Does Blue Cross Blue Shield Cover Symbicort

Discover if Blue Cross Blue Shield covers Symbicort, how to secure coverage, costs without insurance, and get answers to common questions in this comprehensive guide.
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Coverage for Symbicort

 

  • Blue Cross Blue Shield (BCBS) often covers Symbicort, a medication for asthma and COPD, under its prescription drug plans; however, coverage can vary based on your specific plan and location.
  •  

  • It's essential to verify whether Symbicort is listed on your plan's formulary. This formulary outlines medications covered by the plan and any specific rules or limitations associated with them.

 

Requirements

 

  • Prior Authorization may be needed, meaning your doctor must confirm that Symbicort is medically necessary for your condition before BCBS provides coverage.
  •  

  • Ensure you have met any relevant deductibles and co-pays, which vary according to the specifics of your BCBS plan.

 

Steps to Verify Coverage

 

  • Check your plan's formulary online or contact BCBS customer service to confirm Symbicort's coverage and any restrictions or preferred alternatives.
  •  

  • Consult with your healthcare provider to help coordinate the prior authorization process if required by your insurance plan.

 

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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 Blue Cross Blue Shield

 

Contact Blue Cross Blue Shield Customer Service

 

  • Reach out to Blue Cross Blue Shield (BCBS) customer service using the phone number on the back of your insurance card. This will help you understand your specific plan's benefits and coverage policies for prescription medications, including Symbicort.
  •  

  • Ask for detailed information on prescription drug coverage, specifically whether Symbicort is included in your plan's formulary (the list of covered drugs).

 

Check the Formulary

 

  • Visit the BCBS website and access your specific plan's formulary list to confirm whether Symbicort is covered. Formulary information is often available through your online insurance account under the pharmacy benefits section.
  •  

  • If you do not see Symbicort listed, call customer service for clarification. They may offer alternative options or generic equivalents.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider to ensure Symbicort is medically necessary for your condition. They might have to provide documentation or justification for the prescription to meet BCBS's criteria for coverage.
  •  

  • Your healthcare provider can also consider writing a letter of medical necessity if BCBS requires it for coverage approval.

 

Obtain a Prior Authorization

 

  • Some insurance plans require prior authorization for certain medications, including Symbicort. Check with BCBS to see if this is necessary and, if so, begin the process.
  •  

  • Your healthcare provider will typically need to submit a prior authorization request, including necessary documentation like medical history and treatment justifications.

 

Exploring Alternatives and Assistance Programs

 

  • If Symbicort is not covered, inquire about similar medications that are covered. BCBS might suggest alternatives that do not require authorization or have lower co-pays.
  •  

  • Check if AstraZeneca, the manufacturer of Symbicort, offers any patient assistance programs or discounts, which might help offset costs if coverage is unavailable.

 

Appeal a Denied Claim

 

  • If a claim for Symbicort coverage is denied, you have the right to appeal. Contact BCBS for guidance on their appeal process steps and required documentation.
  •  

  • Gather support documents, such as a letter from your healthcare provider and any medical records justifying the need for Symbicort for your condition.

 

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FAQs

Does Blue Cross Blue Shield Cover Symbicort

Discover if Blue Cross Blue Shield covers Symbicort, how to secure coverage, costs without insurance, and get answers to common questions in this comprehensive guide.
Curex allergy drops unboxing

Is Symbicort Covered by Blue Cross Blue Shield

 

Coverage for Symbicort

 

  • Blue Cross Blue Shield (BCBS) often covers Symbicort, a medication for asthma and COPD, under its prescription drug plans; however, coverage can vary based on your specific plan and location.
  •  

  • It's essential to verify whether Symbicort is listed on your plan's formulary. This formulary outlines medications covered by the plan and any specific rules or limitations associated with them.

 

Requirements

 

  • Prior Authorization may be needed, meaning your doctor must confirm that Symbicort is medically necessary for your condition before BCBS provides coverage.
  •  

  • Ensure you have met any relevant deductibles and co-pays, which vary according to the specifics of your BCBS plan.

 

Steps to Verify Coverage

 

  • Check your plan's formulary online or contact BCBS customer service to confirm Symbicort's coverage and any restrictions or preferred alternatives.
  •  

  • Consult with your healthcare provider to help coordinate the prior authorization process if required by your insurance plan.

