Does Blue Cross Blue Shield of Alabama Cover Symbicort

Explore Symbicort coverage with Blue Cross Blue Shield of Alabama. Learn reasons for denial, how to secure coverage, costs without insurance, and more FAQs.
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Coverage of Symbicort by Blue Cross Blue Shield of Alabama

 

  • Blue Cross Blue Shield of Alabama may cover Symbicort under certain plans as part of its prescription drug benefits.
  •  

  • Coverage is typically provided for conditions like asthma or COPD, subject to plan benefits and formulary status.
  •  

  • Patients may need a prescription and sometimes prior authorization from their healthcare provider.
  •  

  • Coverage may vary based on the specific insurance plan, so members should verify their benefits beforehand.
  •  

  • Copayments, deductibles, and out-of-pocket costs can apply based on the policy terms.

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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 of Alabama

 

Check Your Current Prescription Drug Plan

 

  • Log in to your Blue Cross Blue Shield of Alabama member account on their website.
  •  

  • Review your current prescription drug plan to understand your coverage, copayments, and any applicable deductibles.
  •  

  • Look specifically at the coverage for respiratory medications to see if Symbicort is listed.

 

Consult with Your Doctor

 

  • Discuss with your healthcare provider to ensure that Symbicort is the most appropriate medication for your condition.
  •  

  • Ask your doctor to provide you with documentation or a prescription that explains the medical necessity of Symbicort.

 

Contact Blue Cross Blue Shield of Alabama Customer Service

 

  • Call the customer service number on your insurance card to inquire about specific coverage for Symbicort.
  •  

  • Ask if there are any prior authorization requirements or steps you need to take to get coverage for Symbicort.

 

Submit a Prior Authorization if Required

 

  • If your plan requires prior authorization, request the necessary forms from your doctor's office or download them from the Blue Cross Blue Shield website.
  •  

  • Work with your healthcare provider to complete the prior authorization paperwork, providing all necessary medical documentation.
  •  

  • Submit the completed forms to Blue Cross Blue Shield of Alabama for review.

 

Follow Up on Your Request

 

  • Check back with Blue Cross Blue Shield after submitting your prior authorization to ensure it is being processed.
  •  

  • If approved, confirm with your pharmacy that Symbicort is available under your plan and understand any copays or additional costs.
  •  

  • If denied, ask about the appeals process and what additional information may be needed to reconsider the request.

 

Explore Generic Alternatives and Assistance Programs

 

  • If Symbicort is not covered or if out-of-pocket costs are high, ask your doctor about generic alternatives that might be covered.
  •  

  • Investigate patient assistance programs offered by the manufacturer of Symbicort, which might provide discounts or financial aid.

 

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FAQs

Does Blue Cross Blue Shield of Alabama Cover Symbicort

Explore Symbicort coverage with Blue Cross Blue Shield of Alabama. Learn reasons for denial, how to secure coverage, costs without insurance, and more FAQs.
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Is Symbicort Covered by Blue Cross Blue Shield of Alabama

 

Coverage of Symbicort by Blue Cross Blue Shield of Alabama

 

  • Blue Cross Blue Shield of Alabama may cover Symbicort under certain plans as part of its prescription drug benefits.
  •  

  • Coverage is typically provided for conditions like asthma or COPD, subject to plan benefits and formulary status.
  •  

  • Patients may need a prescription and sometimes prior authorization from their healthcare provider.
  •  

  • Coverage may vary based on the specific insurance plan, so members should verify their benefits beforehand.
  •  

  • Copayments, deductibles, and out-of-pocket costs can apply based on the policy terms.

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Blue Cross Blue Shield of Alabama's Approved Criteria for Symbicort Coverage

 

Eligibility for Symbicort Coverage

 

  • Members must have a documented diagnosis of asthma or chronic obstructive pulmonary disease (COPD) that is not adequately controlled by other medications.
  •  

  • The prescribing physician must provide evidence that the member has tried and failed to achieve disease control with other maintenance therapies or is unable to tolerate them.
  •  

  • Age requirements must be met as per the drug indication. For asthma, the member should typically be over 12 years old, and for COPD, the member should be an adult.

