$49$0.99

Does Blue Cross Blue Shield of Arizona Cover Enbrel

Discover if Blue Cross Blue Shield of Arizona covers Enbrel, reasons for denial, coverage tips, costs without insurance, and answer common questions.

Treat your allergies with Curex

as seen on

“Curex is changing the landscape of allergies in 2024”

Coverage for Enbrel

Blue Cross Blue Shield of Arizona may cover Enbrel for conditions such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Coverage typically requires prior authorization and may be subject to specific criteria defined in the policy terms.

Criteria and Requirements

Patients often need to demonstrate that other treatments were ineffective before Enbrel is approved.

A healthcare provider must verify the diagnosis and provide documentation supporting the need for Enbrel.

Policy details vary, so members should consult their specific plan documents or contact BCBS of Arizona for precise criteria.

Additional Considerations

Patients may have to follow step therapy protocols.

It’s crucial to confirm whether Enbrel is considered a specialty medication under the specific plan.

Copayment, deductible, and out-of-pocket expenses can vary greatly depending on the plan details.

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49 $9.99

Review your allergy test results with a Curex allergist.

Start Now

Clinical Support

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 Enbrel Coverage with Blue Cross Blue Shield of Arizona

Initiate Contact with Blue Cross Blue Shield of Arizona

Find the customer service number on your insurance card and call Blue Cross Blue Shield of Arizona (BCBS of AZ) to ask about coverage for Enbrel.

Inquire about the specific requirements and processes for obtaining coverage for Enbrel. Request to speak with a representative who handles prescription drug coverage if necessary.

Review Your Policy Details

Carefully read your current BCBS of AZ policy documents. Look for sections related to prescription drug coverage, specialty medicines, and exclusions.

Pay attention to any tiered medication structure which might categorize Enbrel at a specific coverage level.

Consult with Your Healthcare Provider

Speak with your doctor who prescribed Enbrel to discuss insurance coverage. They might have experience with patients who have faced similar insurance challenges.

Request any necessary paperwork or documentation from your doctor to support your insurance claim. This may include a letter of medical necessity or detailed prescription notes.

Complete a Prior Authorization Form

If required by your insurance policy, download or request a prior authorization form from BCBS of AZ. Your healthcare provider will need to complete this form.

Ensure that all information is accurate and detailed to avoid delays in processing. Include all supporting documents as requested by BCBS of AZ.

Submit Your Documentation

Send all completed forms and supporting documents to BCBS of AZ as directed, typically via mail, fax, or through an online portal if they provide one.

Follow up with BCBS of AZ to confirm receipt of your documents and to inquire about processing times.

Appeal if Necessary

If your initial request for coverage is denied, review the denial letter for reasons and appeal information.

Prepare an appeal by gathering additional documentation or letters from your healthcare provider which argue the necessity of Enbrel for your condition. Submit this information according to the instructions provided in the denial letter.

Utilize Additional Resources

Explore patient assistance programs offered by the manufacturer of Enbrel, which may provide financial assistance or support in navigating insurance coverage issues.

Consult with a health insurance advocate if you encounter continuous challenges in securing coverage for Enbrel through BCBS of AZ.

Happy Customers

We love helping people!

Allie, Nevada

"I have two cats I can finally cuddle!"
‍

Cat and dog allergies

Zachary, Texas

“I can breathe through my nose for the first time in like 20 years!"

Dust and mold allergies

Erika, New York

“I've noticed less sneezing and shortness of breath.”

Tree and grass allergies

Richard, Texas

I love the convenience!
‍

Tree and cat allergies

We Treat Allergies

Food Allergies

Weed Pollens

Cat Allergies

Dog Allergies

Dust Mites

Molds

Tree Pollens

curex user showing allergy treatment kit

a male patient showing allergy drops vial

50,000+ users have overcome their allergies

Am I eligible?

At-home Immunotherapy

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option

Treatment prescribed
by clinician

Clinicaly made allergen extracts are customized for your allergies

Your immune system gets desensitized to allergens, giving you long-term relief.

FAQs

Does Blue Cross Blue Shield of Arizona Cover Enbrel

Discover if Blue Cross Blue Shield of Arizona covers Enbrel, reasons for denial, coverage tips, costs without insurance, and answer common questions.

Achieve Your Goals Faster with Curex

Is Enbrel Covered by Blue Cross Blue Shield of Arizona

Coverage for Enbrel

Blue Cross Blue Shield of Arizona may cover Enbrel for conditions such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Coverage typically requires prior authorization and may be subject to specific criteria defined in the policy terms.

Criteria and Requirements

Patients often need to demonstrate that other treatments were ineffective before Enbrel is approved.

