Does Blue Cross Blue Shield of Illinois Cover Humira

Discover how to secure Humira coverage with Blue Cross Blue Shield of Illinois, understand costs, potential denials, and find answers to common questions.
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Blue Cross Blue Shield of Illinois and Humira Coverage

 

  • Blue Cross Blue Shield of Illinois may cover Humira, primarily for treating certain chronic inflammatory conditions such as rheumatoid arthritis, Crohn’s disease, ankylosing spondylitis, and psoriasis, among others.
  •  

  • Coverage is generally subject to the plan's specific benefits and may require prior authorization, which involves verifying the medical necessity of Humira.
  •  

  • Patients often need to try and fail less expensive treatment options before Humira will be covered, known as "step therapy."
  •  

  • Cost-sharing elements such as copays or coinsurance may apply based on the individual's plan. Verify your plan details to understand your financial responsibilities.
  •  

  • It is essential to consult directly with Blue Cross Blue Shield of Illinois or review your insurance policy documentation to confirm coverage details specific to your situation.

 

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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.

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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 Humira Coverage with Blue Cross Blue Shield of Illinois

 

Review Your Insurance Plan Details

 

  • Log in to your Blue Cross Blue Shield of Illinois account online to check your current coverage details.
  •  

  • Look for prescription drug benefits in your policy documents or member booklet.
  •  

  • Identify whether Humira (adalimumab) is listed under covered medications or biologic drugs.

 

Contact Blue Cross Blue Shield of Illinois

 

  • Call the customer service number found on the back of your insurance card for personalized assistance.
  •  

  • Inquire about Humira-specific coverage, any prerequisites, and steps you need to take to obtain it.
  •  

  • Note down the representative's name, any reference numbers, and key details from the conversation for future reference.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Humira.
  •  

  • Ask your provider to help gather necessary medical documentation, demonstrating why Humira is necessary for your treatment.
  •  

  • Ensure your provider's office is aware of, and prepared to comply with, any specific requirements set by your insurance plan.

 

Obtain a Prior Authorization

 

  • Submit a prior authorization request through your healthcare provider’s office if required by your insurance plan.
  •  

  • Make sure your doctor provides thorough justification, including your medical history and previously tried treatments.
  •  

  • Follow up regularly with both your doctor and insurance company to monitor the status of the authorization request.

 

Explore Financial Assistance Programs

 

  • Research if you qualify for patient assistance programs offered by AbbVie, the manufacturer of Humira.
  •  

  • Complete any necessary applications and submit required documentation to AbbVie Patient Assistance Programs for potential financial support.
  •  

  • Consider other third-party nonprofit organizations that offer co-pay assistance for expensive medications like Humira.

 

Monitor Your Claims and Coverage

 

  • Once Humira is approved, track your insurance claims to make sure they are processed correctly.
  •  

  • Review your Explanation of Benefits (EOB) statements to confirm that the costs align with your coverage details.
  •  

  • Contact Blue Cross Blue Shield of Illinois if discrepancies occur in the coverage or charges for Humira.

 

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Humira

Discover how to secure Humira coverage with Blue Cross Blue Shield of Illinois, understand costs, potential denials, and find answers to common questions.
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Is Humira Covered by Blue Cross Blue Shield of Illinois

 

Blue Cross Blue Shield of Illinois and Humira Coverage

 

  • Blue Cross Blue Shield of Illinois may cover Humira, primarily for treating certain chronic inflammatory conditions such as rheumatoid arthritis, Crohn’s disease, ankylosing spondylitis, and psoriasis, among others.
  •  

  • Coverage is generally subject to the plan's specific benefits and may require prior authorization, which involves verifying the medical necessity of Humira.
  •  

  • Patients often need to try and fail less expensive treatment options before Humira will be covered, known as "step therapy."
  •  

  • Cost-sharing elements such as copays or coinsurance may apply based on the individual's plan. Verify your plan details to understand your financial responsibilities.
  •  

  • It is essential to consult directly with Blue Cross Blue Shield of Illinois or review your insurance policy documentation to confirm coverage details specific to your situation.