 

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Blue Cross Blue Shield's Approved Criteria for Symbicort Coverage

 

Eligibility Criteria for Symbicort Coverage

 

  • Patient must be diagnosed with asthma or chronic obstructive pulmonary disease (COPD) that requires both an inhaled corticosteroid and a long-acting beta-agonist.
  •  

  • Symbicort is approved for patients who have tried and failed or are intolerant to alternative medications such as inhaled corticosteroids and long-acting beta-agonists used separately.
  •  

  • Documentation from the prescribing healthcare provider is necessary, demonstrating that Symbicort is medically necessary due to the condition's severity and patient response to other treatments.

 

Age Criteria

 

  • The patient must meet age requirements as specified by the official Symbicort prescribing information. Symbicort is generally approved for patients aged 12 and older for asthma and adults with COPD.

 

Prescribing Physician Requirements

 

  • Symbicort must be prescribed by a licensed healthcare provider who specializes in treating respiratory conditions, such as a pulmonologist or an allergist.

 

Pre-Authorization Requirements

 

  • Pre-authorization may be required by Blue Cross Blue Shield. The documentation should include a detailed explanation of why Symbicort is the most appropriate choice for the patient based on their medical history and previous treatments.

 

Quantity Limits

 

  • Coverage may include specific quantity limits to ensure appropriate use. The prescribed dosage must be consistent with the approved labeling of Symbicort.

 

Compliance with Plan Formularies

 

  • The use of Symbicort must align with the patient’s specific Blue Cross Blue Shield plan’s formulary guidelines, which may involve using preferred alternatives before Symbicort.

 

Why Blue Cross Blue Shield Might Deny Symbicort Coverage

 

Reasons Blue Cross Blue Shield Might Deny Symbicort Coverage

 

  • Symbicort is not listed on the specific Blue Cross Blue Shield plan's formulary, making it a non-preferred medication.
  •  

  • The policy requires prior authorization, and the request for Symbicort was not approved, potentially due to insufficient documentation of medical necessity.
  •  

  • The prescribed use of Symbicort does not align with FDA-approved indications or is considered "off-label" without enough supporting evidence.
  •  

  • A generic version or preferred alternative medication is available and considered suitable, leading to denial of the brand-name drug.
  •  

  • The patient has not tried and failed a sufficient number of lower-tiered treatments as mandated by the step therapy protocol.
  •  

  • Symbicort prescription exceeds the plan's quantity limits, and no approved exception request has been filed or justified.
  •  

  • The prescription is not consistent with allowed limits due to age restrictions or other specific criteria defined by the policy.

 

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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 Blue Cross Blue Shield

 

Contact Blue Cross Blue Shield Customer Service

 

  • Reach out to Blue Cross Blue Shield (BCBS) customer service using the phone number on the back of your insurance card. This will help you understand your specific plan's benefits and coverage policies for prescription medications, including Symbicort.
  •  

  • Ask for detailed information on prescription drug coverage, specifically whether Symbicort is included in your plan's formulary (the list of covered drugs).

 

Check the Formulary

 

  • Visit the BCBS website and access your specific plan's formulary list to confirm whether Symbicort is covered. Formulary information is often available through your online insurance account under the pharmacy benefits section.
  •  

  • If you do not see Symbicort listed, call customer service for clarification. They may offer alternative options or generic equivalents.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider to ensure Symbicort is medically necessary for your condition. They might have to provide documentation or justification for the prescription to meet BCBS's criteria for coverage.
  •  

  • Your healthcare provider can also consider writing a letter of medical necessity if BCBS requires it for coverage approval.

 

Obtain a Prior Authorization

 

  • Some insurance plans require prior authorization for certain medications, including Symbicort. Check with BCBS to see if this is necessary and, if so, begin the process.
  •  

  • Your healthcare provider will typically need to submit a prior authorization request, including necessary documentation like medical history and treatment justifications.

 

Exploring Alternatives and Assistance Programs

 

  • If Symbicort is not covered, inquire about similar medications that are covered. BCBS might suggest alternatives that do not require authorization or have lower co-pays.
  •  

  • Check if AstraZeneca, the manufacturer of Symbicort, offers any patient assistance programs or discounts, which might help offset costs if coverage is unavailable.

 

Appeal a Denied Claim

 

  • If a claim for Symbicort coverage is denied, you have the right to appeal. Contact BCBS for guidance on their appeal process steps and required documentation.
  •  

  • Gather support documents, such as a letter from your healthcare provider and any medical records justifying the need for Symbicort for your condition.

 

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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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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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