Does Anthem Cover Symbicort

Explore if Anthem covers Symbicort, reasons for denial, ways to secure coverage, costs without insurance, and essential FAQs.
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Coverage for Symbicort

 

  • Anthem may cover Symbicort under some of its health plans, especially those that include prescription drug benefits. Coverage can vary based on the specific plan and state regulations.
  •  

  • It is typically prescribed for asthma and chronic obstructive pulmonary disease (COPD) management. Approval is subject to medical necessity criteria.

 

Basic Rules and Criteria

 

  • Prior authorization may be required, meaning your healthcare provider must demonstrate medical necessity before coverage is granted.
  •  

  • Patients might need to meet specific criteria, such as a documented history of ineffective use of alternative treatments.
  •  

  • Co-pays or co-insurance fees usually apply, depending on your specific plan's formulary and pharmacy benefit terms.

 

Steps to Get Coverage

 

  • Check your specific Anthem plan details for Symbicort coverage and formulary tier placement.
  •  

  • Consult with your healthcare provider to determine the necessity and secure any required documentation.
  •  

  • Contact Anthem Customer Service for any questions related to your plan's benefits and the prior authorization process.

 

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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 Anthem

 

Verify Your Coverage Plan

 

  • Start by logging into your Anthem member portal. This is where you can access your specific health plan details.
  •  

  • Look for the "Prescription Benefits" section to check if Symbicort is on your plan's formulary (the list of covered drugs).
  •  

  • If it’s not listed, you may need to contact Anthem customer support for clarification.

 

Consult with Your Healthcare Provider

 

  • Speak with your physician about the necessity of Symbicort for your condition.
  •  

  • Your doctor can provide clinical justification, which might be needed if Symbicort isn’t readily covered.
  •  

  • Request that your doctor sends a prior authorization or medical necessity letter to Anthem if required.

 

Contact Anthem Directly

 

  • Call the customer service number on the back of your Anthem insurance card to discuss your benefits.
  •  

  • Inquire whether Symbicort requires a prior authorization or if there are any prerequisite steps for coverage.
  •  

  • Request information about any co-payments or out-of-pocket costs associated with Symbicort.

 

Follow Up on Prior Authorization

 

  • If a prior authorization is required, ensure that your healthcare provider sends all necessary documentation.
  •  

  • Track the status of the authorization process through Anthem’s portal or by calling customer service.
  •  

  • Respond promptly if Anthem requests additional information to avoid delays.

 

Review Alternative Options

 

  • If Symbicort is not covered, discuss alternative medications that are on the formulary with your doctor.
  •  

  • Consider using a generic alternative if recommended by your physician.
  •  

  • Investigate whether Anthem offers any discount programs or rebates for Symbicort if it remains uncovered.

 

Appeal a Denied Claim

 

  • In the event that your request for Symbicort coverage is denied, review the denial letter carefully to understand the reason.
  •  

  • Prepare to file an appeal, either online or in writing, detailing why Symbicort is essential for your health.
  •  

  • Consult your doctor to provide additional supporting documentation for your appeal.

 

Utilize Pharmacy Resources

 

  • Check with your pharmacy to see if they offer direct support in dealing with insurance approvals.
  •  

  • Some pharmacies have specialists who can assist with prior authorization paperwork or liaise with Anthem on your behalf.
  •  

  • Inquire about any temporary coverage solutions your pharmacy might offer while your authorization is processed.

 

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FAQs

Does Anthem Cover Symbicort

Explore if Anthem covers Symbicort, reasons for denial, ways to secure coverage, costs without insurance, and essential FAQs.
Curex allergy drops unboxing

Is Symbicort Covered by Anthem

 

Coverage for Symbicort

 

  • Anthem may cover Symbicort under some of its health plans, especially those that include prescription drug benefits. Coverage can vary based on the specific plan and state regulations.
  •  

  • It is typically prescribed for asthma and chronic obstructive pulmonary disease (COPD) management. Approval is subject to medical necessity criteria.

 

Basic Rules and Criteria

 

  • Prior authorization may be required, meaning your healthcare provider must demonstrate medical necessity before coverage is granted.
  •  

  • Patients might need to meet specific criteria, such as a documented history of ineffective use of alternative treatments.
  •  

  • Co-pays or co-insurance fees usually apply, depending on your specific plan's formulary and pharmacy benefit terms.

 

Steps to Get Coverage

 

  • Check your specific Anthem plan details for Symbicort coverage and formulary tier placement.
  •  

  • Consult with your healthcare provider to determine the necessity and secure any required documentation.
  •  

  • Contact Anthem Customer Service for any questions related to your plan's benefits and the prior authorization process.

