Does Blue Cross Blue Shield of Illinois Cover Symbicort

Explore Symbicort coverage by Blue Cross Blue Shield of Illinois, steps to obtain it, costs without insurance, and get answers to your FAQs.
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Coverage for Symbicort

 

  • Blue Cross Blue Shield of Illinois (BCBSIL) typically covers Symbicort for asthma or COPD if prescribed by a healthcare provider.
  •  

  • Coverage depends on the specific plan and formulary, and it's subject to prior authorization.

 

Criteria for Coverage

 

  • Patients must have a confirmed diagnosis of asthma or COPD.
  • Prescriptions generally require prior authorization to ensure appropriate medical necessity and adherence to guidelines.
  • The prescriber may need to document previous treatments tried and their outcomes.

 

Basic Rules

 

  • Check the specific plan to understand copayments, coinsurance, and deductible obligations for Symbicort.
  • Always verify with BCBSIL and consult the benefits booklet for the most accurate and detailed coverage information.

 

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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 Illinois

 

Contact Your Healthcare Provider

 

  • Reach out to your healthcare provider to confirm that Symbicort is the appropriate prescription for your condition.
  •  

  • Request a formal prescription for Symbicort from your healthcare provider.
  •  

  • Ask your healthcare provider to provide any necessary documentation that supports the medical necessity of Symbicort.

 

Review Your Insurance Policy

 

  • Log into your Blue Cross Blue Shield of Illinois (BCBSIL) member account to access your policy details.
  •  

  • Locate the prescription drug coverage section to understand what medications are covered and any specific requirements for coverage.
  •  

  • Check if Symbicort is listed under your policy’s formulary (the list of covered drugs) and if there are specific tiers or restrictions.

 

Contact Blue Cross Blue Shield of Illinois

 

  • Call the customer service number on the back of your BCBSIL insurance card to speak with a representative about Symbicort coverage.
  •  

  • Inquire about any prior authorization, step therapy, or quantity limits that might be applied to Symbicort.
  •  

  • Ask for detailed information on how to proceed if additional steps are needed to secure coverage, such as obtaining prior authorization.

 

Obtain Prior Authorization

 

  • If prior authorization is required, request the necessary forms from BCBSIL or ask your healthcare provider to initiate the prior authorization process.
  •  

  • Ensure your healthcare provider supports the process by submitting the necessary clinical information and documentation as requested by BCBSIL.
  •  

  • Follow up with both BCBSIL and your healthcare provider to confirm the submission and approval of the prior authorization request.

 

Explore Financial Assistance Programs

 

  • If Symbicort is not fully covered or if out-of-pocket costs are high, investigate Symbicort Savings Programs or manufacturer coupons which might reduce costs.
  •  

  • Contact AstraZeneca (the manufacturer of Symbicort) directly to inquire about their patient assistance programs or discounts.
  •  

  • Check if BCBSIL offers any additional pharmacy savings programs or discount opportunities you can leverage.

 

Fill Your Prescription

 

  • Once coverage is approved, take your prescription to a pharmacy within your BCBSIL network, or use a mail-order pharmacy service if available.
  •  

  • Provide the pharmacist with your prescription and insurance details to process the Symbicort prescription.
  •  

  • Verify your copay amount and ensure any discounts or coverage terms are applied before completing the transaction.

 

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Symbicort

Explore Symbicort coverage by Blue Cross Blue Shield of Illinois, steps to obtain it, costs without insurance, and get answers to your FAQs.
Curex allergy drops unboxing

Is Symbicort Covered by Blue Cross Blue Shield of Illinois

 

Coverage for Symbicort

 

  • Blue Cross Blue Shield of Illinois (BCBSIL) typically covers Symbicort for asthma or COPD if prescribed by a healthcare provider.
  •  

  • Coverage depends on the specific plan and formulary, and it's subject to prior authorization.

 

Criteria for Coverage

 

  • Patients must have a confirmed diagnosis of asthma or COPD.
  • Prescriptions generally require prior authorization to ensure appropriate medical necessity and adherence to guidelines.
  • The prescriber may need to document previous treatments tried and their outcomes.

 

Basic Rules

 

  • Check the specific plan to understand copayments, coinsurance, and deductible obligations for Symbicort.
  • Always verify with BCBSIL and consult the benefits booklet for the most accurate and detailed coverage information.

