$49$0.99

Does Blue Cross Blue Shield of Arizona Cover Stelara

Explore Blue Cross Blue Shield of Arizona's policies on Stelara coverage, costs without insurance, and get tips to secure coverage effectively.

Treat your allergies with Curex

as seen on

“Curex is changing the landscape of allergies in 2024”

Coverage Details for Stelara

Blue Cross Blue Shield of Arizona generally covers Stelara, a biologic medication used for treating psoriasis, psoriatic arthritis, and Crohn's disease, based on medical necessity and prior authorization.

Candidates for Stelara typically need to have tried and not responded adequately to other therapies. This includes conventional treatments such as topical steroids and phototherapy for psoriasis, or DMARDs for psoriatic arthritis.

Coverage may also require a healthcare provider's confirmation of diagnosis criteria by the FDA, involving specific severity and conditions that align with those treated by Stelara.

Documentation from the prescribing physician supporting the need for Stelara is critical for obtaining coverage, emphasizing the ineffectiveness of other therapies.

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 Stelara Coverage with Blue Cross Blue Shield of Arizona

Initial Consultation with Your Healthcare Provider

Discuss with your healthcare provider about the necessity of Stelara for your condition. They need to determine and document that it is medically essential.

Make sure your healthcare provider is aware that you are covered by Blue Cross Blue Shield of Arizona (BCBSAZ) and that they have experience working with insurance claims for specialized medications.

Verify BCBSAZ Insurance Policy Coverage

Contact BCBSAZ customer service to review your specific insurance plan’s drug coverage policy. Confirm whether Stelara is included in the list of covered medications.

Check if there are any specific requirements, such as prior authorization, step therapy, or medical history documentation, needed to get Stelara covered.

Gather Documentation and Prescription Details

Work with your healthcare provider to compile necessary medical documentation that supports the requirement for Stelara treatment. This may include your medical records, diagnosis details, and treatment history.

Ensure your healthcare provider writes a detailed prescription with the recommended dosage and administration frequency for Stelara.

Prepare and Submit a Prior Authorization Request

Have your healthcare provider submit a prior authorization request to BCBSAZ, if necessary. This process might involve completing specific forms provided by BCBSAZ.

Include all supporting documents that justify the medical necessity for Stelara, aligning with any criteria provided by BCBSAZ.

Follow-Up and Response

Stay in regular contact with both BCBSAZ and your healthcare provider to monitor the status of your prior authorization request.

Be prepared to provide additional information or clarification if requested by BCBSAZ to facilitate a positive decision.

Appeal if Necessary

If your request is denied, review the rejection letter from BCBSAZ to understand the reasons for the denial.

Work with your healthcare provider to file an appeal. This process may require additional documentation or medical evidence.

Consider seeking assistance from a patient advocate or your healthcare provider’s office to navigate the appeals process effectively.

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 Stelara

Explore Blue Cross Blue Shield of Arizona's policies on Stelara coverage, costs without insurance, and get tips to secure coverage effectively.

Achieve Your Goals Faster with Curex

Is Stelara Covered by Blue Cross Blue Shield of Arizona

Coverage Details for Stelara

Blue Cross Blue Shield of Arizona generally covers Stelara, a biologic medication used for treating psoriasis, psoriatic arthritis, and Crohn's disease, based on medical necessity and prior authorization.

Candidates for Stelara typically need to have tried and not responded adequately to other therapies. This includes conventional treatments such as topical steroids and phototherapy for psoriasis, or DMARDs for psoriatic arthritis.

Coverage may also require a healthcare provider's confirmation of diagnosis criteria by the FDA, involving specific severity and conditions that align with those treated by Stelara.

Documentation from the prescribing physician supporting the need for Stelara is critical for obtaining coverage, emphasizing the ineffectiveness of other therapies.

A weight management program tailored to you

Start with Curex

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

Criteria for Stelara Coverage

Stelara is covered for patients diagnosed with moderate to severe plaque psoriasis who have failed to respond to or have contraindications to at least two systemic therapies or phototherapy.

Coverage is provided for patients diagnosed with active psoriatic arthritis who have an inadequate response to or intolerance of prior disease-modifying antirheumatic drugs (DMARDs).

Stelara is approved for patients aged 18 years or older with moderate to severe Crohn’s disease, who have failed or are intolerant to immunomodulators or corticosteroids, but never failed a tumor necrosis factor (TNF) blocker, or have failed or are intolerant to one or more TNF blockers.

Coverage includes use in patients 18 years or older with moderately to severely active ulcerative colitis who have had an inadequate response to, lost response to, or were intolerant to either conventional therapy or a biologic, or have medical contraindications to such therapies.

Stelara should be prescribed in accordance with FDA recommendations, involving initiation with a weight-based intravenous dose followed by subcutaneous maintenance doses.

Prior authorization is required to ensure that indications align with approved criteria and appropriate clinical documentation is provided.

Why Blue Cross Blue Shield of Arizona Might Deny Stelara Coverage

Exclusion Criteria for Stelara Coverage by Blue Cross Blue Shield of Arizona

**Non-FDA Approved Uses**: Coverage is denied if Stelara is prescribed for conditions or in dosages that are not FDA-approved.