 

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

 

Criteria for Initial Coverage of Humira

 

  • **Diagnosis Verification:** Patients must have a documented diagnosis from a healthcare professional of an FDA-approved condition such as rheumatoid arthritis, ulcerative colitis, psoriasis, etc.
  •  

  • **Prescribing Physician:** Medication must be prescribed by, or in consultation with, a specialist in the condition for which Humira is indicated, such as a rheumatologist, dermatologist, or gastroenterologist.
  •  

  • **Treatment History:** Patients should demonstrate an inadequate response, have contraindications, or experience intolerance to conventional systemic therapies and/or other biologic DMARDs appropriate to the disease state.
  •  

  • **Monitoring and Evaluation:** There must be a plan in place to monitor patients with regular follow-up to assess the effectiveness and safety of the treatment with Humira.
  •  

  • **Step Therapy Protocols:** In some cases, patients might be required to try alternative medications unless clinically inappropriate, and should demonstrate a documented trial of standard treatments as outlined by medical guidelines.

 

Criteria for Continued Coverage of Humira

 

  • **Demonstrated Benefit:** Continuous coverage is based on documented evidence showing improvement or stabilization of the patient’s condition, as evidenced by clinical notes from follow-up visits.
  •  

  • **Periodic Review:** The prescribing physician should periodically evaluate the need for ongoing treatment with Humira and adjust therapy based on clinical assessment.
  •  

  • **Adherence to Therapy:** Patients should adhere to the prescribed Humira regimen, with no significant gaps in treatment, unless justified by medical documentation.
  •  

  • **Safety and Tolerability:** Patients must be monitored for potential adverse effects, and any serious adverse reactions must be reported, with adjustments made to therapy as necessary.

 

Additional Support and Considerations

 

  • **Patient Education:** Insurance covers educational resources and support to ensure patients and caregivers understand the medication use, potential side effects, and administration techniques.
  •  

  • **Coordination of Care:** Coverage may include services that ensure effective coordination among healthcare providers involved in the patient’s care, particularly if the patient sees multiple specialists.
  •  

  • **Financial Assistance Programs:** Enrollment in financial assistance programs or patient support programs may also be covered to help manage out-of-pocket costs associated with Humira treatment.

 

Why Blue Cross Blue Shield of Illinois Might Deny Humira Coverage

 

Possible Reasons for Denial of Humira Coverage

 

  • Lack of Medical Necessity: Blue Cross Blue Shield of Illinois might deny Humira coverage if the treatment is not deemed medically necessary for the patient's condition as determined by their guidelines.
  •  

  • Off-Label Use: If Humira is prescribed for a condition that is not approved by the FDA or not listed in the plan's policy as a covered indication, the insurance may not cover its use.
  •  

  • Failure to Meet Prior Authorization Requirements: Humira might be denied if the necessary prior authorization documents were not submitted or if they do not meet the insurer's criteria.
  •  

  • Non-Adherence to Step Therapy: Coverage may be denied if the patient has not tried and failed cheaper or preferred treatment options that the insurance company requires before approving Humira.
  •  

  • Incomplete or Inaccurate Documentation: If there is missing or incorrect information in the submitted medical documentation, it may lead to denial of coverage for Humira.
  •  

  • Policy Exclusions: The patient's specific insurance policy may include exclusions that specifically deny coverage of Humira for certain conditions or individuals.

 

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How Much Does Humira Cost without Insurance?

 

Understanding Humira's Cost

 

  • Humira, a medication used to treat various autoimmune conditions, can be quite expensive without insurance coverage.
  •  

  • The cost for a single 40 mg/0.4 ml pen of Humira is typically priced between $5,000 and $6,000, depending on the pharmacy and location.
  •  

  • Patients often require multiple pens per month, so monthly costs can range from $10,000 to $24,000 or more, depending on dosage and frequency of use.
  •  

  • Pharmaceutical companies may offer financial assistance programs or patient support to help lower these costs for eligible patients.
  •  

  • Discount programs and manufacturer coupons could sometimes reduce the cost for patients who qualify.