A healthcare provider must verify the diagnosis and provide documentation supporting the need for Enbrel.

Policy details vary, so members should consult their specific plan documents or contact BCBS of Arizona for precise criteria.

Additional Considerations

Patients may have to follow step therapy protocols.

It’s crucial to confirm whether Enbrel is considered a specialty medication under the specific plan.

Copayment, deductible, and out-of-pocket expenses can vary greatly depending on the plan details.

A weight management program tailored to you

Start with Curex

Blue Cross Blue Shield of Arizona's Approved Criteria for Enbrel Coverage

Coverage for Enbrel under Blue Cross Blue Shield of Arizona

Coverage is available for members diagnosed with moderate to severe rheumatoid arthritis (RA), particularly those who have not responded well to other treatments. Physician documentation supporting this diagnosis is required.

Patients diagnosed with psoriatic arthritis are eligible for coverage, provided there is evidence of an inadequate response to one or more non-biologic disease-modifying antirheumatic drugs (DMARDs).

Candidates with ankylosing spondylitis are covered when traditional therapies, such as NSAIDs or physical therapy, have been ineffective. Medical records from a specialist should confirm the diagnosis.

The plan covers those with plaque psoriasis who meet severity criteria and have attempted other systemic therapies or phototherapy without satisfactory results. Documentation from a dermatologist should be included.

Individuals with polyarticular juvenile idiopathic arthritis (pJIA) of moderate to severe levels are covered, contingent on a trial of at least one disease-modifying medication that proved unsuccessful. Verification by a pediatric rheumatologist is necessary.

Verification of a prescription from a licensed healthcare provider who is specialized in the relevant condition and possesses the credentials to administer and manage biologic therapy is required.

Additional Criteria for Enbrel Coverage

Members must be enrolled in and comply with any step therapy protocols, initially trying lower-cost alternatives unless contraindicated or clinically inappropriate as judged by their healthcare provider.

The provider must demonstrate that the member has been appropriately screened for latent tuberculosis infection before the initiation of Enbrel therapy to ensure safe administration.

Continuation of treatment beyond initial authorization requires submission of follow-up documentation suggesting clinical benefits, such as improved functionality or reduced disease activity.

Renewal requests or authorization extensions should provide evidence that the member has adhered to the treatment protocol and that there is no evidence of harmful side effects requiring cessation of the therapy.

Access and Utilization Management

A case manager or specialist will review the proposed use of Enbrel in line with evidence-based guidelines specific to the individual's therapeutic needs.

Coordination with a pharmacy benefit manager (PBM) may be necessary to ensure appropriate dosing and supply management, avoiding waste and optimizing therapeutic outcomes.

The plan encourages participation in educational programs for members to understand the potential side effects and proper self-administration techniques to increase adherence to the therapy.

Why Blue Cross Blue Shield of Arizona Might Deny Enbrel Coverage

Reasons for Denial of Enbrel Coverage by Blue Cross Blue Shield of Arizona

The prescribed use of Enbrel does not comply with the FDA-approved indications. If Enbrel is prescribed for a condition not listed in the FDA indications, coverage may be denied.

Lack of appropriate documentation supporting the medical necessity of Enbrel for the patient's condition. If the physician's records do not sufficiently justify the need for Enbrel, a denial is possible.

Failure to follow the step therapy protocols outlined by Blue Cross Blue Shield of Arizona. Patients may be required to try other medications before Enbrel can be approved. Lack of documentation showing prior treatment attempts with other therapies could lead to denial.

Non-compliance with prior authorization requirements. If the necessary prior approval has not been obtained before Enbrel is prescribed, this could lead to a denial in coverage.

The prescription is for a dosage or administration method not approved by Blue Cross Blue Shield of Arizona. Deviations from approved dosages may result in denial of the claim.

Use of Enbrel for an off-label condition without sufficient evidence or peer-reviewed studies to support its efficacy and safety in that context.

If the insurer determines that the prescribed Enbrel is for a condition for which there are more cost-effective alternative treatments available.

Enbrel being used as the first line of treatment when alternative, more traditional treatments have not been attempted or documented as inadequate.

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

Join Curex

How Much Does Enbrel Cost without Insurance?

Approximate Cost of Enbrel Without Insurance

The approximate cost of Enbrel, an injection used to treat autoimmune conditions such as rheumatoid arthritis and psoriasis, is generally around $5,000 to $7,000 per month without insurance.

This monthly cost can vary depending on the dosage prescribed and the specific pharmacy location.

Patients may be able to find some cost reduction through manufacturer discounts or assistance programs, but these are typically separate from traditional insurance coverage.

Comparing pharmacy prices through services or websites that provide drug price comparisons may help in finding the lowest available price.