 

Clinical Documentation Requirements

 

  • The physician must submit thorough medical documentation showing the necessity of Symbicort for the member’s health condition, including previous treatment failures.
  •  

  • Records of lung function tests or relevant assessments supporting the need for Symbicort may be required if applicable.

 

Step Therapy Requirements

 

  • Prior to approval, the member must attempt treatment with at least one or more preferred alternative medications, which are likely to be other inhaled steroids or bronchodilators, and demonstrate an inadequate response.
  •  

  • If a member is unable to use an alternative due to contraindications or adverse effects, documentation must detail these issues clearly.

 

Quantity Limits

 

  • The coverage will follow specific quantity limits based on typical dosing recommendations. Requests for higher quantities require additional justification and approval from the insurer.
  •  

  • Refills might be subject to prescription review, ensuring compliance with prescribed dosing regimens.

 

Why Blue Cross Blue Shield of Alabama Might Deny Symbicort Coverage

 

Reasons for Symbicort Coverage Denial by Blue Cross Blue Shield of Alabama

 

  • **Non-Medical Necessity**: The medication might be deemed not medically necessary for the condition being treated. If Symbicort is prescribed without strong justification or alternative treatments have not been tried, coverage might be denied.
  •  

  • **Lack of Prior Authorization**: Failing to obtain prior authorization before filling the prescription can lead to a denial of coverage. Blue Cross Blue Shield of Alabama often requires prior approval for certain medications, including Symbicort.
  •  

  • **Exceeding Quantity Limits**: Exceeding the prescribed quantity limits set by Blue Cross Blue Shield of Alabama can result in denial. These limits are typically established based on safe and effective dosing guidelines.
  •  

  • **Non-Formulary Medication**: Symbicort might be excluded from the formulary list or categorized as a non-preferred drug. If Symbicort is not on the approved formulary, an alternative medication on the list must be used or a higher cost may be incurred by the patient.
  •  

  • **Prescription by Non-Network Provider**: If the prescription is written by a healthcare provider outside the approved network, coverage could be denied. Blue Cross Blue Shield of Alabama often requires prescriptions from network providers for 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 Blue Cross Blue Shield of Alabama

 

Check Your Current Prescription Drug Plan

 

  • Log in to your Blue Cross Blue Shield of Alabama member account on their website.
  •  

  • Review your current prescription drug plan to understand your coverage, copayments, and any applicable deductibles.
  •  

  • Look specifically at the coverage for respiratory medications to see if Symbicort is listed.

 

Consult with Your Doctor

 

  • Discuss with your healthcare provider to ensure that Symbicort is the most appropriate medication for your condition.
  •  

  • Ask your doctor to provide you with documentation or a prescription that explains the medical necessity of Symbicort.

 

Contact Blue Cross Blue Shield of Alabama Customer Service

 

  • Call the customer service number on your insurance card to inquire about specific coverage for Symbicort.
  •  

  • Ask if there are any prior authorization requirements or steps you need to take to get coverage for Symbicort.

 

Submit a Prior Authorization if Required

 

  • If your plan requires prior authorization, request the necessary forms from your doctor's office or download them from the Blue Cross Blue Shield website.
  •  

  • Work with your healthcare provider to complete the prior authorization paperwork, providing all necessary medical documentation.
  •  

  • Submit the completed forms to Blue Cross Blue Shield of Alabama for review.

 

Follow Up on Your Request

 

  • Check back with Blue Cross Blue Shield after submitting your prior authorization to ensure it is being processed.
  •  

  • If approved, confirm with your pharmacy that Symbicort is available under your plan and understand any copays or additional costs.
  •  

  • If denied, ask about the appeals process and what additional information may be needed to reconsider the request.

 

Explore Generic Alternatives and Assistance Programs

 

  • If Symbicort is not covered or if out-of-pocket costs are high, ask your doctor about generic alternatives that might be covered.
  •  

  • Investigate patient assistance programs offered by the manufacturer of Symbicort, which might provide discounts or financial aid.

 

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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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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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