Does Blue Cross Blue Shield of North Carolina Cover Humira

Explore if Blue Cross Blue Shield of NC covers Humira, understand potential denials, learn how to secure coverage, and discover Humira costs without insurance.
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Coverage for Humira

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) offers coverage for Humira under certain conditions as part of their prescription drug benefits.
  •  

  • Patients typically require a prior authorization to get Humira covered. This process ensures that the medication is medically necessary for the patient's condition.
  •  

  • The coverage may vary depending on the individual's specific plan, so it’s crucial to verify the details of your policy.

 

Criteria for Coverage

 

  • The patient must have a valid prescription from a healthcare provider.
  •  

  • BCBSNC may require documentation proving that other treatments have been tried unsuccessfully or are not suitable.
  •  

  • Certain plans might require the patient to use a preferred pharmacy to obtain their medication.

 

Additional Considerations

 

  • Check if the policy includes any deductible, copayment, or coinsurance costs associated with Humira.
  •  

  • Consult with BCBSNC customer service or your healthcare provider to assist in the authorization process.

 

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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 Humira Coverage with Blue Cross Blue Shield of North Carolina

 

Verify Your Blue Cross Blue Shield of North Carolina Coverage

 

  • Contact Blue Cross Blue Shield of North Carolina (BCBSNC) directly by calling the customer service number on the back of your insurance card to confirm that your plan covers Humira. You can also check your benefits details online through your account on the BCBSNC website.
  •  

  • Ask about any specific requirements or documents needed to get Humira covered under your plan. This might include prior authorization, step therapy, or proof of medical necessity documents from your healthcare provider.

 

Consult with Your Healthcare Provider

 

  • Discuss your health condition with your healthcare provider to ensure that Humira is the appropriate medication for your treatment plan. If Humira is determined to be necessary, your provider can assist in completing any required paperwork.
  •  

  • Your healthcare provider may need to submit a prior authorization request to BCBSNC, including documentation supporting the medical necessity of Humira for your treatment.

 

Submit Necessary Documents and Requests

 

  • Work with your healthcare provider to gather and submit all required documents to BCBSNC. This may include your medical records, prior authorization forms, and any other documentation requested by the insurance company.
  •  

  • Ensure that all paperwork is complete and accurately filled out to avoid any delays in the approval process.

 

Follow Up with BCBSNC

 

  • After submitting your request, follow up with BCBSNC to verify that all documents have been received and processed. Keep a record of any reference numbers or confirmation emails related to your submission.
  •  

  • If additional information is needed, work promptly to provide it or ask your healthcare provider to supply any missing details as soon as possible.

 

Explore Patient Assistance Programs

 

  • If you encounter challenges with coverage, consider exploring patient assistance programs that may help reduce the cost of Humira. AbbVie, the manufacturer of Humira, offers patient support programs that could assist with medication costs for those who qualify.
  •  

  • Inquire with BCBSNC or your healthcare provider about any available resources or alternative options that may support your medication needs.

 

Review Approval and Benefits Summary

 

  • Once approval is obtained, carefully review the benefits summary provided by BCBSNC to understand the extent of your coverage for Humira, including copayment or coinsurance responsibilities.
  •  

  • Confirm the approved coverage period and any specific conditions or limitations related to your Humira prescription.

 

Secure Your Humira Prescription

 

  • With approved coverage, your healthcare provider can prescribe Humira. Follow the pharmacy or specialty pharmacy instructions provided by BCBSNC to fill your prescription.
  •  

  • Maintain communication with your pharmacy and BCBSNC to ensure your medication is promptly available and to address any issues that may arise.

 

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Humira

Explore if Blue Cross Blue Shield of NC covers Humira, understand potential denials, learn how to secure coverage, and discover Humira costs without insurance.
Curex allergy drops unboxing

Is Humira Covered by Blue Cross Blue Shield of North Carolina

 

Coverage for Humira

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) offers coverage for Humira under certain conditions as part of their prescription drug benefits.
  •  

  • Patients typically require a prior authorization to get Humira covered. This process ensures that the medication is medically necessary for the patient's condition.
  •  

  • The coverage may vary depending on the individual's specific plan, so it’s crucial to verify the details of your policy.

 

Criteria for Coverage

 

  • The patient must have a valid prescription from a healthcare provider.
  •  

  • BCBSNC may require documentation proving that other treatments have been tried unsuccessfully or are not suitable.
  •  

  • Certain plans might require the patient to use a preferred pharmacy to obtain their medication.

 

Additional Considerations

 

  • Check if the policy includes any deductible, copayment, or coinsurance costs associated with Humira.
  •  

  • Consult with BCBSNC customer service or your healthcare provider to assist in the authorization process.

