Does Blue Cross Blue Shield Cover Dulera

Explore Dulera coverage under Blue Cross Blue Shield, understand potential denials, ways to secure coverage, costs without insurance, and get your questions answered.
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Coverage for Dulera

 

  • Blue Cross Blue Shield (BCBS) may cover Dulera under some plans, but coverage can vary based on the specific policy and location.
  •  

  • Generally, Dulera is covered under prescription drug benefits when deemed medically necessary and prescribed by a healthcare professional.
  •  

  • Coverage often requires patients to have a prior authorization, which means your doctor must verify that Dulera is appropriate for your condition.

 

Basic Rules and Criteria

 

  • BCBS may require that you try other medications before approving Dulera, classified as a step therapy.
  •  

  • Prescriptions must be filled at a network pharmacy to qualify for coverage, depending on the specifics of your plan.
  •  

  • A co-payment or co-insurance may apply, varying by plan tier and deductible status.

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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 Dulera Coverage with Blue Cross Blue Shield

 

Check Your Current Coverage

 

  • Review your current Blue Cross Blue Shield (BCBS) insurance policy documents to understand your prescription drug coverage.
  •  

  • Contact your BCBS customer service for clarification on if Dulera is covered under your plan.

 

Consult With Your Physician

 

  • Speak with your healthcare provider about your need for Dulera and discuss potential alternatives if it's not covered by your plan.
  •  

  • Request a letter of medical necessity from your physician, which can strengthen your case for needing Dulera specifically.

 

Access the BCBS Member Portal

 

  • Log in to your Blue Cross Blue Shield member portal on their website to access personalized benefit information.
  •  

  • Navigate to the prescription coverage section to search for Dulera and gather details about its status and any restrictions.

 

Request a Formulary Exception

 

  • If Dulera is not listed in your formulary, submit a formulary exception request through your BCBS member portal or contact customer service for guidance.
  •  

  • Include your doctor’s letter of medical necessity and any supporting medical documents with your request.

 

Verify Step Therapy or Prior Authorization

 

  • Determine if Dulera requires prior authorization or if step therapy is involved by reviewing the pharmacy benefits section in your BCBS plan.
  •  

  • Work with your physician to complete and submit any necessary forms to BCBS for prior authorization or step therapy requirements.

 

Explore Discount Programs

 

  • Investigate manufacturer discount programs or medication coupons for Dulera that can be used in conjunction with your BCBS coverage.
  •  

  • Check with your healthcare provider or pharmacy about known discounts and assistance programs available for Dulera users.

 

Contact BCBS Customer Service

 

  • Reach out to BCBS customer service for any clarifications or to dispute a denial if Dulera coverage is necessary for your treatment.
  •  

  • Document all communications with BCBS for reference, including dates, names, and details of conversations.

 

Stay Informed on Policy Changes

 

  • Regularly check for updates from BCBS regarding changes to your prescription coverage that may affect Dulera inclusion.
  •  

  • Consider annual plan reviews to ensure your coverage remains comprehensive for your medication needs.

 

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FAQs

Does Blue Cross Blue Shield Cover Dulera

Explore Dulera coverage under Blue Cross Blue Shield, understand potential denials, ways to secure coverage, costs without insurance, and get your questions answered.
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Is Dulera Covered by Blue Cross Blue Shield

 

Coverage for Dulera

 

  • Blue Cross Blue Shield (BCBS) may cover Dulera under some plans, but coverage can vary based on the specific policy and location.
  •  

  • Generally, Dulera is covered under prescription drug benefits when deemed medically necessary and prescribed by a healthcare professional.
  •  

  • Coverage often requires patients to have a prior authorization, which means your doctor must verify that Dulera is appropriate for your condition.

 

Basic Rules and Criteria

 

  • BCBS may require that you try other medications before approving Dulera, classified as a step therapy.
  •  

  • Prescriptions must be filled at a network pharmacy to qualify for coverage, depending on the specifics of your plan.
  •  

  • A co-payment or co-insurance may apply, varying by plan tier and deductible status.

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Blue Cross Blue Shield's Approved Criteria for Dulera Coverage

 

Dulera Coverage Criteria

 

  • Dulera is covered for the management of asthma in patients aged 12 years and older.
  •  

  • Patients must demonstrate a clinical need for a combination inhaler that includes both a corticosteroid and a long-acting beta-agonist.
  •  

  • The prescriber must provide evidence that the asthma is not adequately controlled on a single-agent therapy, such as an inhaled corticosteroid alone.
  •  

  • Dulera is approved for patients who have a documented step-up therapy necessity due to poor asthma control despite adherence to current treatment plans.
  •  

  • Criteria is satisfied if the patient has experienced two or more exacerbations that required oral corticosteroids within the past 12 months.
  •  

  • Aspirometry or other pulmonary function testing must indicate a need for combination therapy.
  •  

  • The prescriber must document any previous adverse reactions or contraindications to components of alternative asthma combination therapies before Dulera is approved.
  •  

  • Ongoing coverage requires regular follow-up and monitoring to ensure the continued clinical benefit of Dulera in the patient's asthma management plan.

