Does Blue Cross Blue Shield of Michigan Cover Dulera

Explore if Blue Cross Blue Shield of Michigan covers Dulera, reasons for denial, cost without insurance, and FAQs in this comprehensive guide.
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Blue Cross Blue Shield of Michigan Coverage for Dulera

 

  • Dulera, a prescription inhaler, is used to control and prevent asthma symptoms. Blue Cross Blue Shield of Michigan (BCBSM) may cover it under the pharmacy benefits of some plans.
  •  

    <li>Coverage often depends on the specific health plan. It's crucial to check your individual policy details for any formulary restrictions or requirements.</li>
    

     

    <li>BCBSM might require a prior authorization to ensure the medication is medically necessary. Your physician may need to provide evidence supporting the need for Dulera.</li>
    

     

    <li>Patients usually must try other asthma treatments before getting Dulera authorized, a process known as step therapy.</li>
    

     

    <li>Check if Dulera is on the BCBSM formulary list, which details covered drugs. Formularies can change annually, affecting coverage.</li>
    

     

    <li>Co-pays and out-of-pocket costs can differ based on the plan's tier system, impacting the final cost for Dulera.</li> 
    

     

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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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Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

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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 Dulera Coverage with Blue Cross Blue Shield of Michigan

 

Verify Your Current Plan

 

  • Log into your Blue Cross Blue Shield of Michigan (BCBSM) online account to review your current insurance plan details and benefits.
  •  

  • Check your plan's formulary, which is the list of medications covered by your plan, to see if Dulera (a prescription asthma medication) is included.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Dulera with your doctor. They can provide you with a prescription and may have experience with insurance requirements for coverage.
  •  

  • Your healthcare provider can also write a letter of medical necessity if needed, which can be helpful in securing coverage.

 

Contact Blue Cross Blue Shield of Michigan

 

  • Call the customer service number on the back of your insurance card for specific information on Dulera coverage.
  •  

  • Ask about any required prior authorizations or step therapy protocols that must be followed to have Dulera covered under your plan.

 

Submit Prior Authorization (If Required)

 

  • If your plan requires prior authorization, work with your healthcare provider to complete and submit the necessary paperwork to BCBSM.
  •  

  • Ensure that all required documentation, such as a letter of medical necessity, is included to avoid delays.

 

Review Approval or Denial

 

  • Once submitted, BCBSM will review your prior authorization request. Monitor your email or postal mail for any correspondence from the insurance company.
  •  

  • If approved, note the duration of coverage and any applicable copayments or coinsurance.

 

Appeal a Denial

 

  • If your authorization request is denied, examine the reason for denial and consult with your healthcare provider to address the issues noted.
  •  

  • File an appeal with BCBSM, including any additional supporting documentation to strengthen your case for coverage.

 

Fill Your Prescription

 

  • Once coverage is approved, visit a network pharmacy to fill your Dulera prescription. Use your BCBSM member ID to receive the covered benefits.
  •  

  • Stay within your network to minimize out-of-pocket costs.

 

Stay Informed

 

  • Regularly check for updates on your BCBSM plan that might affect your medication coverage, such as formulary changes or new authorization requirements.
  •  

  • Maintain communication with both your provider and BCBSM to ensure ongoing coverage of Dulera.

 

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FAQs

Does Blue Cross Blue Shield of Michigan Cover Dulera

Explore if Blue Cross Blue Shield of Michigan covers Dulera, reasons for denial, cost without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

Is Dulera Covered by Blue Cross Blue Shield of Michigan

 

Blue Cross Blue Shield of Michigan Coverage for Dulera

 

  • Dulera, a prescription inhaler, is used to control and prevent asthma symptoms. Blue Cross Blue Shield of Michigan (BCBSM) may cover it under the pharmacy benefits of some plans.
  •  

    <li>Coverage often depends on the specific health plan. It's crucial to check your individual policy details for any formulary restrictions or requirements.</li>
    

     

    <li>BCBSM might require a prior authorization to ensure the medication is medically necessary. Your physician may need to provide evidence supporting the need for Dulera.</li>
    