 

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Anthem's Approved Criteria for Symbicort Coverage

 

Approved Criteria for Symbicort Coverage

 

  • **Diagnosis Requirement**: Member must have a diagnosis of asthma or chronic obstructive pulmonary disease (COPD) that is documented in the medical record.
  •  

  • **Clinical Justification**: Symbicort must be prescribed when other treatment options have been ineffective, not tolerated, or are contraindicated.
  •  

  • **Age Criteria**: Member should be of an age that Symbicort is approved for usage, typically those aged 6 years and older for asthma, and adults for COPD.
  •  

  • **Prescription Details**: Prescription for Symbicort must be from a qualified healthcare provider. The indication, dosage, and frequency should align with FDA-approved labeling.
  •  

  • **Step Therapy Requirement**: Typically, members may need to demonstrate inadequate response or intolerance to other inhaled corticosteroid and long-acting beta-agonist (LABA) combination therapies before qualifying for Symbicort.
  •  

  • **Documentation of Exacerbations**: Member should have documented history of exacerbations or hospitalizations requiring steroid treatment, supporting the need for a combination therapy like Symbicort.
  •  

  • **Pulmonary Function Testing**: Evidence from pulmonary function tests may be necessary to validate the need for Symbicort in the treatment plan.
  •  

  • **Disease Severity**: In cases of asthma, severity such as moderate to severe persistent asthma should be documented. For COPD, medications consistent with moderate to severe COPD should be indicated.
  •  

Why Anthem Might Deny Symbicort Coverage

 

Reasons for Denial of Symbicort Coverage by Anthem

 

  • Symbicort is prescribed for a condition that is not FDA-approved, also known as "off-label" use, which Anthem might not cover.
  •  

  • The prescription does not meet the step therapy criteria, meaning alternative drugs must be tried first according to Anthem's policy.
  •  

  • The prescribed dosage or form of Symbicort is not in line with Anthem's coverage guidelines.
  •  

  • Anthem's formulary, or list of covered medications, does not include Symbicort due to negotiated contracts with other drug manufacturers or tier placements.
  •  

  • Failure to provide necessary documentation or fulfill prior authorization requirements may result in denial.
  •  

  • The patient’s policy does not include coverage for certain respiratory conditions that Symbicort treats.
  •  

  • Symbicort is prescribed by a non-network provider, which might not be covered under certain Anthem plans.
  •  

 

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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 Anthem

 

Verify Your Coverage Plan

 

  • Start by logging into your Anthem member portal. This is where you can access your specific health plan details.
  •  

  • Look for the "Prescription Benefits" section to check if Symbicort is on your plan's formulary (the list of covered drugs).
  •  

  • If it’s not listed, you may need to contact Anthem customer support for clarification.

 

Consult with Your Healthcare Provider

 

  • Speak with your physician about the necessity of Symbicort for your condition.
  •  

  • Your doctor can provide clinical justification, which might be needed if Symbicort isn’t readily covered.
  •  

  • Request that your doctor sends a prior authorization or medical necessity letter to Anthem if required.

 

Contact Anthem Directly

 

  • Call the customer service number on the back of your Anthem insurance card to discuss your benefits.
  •  

  • Inquire whether Symbicort requires a prior authorization or if there are any prerequisite steps for coverage.
  •  

  • Request information about any co-payments or out-of-pocket costs associated with Symbicort.

 

Follow Up on Prior Authorization

 

  • If a prior authorization is required, ensure that your healthcare provider sends all necessary documentation.
  •  

  • Track the status of the authorization process through Anthem’s portal or by calling customer service.
  •  

  • Respond promptly if Anthem requests additional information to avoid delays.

 

Review Alternative Options

 

  • If Symbicort is not covered, discuss alternative medications that are on the formulary with your doctor.
  •  

  • Consider using a generic alternative if recommended by your physician.
  •  

  • Investigate whether Anthem offers any discount programs or rebates for Symbicort if it remains uncovered.

 

Appeal a Denied Claim

 

  • In the event that your request for Symbicort coverage is denied, review the denial letter carefully to understand the reason.
  •  

  • Prepare to file an appeal, either online or in writing, detailing why Symbicort is essential for your health.
  •  

  • Consult your doctor to provide additional supporting documentation for your appeal.

 

Utilize Pharmacy Resources

 

  • Check with your pharmacy to see if they offer direct support in dealing with insurance approvals.
  •  

  • Some pharmacies have specialists who can assist with prior authorization paperwork or liaise with Anthem on your behalf.
  •  

  • Inquire about any temporary coverage solutions your pharmacy might offer while your authorization is processed.

 

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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.

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.

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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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