 

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 Humira Coverage with Blue Cross Blue Shield of Illinois

 

Review Your Insurance Plan Details

 

  • Log in to your Blue Cross Blue Shield of Illinois account online to check your current coverage details.
  •  

  • Look for prescription drug benefits in your policy documents or member booklet.
  •  

  • Identify whether Humira (adalimumab) is listed under covered medications or biologic drugs.

 

Contact Blue Cross Blue Shield of Illinois

 

  • Call the customer service number found on the back of your insurance card for personalized assistance.
  •  

  • Inquire about Humira-specific coverage, any prerequisites, and steps you need to take to obtain it.
  •  

  • Note down the representative's name, any reference numbers, and key details from the conversation for future reference.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Humira.
  •  

  • Ask your provider to help gather necessary medical documentation, demonstrating why Humira is necessary for your treatment.
  •  

  • Ensure your provider's office is aware of, and prepared to comply with, any specific requirements set by your insurance plan.

 

Obtain a Prior Authorization

 

  • Submit a prior authorization request through your healthcare provider’s office if required by your insurance plan.
  •  

  • Make sure your doctor provides thorough justification, including your medical history and previously tried treatments.
  •  

  • Follow up regularly with both your doctor and insurance company to monitor the status of the authorization request.

 

Explore Financial Assistance Programs

 

  • Research if you qualify for patient assistance programs offered by AbbVie, the manufacturer of Humira.
  •  

  • Complete any necessary applications and submit required documentation to AbbVie Patient Assistance Programs for potential financial support.
  •  

  • Consider other third-party nonprofit organizations that offer co-pay assistance for expensive medications like Humira.

 

Monitor Your Claims and Coverage

 

  • Once Humira is approved, track your insurance claims to make sure they are processed correctly.
  •  

  • Review your Explanation of Benefits (EOB) statements to confirm that the costs align with your coverage details.
  •  

  • Contact Blue Cross Blue Shield of Illinois if discrepancies occur in the coverage or charges for Humira.

 

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Humira FAQ

What are the side effects of Humira?

 

Common Side Effects of Humira

 

  • Injection site reactions: redness, itching, or swelling.
  • Upper respiratory infections: sinus congestion and sore throat.
  • Headaches and nausea.

 

Serious Side Effects

 

  • Severe allergic reactions: difficulty breathing, chest pain, or swelling of the face.
  • Risk of infections: tuberculosis, fungal, or viral infections.
  • Blood disorders: unusual bruising or bleeding, pale skin.
  • Heart problems: shortness of breath, swelling of ankles/feet.

 

Long-term Considerations

 

  • Increased risk of certain cancers, particularly lymphomas.
  • Possible liver issues: jaundice or dark urine.

 

How does Humira work for rheumatoid arthritis?

 

How Humira Works

 

  • Humira is a TNF inhibitor. TNF, or tumor necrosis factor, is a substance in the body that causes inflammation.
  •  

  • By blocking TNF, Humira helps reduce inflammation and slow disease progression in rheumatoid arthritis patients.
  •  

  • It targets the underlying cause of inflammation instead of just managing symptoms, providing longer-term relief from discomfort and joint damage.

 

Administration and Effects

 

  • Administered as a subcutaneous injection, typically every two weeks.
  •  

  • Many patients start experiencing relief within a few weeks, though full benefits may take longer.
  •  

  • Consistent use can lead to improved mobility, reduced pain, and decreased swelling, assisting in daily activities.

How often do you take Humira injections?

 

Frequency of Humira Injections

 

  • **Initial Dose**: Typically, patients start with a loading dose. For example, in rheumatoid arthritis, a patient may begin with 160 mg on day 1, followed by 80 mg on day 15.
  •  

  • **Maintenance Dose**: After the initial period, the standard maintenance dose is usually 40 mg every other week. However, some patients may benefit from a weekly dose, depending on the condition and doctor's advice.
  •  

  • **Adjustments**: Dosage frequency may be adjusted based on response and tolerability, making healthcare provider consultation crucial.

 

Consulting Your Physician

 

  • Due to the varying nature of autoimmune conditions, always consult your healthcare professional to determine the appropriate regimen for your specific situation.

 

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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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