Does Blue Cross Blue Shield of Massachusetts Cover Symbicort

Explore Symbicort coverage by Blue Cross Blue Shield of Massachusetts. Learn reasons for denial, get coverage tips, costs without insurance, and FAQs.
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Coverage for Symbicort

 

  • Symbicort, used for asthma and COPD, is often covered under Blue Cross Blue Shield of Massachusetts prescription drug plans.
  •  

  • Coverage levels may vary depending on the specific plan and tier placement of the medication.

 

Criteria for Coverage

 

  • Preauthorization might be required for Symbicort to ensure it is medically necessary and considered first-line therapy.
  •  

  • To qualify, patients usually need to have a diagnosis confirming COPD or asthma.

 

Basic Rules

 

  • Doctors may need to provide documentation of treatment history, including failure of other medications if required.
  •  

  • Patients should check their specific plan details or contact customer service to understand copayments and any step therapy protocols.

 

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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 Massachusetts

 

Evaluate Your Prescription Drug Plan

 

  • Review your Blue Cross Blue Shield of Massachusetts plan to determine if Symbicort is covered under your current prescription drug plan.
  •  

  • Access your online member account or consult the plan's benefits booklet for the list of covered medications.
  •  

  • Contact Blue Cross Blue Shield customer service for assistance in understanding your coverage benefits.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor whether Symbicort is the most suitable medication for your condition.
  •  

  • Ensure that your healthcare provider prescribes Symbicort if it is deemed necessary for your treatment.
  •  

  • Request your healthcare provider to provide any necessary documentation or justification that might support the need for Symbicort coverage.

 

Locate Participating Pharmacies

 

  • Identify pharmacies within the Blue Cross Blue Shield of Massachusetts network to fill your prescription for Symbicort.
  •  

  • Use the insurer’s website or contact their customer service to find in-network pharmacies near you.
    •  

      Request Prior Authorization if Needed

       

      • Determine if Symbicort requires prior authorization under your policy by checking your plan details or speaking with a representative.
      •  

      • Work with your healthcare provider to submit a prior authorization request to Blue Cross Blue Shield of Massachusetts, if needed.
      •  

      • Ensure that the required documentation and medical justification are provided with the authorization request.

       

      Explore Financial Assistance Options

       

      • Investigate manufacturer coupon programs or assistance plans that can help reduce the cost of Symbicort.
      •  

      • Check if there are any applicable discount programs or savings cards available specifically for Blue Cross Blue Shield members.
        •  

          Review Your Explanation of Benefits (EOB) Statements

           

          • After filling your prescription, examine the Explanation of Benefits statements to ensure it reflects the correct level of coverage for Symbicort.
          •  

          • Contact Blue Cross Blue Shield of Massachusetts if there are discrepancies or errors in coverage that need to be addressed.
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FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Symbicort

Explore Symbicort coverage by Blue Cross Blue Shield of Massachusetts. Learn reasons for denial, get coverage tips, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Symbicort Covered by Blue Cross Blue Shield of Massachusetts

 

Coverage for Symbicort

 

  • Symbicort, used for asthma and COPD, is often covered under Blue Cross Blue Shield of Massachusetts prescription drug plans.
  •  

  • Coverage levels may vary depending on the specific plan and tier placement of the medication.

 

Criteria for Coverage

 

  • Preauthorization might be required for Symbicort to ensure it is medically necessary and considered first-line therapy.
  •  

  • To qualify, patients usually need to have a diagnosis confirming COPD or asthma.

 

Basic Rules

 

  • Doctors may need to provide documentation of treatment history, including failure of other medications if required.
  •  

  • Patients should check their specific plan details or contact customer service to understand copayments and any step therapy protocols.