     

    <li>Patients usually must try other asthma treatments before getting Dulera authorized, a process known as step therapy.</li>
    

     

    <li>Check if Dulera is on the BCBSM formulary list, which details covered drugs. Formularies can change annually, affecting coverage.</li>
    

     

    <li>Co-pays and out-of-pocket costs can differ based on the plan's tier system, impacting the final cost for Dulera.</li> 
    

     

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Blue Cross Blue Shield of Michigan's Approved Criteria for Dulera Coverage

 

Eligibility Criteria for Dulera Coverage

 

  • The patient must have a documented diagnosis of asthma, confirmed by pulmonary function tests or other medical records.
  •  

  • The patient should be 12 years of age or older for coverage eligibility.
  •  

  • The condition must require a combination therapy for long-term control, as demonstrated by a history of frequent exacerbations or poor control on inhaled corticosteroids alone.

 

Trial of Alternative Therapies

 

  • The patient must have tried and failed, or have contraindications to, other inhaled corticosteroid and long-acting beta-agonist (LABA) combinations, such as Advair or Symbicort.
  •  

  • Documented evidence of failure, intolerance, or contraindications should be provided, detailing the reasons why alternative therapies were ineffective or unsuitable.

 

Prescription Requirements

 

  • The prescription for Dulera must be written by a board-certified specialist, such as a pulmonologist or allergist, or a primary care physician in consultation with such a specialist.
  •  

  • A comprehensive asthma action plan, outlining the use of Dulera as part of the patient’s overall treatment strategy, should be documented in the patient's medical records.

 

Ongoing Treatment Evaluation

 

  • Continuous evaluation of the patient's asthma condition is required, with documented follow-ups at least every 6 to 12 months to assess the effectiveness of Dulera in managing the patient's symptoms.
  •  

  • Treatment with Dulera should be reassessed if there are any significant changes in the patient's asthma status or if the patient experiences adverse effects.

 

Why Blue Cross Blue Shield of Michigan Might Deny Dulera Coverage

 

Reasons Blue Cross Blue Shield of Michigan Might Deny Dulera Coverage

 

  • Dulera is deemed not medically necessary for the patient's condition. If the treatment does not meet the insurer's criteria for necessity, coverage can be denied.
  •  

  • The prescription for Dulera does not comply with the established guidelines or protocols set forth by Blue Cross Blue Shield of Michigan.
  •  

  • A lack of prior authorization obtained before the prescription was filled could result in a denial of coverage for Dulera.
  •  

  • The medication is considered experimental or investigational for the diagnosed condition, according to Blue Cross Blue Shield's policy definitions.
  •  

  • Billing errors or discrepancies, including incorrect coding, could lead to a denial of claims for Dulera coverage.
  •  

  • The medication is not included in the plan's formulary, the list of covered drugs, thus making it ineligible for coverage.
  •  

  • Coverage might be denied if an equivalent or alternative drug is available at a lower cost, suggesting that Dulera is not the most cost-effective treatment option according to the insurer’s policy.
  •  

 

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How Much Does Dulera Cost without Insurance?

 

Approximate Cost of Dulera Without Insurance

 

  • The cost of Dulera, which is used to help control symptoms of asthma, can vary depending on the pharmacy and location. However, the typical price for a one-month supply (inhaler) of Dulera without insurance is approximately $250 to $350.
  •  

  • This price may differ based on dosage strength, and whether you're purchasing a brand name or a generic version if available.
  •  

  • Prices can fluctuate, and it is advisable to check with different pharmacies or consider using discount cards or coupons that might be available to reduce the cost.
  •  

  • Additionally, some pharmaceutical companies offer patient assistance programs for those who qualify, which can significantly lower the cost of Dulera.

