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Does Blue Cross Blue Shield of Illinois Cover Dupixent

Discover if Blue Cross Blue Shield of Illinois covers Dupixent, potential coverage hurdles, costs without insurance, and essential FAQs.

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Coverage for Dupixent with BCBS Illinois

Blue Cross Blue Shield of Illinois may cover Dupixent for certain conditions such as moderate-to-severe eczema (atopic dermatitis), asthma, or chronic rhinosinusitis with nasal polyps.

Coverage is typically subject to prior authorization, which means your healthcare provider must demonstrate that Dupixent is medically necessary based on your condition.

Criteria for coverage often include failure of other treatments or therapies, or specific clinical factors that justify the use of Dupixent as a necessary step in treatment.

It’s important to check with BCBS of Illinois for your specific plan details as coverage can vary based on factors like plan type, policyholder specifics, and state regulations.

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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.

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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.

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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 Dupixent Coverage with Blue Cross Blue Shield of Illinois

Initiate a Consultation with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your condition and the potential benefits of Dupixent.

Ensure that your provider agrees that Dupixent is medically necessary for your treatment.

Have your healthcare provider prepare a prior authorization request for Dupixent, as this is often a requisite for insurance coverage.

Review Your Blue Cross Blue Shield of Illinois Plan

Carefully read through your health insurance policy to understand the coverage for prescription drugs. Specific plans may cover biologic drugs like Dupixent differently.

Identify the tier or category Dupixent falls under in your plan's drug formulary. This will help determine your potential out-of-pocket costs.

Check if there are any specific requirements, such as step therapy or prior authorization, mentioned in your plan for Dupixent coverage.

Contact Blue Cross Blue Shield of Illinois

Get in touch with Blue Cross Blue Shield of Illinois' customer service to clarify any questions regarding coverage of Dupixent. Use the phone number found on your insurance card.

Ask about any specific documentation or forms required for the prior authorization process.

Inquire about any copay assistance programs or additional coverage options available for expensive medications like Dupixent.

Submit the Prior Authorization Request

Work with your healthcare provider to submit the necessary prior authorization forms to Blue Cross Blue Shield of Illinois.

Include any supporting documentation that demonstrates the medical necessity of Dupixent for your condition.

Follow up with your insurance provider to ensure they have received all needed information for the authorization process.

Remain in Touch for Updates

Keep in regular contact with both your healthcare provider and Blue Cross Blue Shield of Illinois to monitor the status of your prior authorization request.

If your request is denied, ask for detailed reasons and inquire about the appeals process.

Be prepared to provide further documentation or letters of medical necessity if requested during the appeals process.

Utilize Copay Assistance Programs

Explore manufacturer copay assistance or patient savings programs offered by Sanofi and Regeneron, the makers of Dupixent.

Contact patient advocacy organizations that may offer financial assistance or guidance for expensive medications.

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Dupixent

Discover if Blue Cross Blue Shield of Illinois covers Dupixent, potential coverage hurdles, costs without insurance, and essential FAQs.

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Is Dupixent Covered by Blue Cross Blue Shield of Illinois

Coverage for Dupixent with BCBS Illinois

Blue Cross Blue Shield of Illinois may cover Dupixent for certain conditions such as moderate-to-severe eczema (atopic dermatitis), asthma, or chronic rhinosinusitis with nasal polyps.

Coverage is typically subject to prior authorization, which means your healthcare provider must demonstrate that Dupixent is medically necessary based on your condition.

Criteria for coverage often include failure of other treatments or therapies, or specific clinical factors that justify the use of Dupixent as a necessary step in treatment.

It’s important to check with BCBS of Illinois for your specific plan details as coverage can vary based on factors like plan type, policyholder specifics, and state regulations.

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Blue Cross Blue Shield of Illinois's Approved Criteria for Dupixent Coverage

Dupixent Coverage Criteria

The patient must have a documented diagnosis of moderate-to-severe atopic dermatitis that is not adequately controlled with topical prescription therapies or when those therapies are not advisable.

The patient has a diagnosis of moderate-to-severe asthma with an eosinophilic phenotype or oral corticosteroid-dependent asthma, and Dupixent is considered as an add-on maintenance treatment.

The patient has a confirmed diagnosis of chronic rhinosinusitis with nasal polyposis (CRSwNP) and the use of Dupixent is for the add-on maintenance treatment to enhance the control of the condition.

Documentation is provided indicating that the patient is 6 years of age or older for the treatment of atopic dermatitis, 12 years or older for the treatment of asthma, and 18 years or older for CRSwNP.

The prescribing physician or healthcare provider specializes in dermatology, allergy, immunology, pulmonology, or another field directly related to the treatment of the condition under consideration with Dupixent.

Prior treatment with other medications or modalities for the condition being treated has been documented to have failed, be contraindicated, or not tolerated.

The initial approval duration for Dupixent is typically 6 months, with extensions contingent upon demonstration of clinical improvement or stabilization of the condition being targeted with therapy.

Why Blue Cross Blue Shield of Illinois Might Deny Dupixent Coverage

Reasons for Denial of Dupixent Coverage by Blue Cross Blue Shield of Illinois

The requested use of Dupixent does not meet the established medical necessity criteria as determined by the insurer's clinical guidelines.