Clinical Support

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

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

Kayla Mardaga, NP

How to Get Enbrel Coverage with Blue Cross Blue Shield of Arizona

Initiate Contact with Blue Cross Blue Shield of Arizona

Find the customer service number on your insurance card and call Blue Cross Blue Shield of Arizona (BCBS of AZ) to ask about coverage for Enbrel.

Inquire about the specific requirements and processes for obtaining coverage for Enbrel. Request to speak with a representative who handles prescription drug coverage if necessary.

Review Your Policy Details

Carefully read your current BCBS of AZ policy documents. Look for sections related to prescription drug coverage, specialty medicines, and exclusions.

Pay attention to any tiered medication structure which might categorize Enbrel at a specific coverage level.

Consult with Your Healthcare Provider

Speak with your doctor who prescribed Enbrel to discuss insurance coverage. They might have experience with patients who have faced similar insurance challenges.

Request any necessary paperwork or documentation from your doctor to support your insurance claim. This may include a letter of medical necessity or detailed prescription notes.

Complete a Prior Authorization Form

If required by your insurance policy, download or request a prior authorization form from BCBS of AZ. Your healthcare provider will need to complete this form.

Ensure that all information is accurate and detailed to avoid delays in processing. Include all supporting documents as requested by BCBS of AZ.

Submit Your Documentation

Send all completed forms and supporting documents to BCBS of AZ as directed, typically via mail, fax, or through an online portal if they provide one.

Follow up with BCBS of AZ to confirm receipt of your documents and to inquire about processing times.

Appeal if Necessary

If your initial request for coverage is denied, review the denial letter for reasons and appeal information.

Prepare an appeal by gathering additional documentation or letters from your healthcare provider which argue the necessity of Enbrel for your condition. Submit this information according to the instructions provided in the denial letter.

Utilize Additional Resources

Explore patient assistance programs offered by the manufacturer of Enbrel, which may provide financial assistance or support in navigating insurance coverage issues.

Consult with a health insurance advocate if you encounter continuous challenges in securing coverage for Enbrel through BCBS of AZ.

Premium Medication you can trust

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.

‍

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Enbrel FAQ

What conditions does Enbrel treat?

Conditions Treated by Enbrel

Rheumatoid Arthritis: Enbrel is commonly used for treating moderate to severe rheumatoid arthritis in adults, helping to reduce joint pain and swelling.
Juvenile Idiopathic Arthritis: Effective for kids aged 2 and older, Enbrel helps manage symptoms of juvenile idiopathic arthritis.
Psoriatic Arthritis: Patients with psoriatic arthritis can benefit from Enbrel, as it alleviates joint and skin symptoms.
Ankylosing Spondylitis: It aids in managing stiffness and inflammation linked to ankylosing spondylitis.
Plaque Psoriasis: Enbrel is used for treating moderate to severe plaque psoriasis in adult patients, reducing skin lesions.

What are common side effects of Enbrel?

Common Side Effects of Enbrel

Injection Site Reactions: Pain, redness, and swelling at the injection site are quite common.

Infections: Users may experience an increased risk of infections, including upper respiratory tract infections.

Headache: Some patients report headaches following administration.

Nausea and Vomiting: These gastrointestinal issues can occur.

Rash: Skin reactions such as rashes are noted in some individuals.

Heartburn: Stomach discomfort and heartburn are possible.

Be sure to consult your healthcare provider for any concerning symptoms or persistent side effects.

How is Enbrel administered?

Administration of Enbrel

Enbrel is administered via subcutaneous injection.
It is typically provided in a prefilled syringe, autoinjector (SureClick), or a vial requiring reconstitution.
Injections are usually administered on the thigh, abdomen, or outer area of the upper arm.
It's crucial to rotate the injection sites to avoid irritation.

Preparation and Injection

Check the solution for particles or discoloration before use.
If needed, allow the solution to reach room temperature for about 15–30 minutes.
Wash your hands thoroughly before handling the medication.
Use an alcohol swab to clean the injection site.
Inject Enbrel by angling the needle at 90 degrees for optimal delivery.

Have questions left?

‍

Get a personalized online consultation with a doctor at Curex

Learn More

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”

Becky D.

"If I could give 6 stars, I would. BEST... BEST… BEST… service.”

Ferdian K.

“The Curex staff has been professional, efficient, and really focused on my individual needs.”

Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

Button Text

A weight management program tailored to you

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. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does Blue Cross Blue Shield of Arizona Cover Enbrel

Discover if Blue Cross Blue Shield of Arizona covers Enbrel, reasons for denial, coverage tips, costs without insurance, and answer common questions.

Achieve Your Goals Faster with Curex