 

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 Dulera Coverage with Blue Cross Blue Shield of Michigan

 

Verify Your Current Plan

 

  • Log into your Blue Cross Blue Shield of Michigan (BCBSM) online account to review your current insurance plan details and benefits.
  •  

  • Check your plan's formulary, which is the list of medications covered by your plan, to see if Dulera (a prescription asthma medication) is included.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Dulera with your doctor. They can provide you with a prescription and may have experience with insurance requirements for coverage.
  •  

  • Your healthcare provider can also write a letter of medical necessity if needed, which can be helpful in securing coverage.

 

Contact Blue Cross Blue Shield of Michigan

 

  • Call the customer service number on the back of your insurance card for specific information on Dulera coverage.
  •  

  • Ask about any required prior authorizations or step therapy protocols that must be followed to have Dulera covered under your plan.

 

Submit Prior Authorization (If Required)

 

  • If your plan requires prior authorization, work with your healthcare provider to complete and submit the necessary paperwork to BCBSM.
  •  

  • Ensure that all required documentation, such as a letter of medical necessity, is included to avoid delays.

 

Review Approval or Denial

 

  • Once submitted, BCBSM will review your prior authorization request. Monitor your email or postal mail for any correspondence from the insurance company.
  •  

  • If approved, note the duration of coverage and any applicable copayments or coinsurance.

 

Appeal a Denial

 

  • If your authorization request is denied, examine the reason for denial and consult with your healthcare provider to address the issues noted.
  •  

  • File an appeal with BCBSM, including any additional supporting documentation to strengthen your case for coverage.

 

Fill Your Prescription

 

  • Once coverage is approved, visit a network pharmacy to fill your Dulera prescription. Use your BCBSM member ID to receive the covered benefits.
  •  

  • Stay within your network to minimize out-of-pocket costs.

 

Stay Informed

 

  • Regularly check for updates on your BCBSM plan that might affect your medication coverage, such as formulary changes or new authorization requirements.
  •  

  • Maintain communication with both your provider and BCBSM to ensure ongoing coverage of Dulera.

 

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Dulera FAQ

What are the side effects of Dulera?

 

Common Side Effects of Dulera

 

  • Headache
  • Sore throat
  • Sinus pain
  • Nosebleed
  • Oral thrush (fungal infection)

 

Serious Side Effects

 

  • Wheezing or breathing problems
  • Severe allergic reactions (rash, itching/swelling)
  • Vision problems
  • Reduced bone density with long-term use

 

Monitoring and Precautions

 

  • Regularly check bone health and eye exams
  • Rinse mouth after inhalation to prevent oral infections
  • Consult your doctor if side effects worsen or persist

 

How does Dulera work for asthma?

 

Mechanism of Action

 

  • Dulera is a combination inhaler containing mometasone (a corticosteroid) and formoterol (a long-acting beta-agonist).
  •  

  • Mometasone reduces inflammation in the airways, minimizing swelling and irritation.
  •  

  • Formoterol relaxes bronchial muscles, improving airflow and easing breathing.

 

Benefits for Asthma

 

  • Helps prevent asthma attacks by maintaining open airways over long periods.
  •  

  • Decreases the usage frequency of rescue inhalers due to improved control of symptoms.

 

Usage Guidance

 

  • Use regularly as prescribed, even without current symptoms, for effective management.
  •  

  • Rinse mouth after inhalation to reduce risks of oral thrush from corticosteroid use.

 

Consultation Necessity

 

  • Discuss with healthcare provider if side effects occur or asthma symptoms do not improve.

 

Is Dulera a steroid inhaler?

 

Is Dulera a Steroid Inhaler?

 

  • Dulera is a combination inhaler used for asthma management, containing both formoterol, a long-acting beta-agonist (LABA), and mometasone furoate, which is a corticosteroid.
  •  

  • Corticosteroids in Dulera are used to reduce inflammation in the airways, helping to prevent and control asthma symptoms.
  •  

  • Formoterol helps in relaxing muscles around the airways, making breathing easier by widening the air passages.
  •  

  • It's essential to use Dulera regularly for it to be effective; it is not intended for relief of acute asthma attacks.
  •  

  • Patients should be aware of potential side effects like throat irritation or thrush due to the steroid component, and rinsing the mouth after use may help minimize these risks.

 

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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.

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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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