 

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

 

Approved Coverage Criteria for Symbicort

 

  • Patient must have a documented diagnosis of asthma or Chronic Obstructive Pulmonary Disease (COPD).
  •  

  • Patient must have demonstrated inadequate control of symptoms with conventional maintenance therapies. This includes, but is not limited to, inhaled corticosteroids or long-acting beta agonists.
  •  

  • Physician prescription must indicate a medical necessity for combination therapy in order to achieve symptom control.
  •  

  • Symbicort must be prescribed in a dosage consistent with FDA-approved labeling for the specific condition being treated.
  •  

  • Patient's health record should include a history of at least one previous trial with a different maintenance medication unless contraindicated or not tolerated.
  •  

  • The patient must be 6 years of age or older for asthma-related uses, reflecting the FDA-approved age range.
  •  

  • For COPD, coverage is typically approved for patients who have reached the age of 18, adhering to FDA guidelines.
  •  

  • A consideration for coverage may include an assessment of the patient's medication adherence history to previous therapies.

 

Additional Considerations

 

  • Patients with a documented hypersensitivity to any component of Symbicort may require an alternate medication, and these cases will be assessed individually for potential exceptions.
  •  

  • The required documentation for coverage will typically include office visit notes and patient history that supports the diagnosis of asthma or COPD and the necessity for combination therapy.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Symbicort Coverage

 

Reasons for Denial of Symbicort Coverage

 

  • Symbicort is not included in the tier of medications covered under the patient's specific plan or policy. Some plans may categorize Symbicort in a more expensive tier or exclude it entirely.
  •  

  • The medication is being prescribed for an off-label use that does not meet the insurer's criteria for coverage. Blue Cross Blue Shield of Massachusetts might have specific guidelines regarding approved indications for this drug.
  •  

  • The patient did not meet the step therapy requirements. This may include having to try and fail other preferred medications before coverage of Symbicort is approved.
  •  

  • There is a lack of prior authorization or documentation required to justify the necessity of Symbicort. This might occur if healthcare providers have not submitted enough evidence showing why Symbicort is needed over other treatment options.
  •  

  • The prescription exceeds the quantity limit set by the insurance policy. This could be based on the typical dosing needs for a patient within a given time period, and any amount above this limit may not be covered.
  •  

  • The patient is not eligible for coverage based on their age group or the medication is not deemed suitable for certain demographics under the plan's guidelines.

 

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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 Massachusetts

 

Evaluate Your Prescription Drug Plan

 

  • Review your Blue Cross Blue Shield of Massachusetts plan to determine if Symbicort is covered under your current prescription drug plan.
  •  

  • Access your online member account or consult the plan's benefits booklet for the list of covered medications.
  •  

  • Contact Blue Cross Blue Shield customer service for assistance in understanding your coverage benefits.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor whether Symbicort is the most suitable medication for your condition.
  •  

  • Ensure that your healthcare provider prescribes Symbicort if it is deemed necessary for your treatment.
  •  

  • Request your healthcare provider to provide any necessary documentation or justification that might support the need for Symbicort coverage.

 

Locate Participating Pharmacies

 

  • Identify pharmacies within the Blue Cross Blue Shield of Massachusetts network to fill your prescription for Symbicort.
  •  

  • Use the insurer’s website or contact their customer service to find in-network pharmacies near you.
    •  

      Request Prior Authorization if Needed

       

      • Determine if Symbicort requires prior authorization under your policy by checking your plan details or speaking with a representative.
      •  

      • Work with your healthcare provider to submit a prior authorization request to Blue Cross Blue Shield of Massachusetts, if needed.
      •  

      • Ensure that the required documentation and medical justification are provided with the authorization request.

       

      Explore Financial Assistance Options

       

      • Investigate manufacturer coupon programs or assistance plans that can help reduce the cost of Symbicort.
      •  

      • Check if there are any applicable discount programs or savings cards available specifically for Blue Cross Blue Shield members.
        •  

          Review Your Explanation of Benefits (EOB) Statements

           

          • After filling your prescription, examine the Explanation of Benefits statements to ensure it reflects the correct level of coverage for Symbicort.
          •  

          • Contact Blue Cross Blue Shield of Massachusetts if there are discrepancies or errors in coverage that need to be addressed.

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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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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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