**Lack of Medical Necessity**: If there is insufficient evidence to establish the medical necessity of Stelara for the member's condition, coverage will not be provided.

**Non-compliance with Step Therapy Requirements**: If the patient has not tried and failed specified alternative therapies prior to Stelara, the insurer may deny coverage.

**Absence of Prior Authorization**: Coverage can be denied if Stelara use was not pre-approved by Blue Cross Blue Shield of Arizona through their prior authorization process.

**Out-of-Network Providers**: If Stelara is administered by an out-of-network provider without proper referrals or approvals, coverage could be denied.

**Policy Limitations and Exclusions**: Any specific limitations or exclusions relating to biologic drugs outlined in the insurance policy might result in a denial.

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

Join Curex

How Much Does Stelara Cost without Insurance?

Approximate Cost of Stelara without Insurance

The price of Stelara, a medication used primarily for treating conditions such as psoriasis and Crohn's disease, can vary based on the pharmacy and other location-based factors, but without insurance, it typically costs around $20,000 to $40,000 per year.

Individual dosage needs and treatment plans can affect the total cost, as Stelara injections are spaced differently depending on treatment guidelines for specific conditions.

Pricing can also vary depending on the dosage strength; the standard doses are 45 mg and 90 mg, with the 90 mg dose generally being more expensive.

Patients can sometimes find manufacturer coupons or patient assistance programs that help reduce the cost of Stelara. These programs usually require an application process and eligibility criteria.

Additionally, discount pharmacy programs or third-party coupon providers might offer savings, although these are often limited and may vary in percentage or availability.

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 Stelara Coverage with Blue Cross Blue Shield of Arizona

Initial Consultation with Your Healthcare Provider

Discuss with your healthcare provider about the necessity of Stelara for your condition. They need to determine and document that it is medically essential.

Make sure your healthcare provider is aware that you are covered by Blue Cross Blue Shield of Arizona (BCBSAZ) and that they have experience working with insurance claims for specialized medications.

Verify BCBSAZ Insurance Policy Coverage

Contact BCBSAZ customer service to review your specific insurance plan’s drug coverage policy. Confirm whether Stelara is included in the list of covered medications.

Check if there are any specific requirements, such as prior authorization, step therapy, or medical history documentation, needed to get Stelara covered.

Gather Documentation and Prescription Details

Work with your healthcare provider to compile necessary medical documentation that supports the requirement for Stelara treatment. This may include your medical records, diagnosis details, and treatment history.

Ensure your healthcare provider writes a detailed prescription with the recommended dosage and administration frequency for Stelara.

Prepare and Submit a Prior Authorization Request

Have your healthcare provider submit a prior authorization request to BCBSAZ, if necessary. This process might involve completing specific forms provided by BCBSAZ.

Include all supporting documents that justify the medical necessity for Stelara, aligning with any criteria provided by BCBSAZ.

Follow-Up and Response

Stay in regular contact with both BCBSAZ and your healthcare provider to monitor the status of your prior authorization request.

Be prepared to provide additional information or clarification if requested by BCBSAZ to facilitate a positive decision.

Appeal if Necessary

If your request is denied, review the rejection letter from BCBSAZ to understand the reasons for the denial.

Work with your healthcare provider to file an appeal. This process may require additional documentation or medical evidence.

Consider seeking assistance from a patient advocate or your healthcare provider’s office to navigate the appeals process effectively.

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.

Stelara FAQ

What are the common side effects of Stelara?

Common Side Effects of Stelara

**Infections:** Increased susceptibility to infections such as upper respiratory infections and strep throat.
**Headache:** This is a frequently reported side effect among patients who use Stelara.
**Tiredness:** Many individuals may experience fatigue or tiredness while on this medication.
**Redness at Injection Site:** Skin irritation, including redness, itching, or swelling, can occur at the site of injection.
**Nausea:** Some patients report feeling mildly nauseated after taking the medication.

How does Stelara work for psoriasis?

Mechanism of Action

Stelara is a monoclonal antibody that targets interleukin-12 (IL-12) and interleukin-23 (IL-23), which are proteins involved in inflammatory processes associated with psoriasis.

Impact on the Immune System

By inhibiting IL-12 and IL-23, Stelara reduces the activity of specific immune cells (T-cells) that contribute to the inflammation and rapid skin cell production characteristic of psoriasis.

Clinical Efficacy

Many patients experience significant reductions in psoriasis symptoms, including skin clearance, with improvements often visible within weeks after initial treatment.

Administration and Dosage

Stelara is administered via subcutaneous injection, starting with a loading dose followed by maintenance doses every 12 weeks thereafter.

How often do you need Stelara injections?

Stelara Injection Schedule

Initial Doses: After the first dose is administered, a second dose follows four weeks later.

Maintenance Doses: Subsequent injections are given every 12 weeks.

Special Cases: Depending on specific conditions like Crohn's disease, the frequency may vary under a physician's guidance.

Administration: Stelara is typically administered as a subcutaneous injection which can be performed in a healthcare setting or self-administered after proper training.

Consult Your Doctor: Always consult with your healthcare provider to tailor the schedule to your medical needs.

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 Stelara

Explore Blue Cross Blue Shield of Arizona's policies on Stelara coverage, costs without insurance, and get tips to secure coverage effectively.

Achieve Your Goals Faster with Curex