 

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

 

Coverage Criteria for Symbicort Under Blue Cross Blue Shield of Illinois

 

  • **Diagnosis Requirement:** Symbicort coverage is approved for individuals diagnosed with asthma or chronic obstructive pulmonary disease (COPD) where medication management is necessary to improve lung function and control symptoms.
  •  

  • **Age Specifications:** Symbicort may be prescribed to individuals aged 12 years and older for asthma, and for adult patients for the treatment of COPD.
  •  

  • **Prior Medication Use:** Patients should have a documented inadequate response to, or inability to tolerate, preferred alternative treatments such as other inhaled corticosteroids or long-acting bronchodilators.
  •  

  • **Physician Statement:** A physician’s statement or submitted medical records must indicate the medical necessity for using Symbicort as part of the patient’s treatment plan.
  •  

  • **Appropriate Dosage:** Coverage is contingent upon Symbicort being prescribed within the FDA-approved dosage guidelines unless there is a special medical necessity documented by a healthcare provider.
  •  

  • **Frequent Assessment:** Regular reassessment by a healthcare provider is needed to ensure the continued effectiveness of the treatment, supporting ongoing coverage.
  •  

  • **Combination Therapy:** For COPD patients, Symbicort may be covered as part of a combination therapy approach, assuming documentation shows improved patient outcomes.

 

Authorization Requirements

 

  • **Prior Authorization:** A prior authorization may be required to determine initial and continued coverage, ensuring that all above criteria are met effectively.
  •  

  • **Consultation and Approval:** Coverage may be subject to the review and approval of the case by Blue Cross Blue Shield of Illinois clinical staff or an authorized pharmacist.

 

Why Blue Cross Blue Shield of Illinois Might Deny Symbicort Coverage

 

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

 

  • Not Medically Necessary: Blue Cross Blue Shield of Illinois might deny coverage for Symbicort if it is determined not to be medically necessary according to their set criteria. This can include situations where alternative treatments are available at a lower cost or are considered more effective for the patient's condition.
  •  

  • Exclusion of Coverage: Certain plans might have specific exclusions that apply to Symbicort or similar medications. If Symbicort is listed within these exclusions, coverage might be denied.
  •  

  • Failure to Meet Step Therapy Requirements: Some insurance plans require patients to try and fail a less expensive or a different medication before approving a more expensive option like Symbicort. Denial may occur if the patient has not completed these prerequisite steps.
  •  

  • Lack of Prior Authorization: If the prescription for Symbicort requires prior authorization and this process is not completed or approved, Blue Cross Blue Shield of Illinois may deny coverage.
  •  

  • Non-adherence to Plan Guidelines: Coverage might be denied if the prescription does not follow specific drug formulary guidelines or if there is a deviation from treatment plans or protocols outlined by the insurance provider.
  •  

  • Plan Limitations: Some health plans have limitations on the quantity or refills of certain medications per benefit period. If these limits are exceeded, further coverage may be denied.

 

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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 Illinois

 

Contact Your Healthcare Provider

 

  • Reach out to your healthcare provider to confirm that Symbicort is the appropriate prescription for your condition.
  •  

  • Request a formal prescription for Symbicort from your healthcare provider.
  •  

  • Ask your healthcare provider to provide any necessary documentation that supports the medical necessity of Symbicort.

 

Review Your Insurance Policy

 

  • Log into your Blue Cross Blue Shield of Illinois (BCBSIL) member account to access your policy details.
  •  

  • Locate the prescription drug coverage section to understand what medications are covered and any specific requirements for coverage.
  •  

  • Check if Symbicort is listed under your policy’s formulary (the list of covered drugs) and if there are specific tiers or restrictions.

 

Contact Blue Cross Blue Shield of Illinois

 

  • Call the customer service number on the back of your BCBSIL insurance card to speak with a representative about Symbicort coverage.
  •  

  • Inquire about any prior authorization, step therapy, or quantity limits that might be applied to Symbicort.
  •  

  • Ask for detailed information on how to proceed if additional steps are needed to secure coverage, such as obtaining prior authorization.

 

Obtain Prior Authorization

 

  • If prior authorization is required, request the necessary forms from BCBSIL or ask your healthcare provider to initiate the prior authorization process.
  •  

  • Ensure your healthcare provider supports the process by submitting the necessary clinical information and documentation as requested by BCBSIL.
  •  

  • Follow up with both BCBSIL and your healthcare provider to confirm the submission and approval of the prior authorization request.

 

Explore Financial Assistance Programs

 

  • If Symbicort is not fully covered or if out-of-pocket costs are high, investigate Symbicort Savings Programs or manufacturer coupons which might reduce costs.
  •  

  • Contact AstraZeneca (the manufacturer of Symbicort) directly to inquire about their patient assistance programs or discounts.
  •  

  • Check if BCBSIL offers any additional pharmacy savings programs or discount opportunities you can leverage.

 

Fill Your Prescription

 

  • Once coverage is approved, take your prescription to a pharmacy within your BCBSIL network, or use a mail-order pharmacy service if available.
  •  

  • Provide the pharmacist with your prescription and insurance details to process the Symbicort prescription.
  •  

  • Verify your copay amount and ensure any discounts or coverage terms are applied before completing the transaction.

 

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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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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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