna requires prior authorization for Symbicort, work with your healthcare provider to gather necessary documents and forms.
  •  

  • Submit these documents via Aetna's preferred method, which may be through their online portal, fax, or mail.
  •  

  • Follow up with Aetna to ensure they received the documentation and inquire about expected processing times.

 

Fill Your Prescription

 

  • Once coverage has been confirmed, take your prescription for Symbicort to a participating pharmacy that accepts your Aetna plan.
  •  

  • Provide the pharmacy with your insurance details to process the coverage, ensuring that Symbicort is billed correctly under your plan.
  •  

  • Plan to pick up your medication once the pharmacist confirms your insurance coverage and medication cost, if applicable.

 

Appeal Denials, if Required

 

  • If your request for coverage is denied, review the explanation of benefits document provided by Aetna to understand the reason for denial.
  •  

  • Contact Aetna to verify the exact nature of the denial and inquire about the appeals process.
  •  

  • Prepare an appeal with the help of your healthcare provider, including any additional documentation or justifications that may support your need for Symbicort.
  •  

  • Submit the appeal according to Aetna's guidelines and follow up regularly until a decision is reached.

 

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Symbicort FAQ

1. What are the side effects of Symbicort?

 

Common Side Effects of Symbicort

 

  • Headache: Frequently reported and usually mild.
  • Throat irritation: Can occur due to inhalation route.
  • Hoarseness: Temporary voice changes may be noticed.
  • Cough: Occasional, linked to inhaler use.

 

Less Common Side Effects

 

  • Nausea: A less frequent side effect.
  • Increased blood pressure: Monitor regularly.
  • Palpitations: Uncommon but notable.
  • Muscle cramps: May occur in some patients.

 

Rare but Serious Side Effects

 

  • Allergic reactions: Rash, itching, or difficulty breathing.
  • Worsening of asthma: Requires immediate attention.
  • Pneumonia: Particularly in COPD patients.
  • Cardiac arrhythmias: Monitor heart rhythm.

 

2. How does Symbicort work for asthma?

 

How Symbicort Works

 

  • Combination Therapy: Symbicort contains budesonide, a corticosteroid, and formoterol, a long-acting beta-agonist. Together, they manage asthma by reducing inflammation and opening airways.
  •  

  • Inflammation Control: Budesonide targets the inflammatory process in the lungs, decreasing swelling and irritation to prevent asthma symptoms.
  •  

  • Bronchodilation: Formoterol relaxes muscles around the airways, quickly improving breathing and reducing wheezing.
  •  

  • Maintenance and Relief: While primarily for maintenance, Symbicort provides relief from symptoms and reduces the frequency of asthma attacks.

 

3. Is Symbicort a steroid inhaler?

 

Is Symbicort a Steroid Inhaler?

 

  • Yes, Symbicort is a combination inhaler that contains a steroid. It combines budesonide, a corticosteroid, and formoterol, a long-acting beta agonist (LABA).
  •  

  • Corticosteroids like budesonide help to reduce inflammation in the airways, which is crucial for managing asthma and chronic obstructive pulmonary disease (COPD).
  •  

  • Formoterol helps in relaxing the muscles around the airways to make breathing easier.
  •  

  • Symbicort is prescribed for long-term management and not for immediate relief of acute symptoms.
  •  

  • Regular use is essential to decrease the chance of flare-ups and improve overall lung function.

 

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Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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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.

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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 (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.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

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.

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.

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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