 

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Blue Cross Blue Shield of North Carolina's Approved Criteria for Humira Coverage

 

Criteria for Humira Coverage

 

  • The patient must have a diagnosis of one of the following conditions:
    • Rheumatoid Arthritis (RA)
    • Juvenile Idiopathic Arthritis (JIA)
    • Psoriatic Arthritis
    • Ankylosing Spondylitis
    • Ulcerative Colitis
    • Chronic Plaque Psoriasis
    • Hidradenitis Suppurativa
    • Uveitis
    • Crohn's Disease
  •  

  • Documented failure, intolerance, or contraindication to at least one conventional therapy related to the specific diagnosis. This could include nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or disease-modifying antirheumatic drugs (DMARDs).
  •  

  • A physician's prescription must be submitted, detailing the necessity of Humira based on clinical evidence and the patient's medical history and condition.
  •  

  • Patients must be 18 years or older, unless the condition has specific age-related guidelines (e.g., JIA).
  •  

  • The prescribed dosage must be consistent with FDA-approved labeling or peer-reviewed medical literature for the respective condition.
  •  

  • A trial period may be required, during which the patient's response to Humira is monitored and documented to assess efficacy and safety.
  •  

  • Regular follow-up and periodic assessment of the treatment's effectiveness by a healthcare professional are necessary.
  •  

 

Why Blue Cross Blue Shield of North Carolina Might Deny Humira Coverage

 

Situations Leading to Denial of Humira Coverage

 

  • Not Following Prescription: Blue Cross Blue Shield of North Carolina may deny coverage for Humira if the prescription is not filed or approved by a licensed healthcare professional meeting their criteria.
  •  

  • Off-label Use: Humira prescribed for conditions not explicitly approved by the FDA or not included in the insurer’s formulary list may lead to denial.
  •  

  • Non-compliance with Step Therapy: If beneficiaries do not first try cheaper or alternative medications as required by the insurer’s step therapy protocol, coverage for Humira might be denied.
  •  

  • Lack of Prior Authorization: Failure to receive prior authorization, which is often necessary for expensive medications like Humira, can result in denial of coverage.
  •  

  • Non-network Providers: Seeking prescriptions from healthcare providers not within the Blue Cross Blue Shield of North Carolina network can also be a reason for denying coverage.
  •  

  • Non-adherence to Plan Requirements: If the individual does not adhere to specific requirements outlined in the insurance plan, such as regular monitoring or laboratory testing, coverage might be denied.
  •  

  • Failure to Provide Necessary Medical Records: Lack of sufficient documentation proving the medical necessity of Humira for the patient’s condition can lead to denial of claims.
  •  

  • Exclusion from Policy: Humira might be explicitly excluded in certain policies for specific conditions based on the insured’s plan type or tier.

 

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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 North Carolina

 

Verify Your Blue Cross Blue Shield of North Carolina Coverage

 

  • Contact Blue Cross Blue Shield of North Carolina (BCBSNC) directly by calling the customer service number on the back of your insurance card to confirm that your plan covers Humira. You can also check your benefits details online through your account on the BCBSNC website.
  •  

  • Ask about any specific requirements or documents needed to get Humira covered under your plan. This might include prior authorization, step therapy, or proof of medical necessity documents from your healthcare provider.

 

Consult with Your Healthcare Provider

 

  • Discuss your health condition with your healthcare provider to ensure that Humira is the appropriate medication for your treatment plan. If Humira is determined to be necessary, your provider can assist in completing any required paperwork.
  •  

  • Your healthcare provider may need to submit a prior authorization request to BCBSNC, including documentation supporting the medical necessity of Humira for your treatment.

 

Submit Necessary Documents and Requests

 

  • Work with your healthcare provider to gather and submit all required documents to BCBSNC. This may include your medical records, prior authorization forms, and any other documentation requested by the insurance company.
  •  

  • Ensure that all paperwork is complete and accurately filled out to avoid any delays in the approval process.

 

Follow Up with BCBSNC

 

  • After submitting your request, follow up with BCBSNC to verify that all documents have been received and processed. Keep a record of any reference numbers or confirmation emails related to your submission.
  •  

  • If additional information is needed, work promptly to provide it or ask your healthcare provider to supply any missing details as soon as possible.

 

Explore Patient Assistance Programs

 

  • If you encounter challenges with coverage, consider exploring patient assistance programs that may help reduce the cost of Humira. AbbVie, the manufacturer of Humira, offers patient support programs that could assist with medication costs for those who qualify.
  •  

  • Inquire with BCBSNC or your healthcare provider about any available resources or alternative options that may support your medication needs.

 

Review Approval and Benefits Summary

 

  • Once approval is obtained, carefully review the benefits summary provided by BCBSNC to understand the extent of your coverage for Humira, including copayment or coinsurance responsibilities.
  •  

  • Confirm the approved coverage period and any specific conditions or limitations related to your Humira prescription.

 

Secure Your Humira Prescription

 

  • With approved coverage, your healthcare provider can prescribe Humira. Follow the pharmacy or specialty pharmacy instructions provided by BCBSNC to fill your prescription.
  •  

  • Maintain communication with your pharmacy and BCBSNC to ensure your medication is promptly available and to address any issues that may arise.

 

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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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Initial Dosage

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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