The prescribed use is for an off-label condition that has not been supported by sufficient evidence or studies recognized by the plan.

Dupixent is being used in combination with other medications not approved in conjunction by the insurer’s policies.

The patient does not fulfill the specific demographic or clinical characteristics outlined in the policy's coverage criteria, such as age or disease severity.

The treatment duration exceeds the insurer's predetermined timelines without documented beneficial response from previous coverage periods.

Lack of adequate documentation supporting previous trial and failure of standard therapies before consideration of Dupixent.

Exceeds quantity limits or dosage restrictions imposed by the insurance plan.

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How Much Does Dupixent Cost without Insurance?

Approximate Cost of Dupixent Without Insurance

The cost of Dupixent without insurance can be quite high, usually ranging between $3,200 to $3,500 per month. This cost is for the standard dose, which consists of two pre-filled syringes or injection pens, each containing 300 mg of medication.

Prices can vary depending on the pharmacy, location, and any potential deals or discounts offered by specific pharmacies or third-party services.

Patients are encouraged to explore manufacturer copay cards, patient assistance programs, or discount cards which might be available to help reduce out-of-pocket expenses.

For those requiring treatment for conditions like eczema, asthma, or other approved uses, Dupixent is often administered bi-weekly after an initial loading dose, which should be taken into consideration when calculating monthly or annual expenses.

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 Dupixent Coverage with Blue Cross Blue Shield of Illinois

Initiate a Consultation with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your condition and the potential benefits of Dupixent.

Ensure that your provider agrees that Dupixent is medically necessary for your treatment.

Have your healthcare provider prepare a prior authorization request for Dupixent, as this is often a requisite for insurance coverage.

Review Your Blue Cross Blue Shield of Illinois Plan

Carefully read through your health insurance policy to understand the coverage for prescription drugs. Specific plans may cover biologic drugs like Dupixent differently.

Identify the tier or category Dupixent falls under in your plan's drug formulary. This will help determine your potential out-of-pocket costs.

Check if there are any specific requirements, such as step therapy or prior authorization, mentioned in your plan for Dupixent coverage.

Contact Blue Cross Blue Shield of Illinois

Get in touch with Blue Cross Blue Shield of Illinois' customer service to clarify any questions regarding coverage of Dupixent. Use the phone number found on your insurance card.

Ask about any specific documentation or forms required for the prior authorization process.

Inquire about any copay assistance programs or additional coverage options available for expensive medications like Dupixent.

Submit the Prior Authorization Request

Work with your healthcare provider to submit the necessary prior authorization forms to Blue Cross Blue Shield of Illinois.

Include any supporting documentation that demonstrates the medical necessity of Dupixent for your condition.

Follow up with your insurance provider to ensure they have received all needed information for the authorization process.

Remain in Touch for Updates

Keep in regular contact with both your healthcare provider and Blue Cross Blue Shield of Illinois to monitor the status of your prior authorization request.

If your request is denied, ask for detailed reasons and inquire about the appeals process.

Be prepared to provide further documentation or letters of medical necessity if requested during the appeals process.

Utilize Copay Assistance Programs

Explore manufacturer copay assistance or patient savings programs offered by Sanofi and Regeneron, the makers of Dupixent.

Contact patient advocacy organizations that may offer financial assistance or guidance for expensive medications.

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Dupixent FAQ

1. What are the common side effects of Dupixent?

Common Side Effects of Dupixent

Injection site reactions: redness, swelling, and pain at the injection site are frequently reported. These reactions usually subside shortly after injection.

Conjunctivitis: Some patients experience symptoms like red, itchy, or watery eyes.

Blepharitis: Inflammation of the eyelids, leading to symptoms such as redness, swelling, and itching, may occur.

Oral herpes: A mild increase in probabilities of cold sores has been noted in some cases.

Sore throat: Some individuals may develop pharyngitis, which manifests as throat discomfort or pain.

2. How does Dupixent work for eczema?

How Dupixent Works for Eczema

Dupixent is a monoclonal antibody that targets interleukin-4 receptor alpha (IL-4Rα).

By blocking IL-4Rα, it inhibits the signaling pathways of IL-4 and IL-13, key cytokines involved in the inflammatory response in eczema.

This leads to a reduction in the overactive immune response, which is characterized by inflammation and itchiness in atopic dermatitis.

As a result, Dupixent helps alleviate symptoms like redness, itch, and skin thickening by modulating the immune response.

3. Is Dupixent used for asthma treatment?

Dupixent for Asthma

Dupixent (dupilumab) is approved for use in the treatment of moderate-to-severe asthma in adults and adolescents (12 years and older).

It is particularly beneficial for patients with eosinophilic asthma or those dependent on oral corticosteroids.

Dupixent acts by targeting and inhibiting the signaling of interleukins IL-4 and IL-13, which play central roles in the inflammatory response involved in asthma.

The medication is administered via subcutaneous injection, typically every two weeks after an initial loading dose.

Clinical trials have shown Dupixent to reduce asthma exacerbations and improve lung function, thereby potentially reducing the need for oral corticosteroids.

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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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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.

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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 Illinois Cover Dupixent

Discover if Blue Cross Blue Shield of Illinois covers Dupixent, potential coverage hurdles, costs without insurance, and essential FAQs.

Achieve Your Goals Faster with Curex