 

Why Blue Cross Blue Shield Might Deny Dulera Coverage

 

Reasons for Dulera Coverage Denial by Blue Cross Blue Shield

 

  • Non-Formulary Status: Dulera may not be included in the specific formulary (list of covered medications) for a particular Blue Cross Blue Shield plan. Medications not listed are typically not covered.
  •  

  • Lack of Prior Authorization: Coverage might be denied if prior authorization is required and has not been obtained. Prior authorization is often needed to verify the medical necessity of the medication.
  •  

  • Off-Label Use: If Dulera is prescribed for a condition not approved by the FDA, coverage could be denied as the insurer may not cover off-label drug use.
  •  

  • Step Therapy Requirements: Insurance might require patients to try less expensive medications before covering Dulera. If these conditions are not met, coverage may be denied.
  •  

  • Non-Compliance with Plan Requirements: Lack of adherence to specific plan requirements, such as using a participating pharmacy or failing to provide necessary documentation, can lead to a denial.
  •  

  • Exceeding Quantity Limits: Dulera prescriptions exceeding the plan's allowable quantity limits or deemed as overly frequent refills may not be covered.
  •  

  • Plan-Specific Exclusions: Certain plan types might have specific exclusions for specific medications, including Dulera, which would result in non-coverage.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Dulera Cost without Insurance?

 

Approximate Cost of Dulera Without Insurance

 

  • The cost of Dulera, which is used to help control symptoms of asthma, can vary depending on the pharmacy and location. However, the typical price for a one-month supply (inhaler) of Dulera without insurance is approximately $250 to $350.
  •  

  • This price may differ based on dosage strength, and whether you're purchasing a brand name or a generic version if available.
  •  

  • Prices can fluctuate, and it is advisable to check with different pharmacies or consider using discount cards or coupons that might be available to reduce the cost.
  •  

  • Additionally, some pharmaceutical companies offer patient assistance programs for those who qualify, which can significantly lower the cost of Dulera.

 

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 Dulera Coverage with Blue Cross Blue Shield

 

Check Your Current Coverage

 

  • Review your current Blue Cross Blue Shield (BCBS) insurance policy documents to understand your prescription drug coverage.
  •  

  • Contact your BCBS customer service for clarification on if Dulera is covered under your plan.

 

Consult With Your Physician

 

  • Speak with your healthcare provider about your need for Dulera and discuss potential alternatives if it's not covered by your plan.
  •  

  • Request a letter of medical necessity from your physician, which can strengthen your case for needing Dulera specifically.

 

Access the BCBS Member Portal

 

  • Log in to your Blue Cross Blue Shield member portal on their website to access personalized benefit information.
  •  

  • Navigate to the prescription coverage section to search for Dulera and gather details about its status and any restrictions.

 

Request a Formulary Exception

 

  • If Dulera is not listed in your formulary, submit a formulary exception request through your BCBS member portal or contact customer service for guidance.
  •  

  • Include your doctor’s letter of medical necessity and any supporting medical documents with your request.

 

Verify Step Therapy or Prior Authorization

 

  • Determine if Dulera requires prior authorization or if step therapy is involved by reviewing the pharmacy benefits section in your BCBS plan.
  •  

  • Work with your physician to complete and submit any necessary forms to BCBS for prior authorization or step therapy requirements.

 

Explore Discount Programs

 

  • Investigate manufacturer discount programs or medication coupons for Dulera that can be used in conjunction with your BCBS coverage.
  •  

  • Check with your healthcare provider or pharmacy about known discounts and assistance programs available for Dulera users.

 

Contact BCBS Customer Service

 

  • Reach out to BCBS customer service for any clarifications or to dispute a denial if Dulera coverage is necessary for your treatment.
  •  

  • Document all communications with BCBS for reference, including dates, names, and details of conversations.

 

Stay Informed on Policy Changes

 

  • Regularly check for updates from BCBS regarding changes to your prescription coverage that may affect Dulera inclusion.
  •  

  • Consider annual plan reviews to ensure your coverage remains comprehensive for your medication needs.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Dulera FAQ

What are the side effects of Dulera?

 

Common Side Effects of Dulera

 

  • Headache
  • Sore throat
  • Sinus pain
  • Nosebleed
  • Oral thrush (fungal infection)

 

Serious Side Effects

 

  • Wheezing or breathing problems
  • Severe allergic reactions (rash, itching/swelling)
  • Vision problems
  • Reduced bone density with long-term use

 

Monitoring and Precautions

 

  • Regularly check bone health and eye exams
  • Rinse mouth after inhalation to prevent oral infections
  • Consult your doctor if side effects worsen or persist

 

How does Dulera work for asthma?

 

Mechanism of Action

 

  • Dulera is a combination inhaler containing mometasone (a corticosteroid) and formoterol (a long-acting beta-agonist).
  •  

  • Mometasone reduces inflammation in the airways, minimizing swelling and irritation.
  •  

  • Formoterol relaxes bronchial muscles, improving airflow and easing breathing.

 

Benefits for Asthma

 

  • Helps prevent asthma attacks by maintaining open airways over long periods.
  •  

  • Decreases the usage frequency of rescue inhalers due to improved control of symptoms.

 

Usage Guidance

 

  • Use regularly as prescribed, even without current symptoms, for effective management.
  •  

  • Rinse mouth after inhalation to reduce risks of oral thrush from corticosteroid use.

 

Consultation Necessity

 

  • Discuss with healthcare provider if side effects occur or asthma symptoms do not improve.

 

Is Dulera a steroid inhaler?

 

Is Dulera a Steroid Inhaler?

 

  • Dulera is a combination inhaler used for asthma management, containing both formoterol, a long-acting beta-agonist (LABA), and mometasone furoate, which is a corticosteroid.
  •  

  • Corticosteroids in Dulera are used to reduce inflammation in the airways, helping to prevent and control asthma symptoms.
  •  

  • Formoterol helps in relaxing muscles around the airways, making breathing easier by widening the air passages.
  •  

  • It's essential to use Dulera regularly for it to be effective; it is not intended for relief of acute asthma attacks.
  •  

  • Patients should be aware of potential side effects like throat irritation or thrush due to the steroid component, and rinsing the mouth after use may help minimize these risks.

 

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

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.

Got questions? We have answers.

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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