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Does Blue Cross Blue Shield of North Carolina Cover Symbicort

Learn about Symbicort coverage with Blue Cross NC, reasons for denial, steps for approval, costs without insurance, and find answers to common questions.
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Coverage Criteria for Symbicort

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) typically covers Symbicort, a medication for asthma and COPD, under its prescription drug plans.

    •  

  • Coverage depends on the specific plan and may require that the medication be included on the plan's formulary list.

    •  

    Eligibility Requirements

     

  • Members may need a prior authorization before filling prescriptions for Symbicort. This involves a review to confirm the medical necessity.

    •  

  • Doctors must provide documentation to justify Symbicort as part of the treatment plan, ensuring it meets the insurer's guidelines.

    •  

    General Rules

     

  • Some plans may have tiered drug pricing, which affects copay amounts for medications like Symbicort.

    •  

  • Policies could include step therapy, requiring members to try cheaper alternatives before approving Symbicort.

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Clinical Support

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 North Carolina

 

Check Current Coverage

 

  • Begin by reviewing your current insurance policy. Log into your Blue Cross Blue Shield of North Carolina member portal to see details of your prescription drug coverage.

    •  

  • Refer to your policy’s formulary, which lists medications covered under your plan. Confirm if Symbicort is included and under which tier it falls.

 

Consult Your Healthcare Provider

 

  • Discuss Symbicort with your healthcare provider to ensure it is an appropriate medication for your condition.

    •  

  • Request your provider to write a prescription for Symbicort if they agree it's necessary for your treatment plan.

 

Contact Blue Cross Blue Shield Customer Service

 

  • Call the Blue Cross Blue Shield of North Carolina customer service number found on the back of your insurance card.

    •  

  • Inquire specifically about coverage for Symbicort and any requirements such as prior authorization, step therapy, or quantity limits.

 

Obtain Prior Authorization

 

  • If prior authorization is needed, ask your healthcare provider to submit the necessary documentation to Blue Cross Blue Shield of North Carolina.

    •  

  • Follow up with both your provider and insurance to ensure all paperwork is submitted and processed promptly.

 

Utilize Mail Order Pharmacy

 

  • Consider using Blue Cross Blue Shield's mail order pharmacy services, which may offer reduced co-pays and ease of access.

    •  

  • Check the prescription details and register for mail order if available and beneficial for your prescription requirements.

 

Review and Appeal Denials

 

  • If coverage for Symbicort is denied, review the explanation of benefits for the reason provided by Blue Cross Blue Shield.

    •  

  • Work with your healthcare provider to submit an appeal if necessary, providing justification and additional medical evidence as needed.

 

Regularly Check for Changes

 

  • Periodically revisit your policy’s formulary to stay informed of any updates or changes to medication coverage.

    •  

  • Reassess your insurance plan during open enrollment periods to ensure your medications continue to be covered or explore alternative options if changes have occurred.

 

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Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Symbicort

Learn about Symbicort coverage with Blue Cross NC, reasons for denial, steps for approval, costs without insurance, and find answers to common questions.
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Is Symbicort Covered by Blue Cross Blue Shield of North Carolina

 

Coverage Criteria for Symbicort

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) typically covers Symbicort, a medication for asthma and COPD, under its prescription drug plans.

    •  

  • Coverage depends on the specific plan and may require that the medication be included on the plan's formulary list.

    •  

    Eligibility Requirements

     

  • Members may need a prior authorization before filling prescriptions for Symbicort. This involves a review to confirm the medical necessity.

    •  

  • Doctors must provide documentation to justify Symbicort as part of the treatment plan, ensuring it meets the insurer's guidelines.

    •  

    General Rules

     

  • Some plans may have tiered drug pricing, which affects copay amounts for medications like Symbicort.

    •  

  • Policies could include step therapy, requiring members to try cheaper alternatives before approving Symbicort.

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

 

Blue Cross Blue Shield of North Carolina's Criteria for Symbicort Coverage

 

  • **Patient has a documented diagnosis**: Patients must have a confirmed diagnosis of asthma or chronic obstructive pulmonary disease (COPD) that necessitates the use of Symbicort.

    •  

  • **Trial of conservative therapy**: Documentation of previous trials and failures, contraindications, or intolerable side effects with standard therapies, such as inhaled corticosteroids and long-acting beta-agonists.

    •  

  • **Specialist recommendation**: A recommendation or prescription from a pulmonary specialist, allergist, or other relevant healthcare provider supporting the necessity of Symbicort.

    •  

  • **Age criteria**: Coverage may consider age-appropriate use, generally for individuals 12 years and older for asthma or COPD indication, as specified by the approved labeling of the medication.

    •  

  • **Dosage and administration in accordance**: Symbicort must be prescribed in accordance with the FDA-approved labeling, including dosage frequency and conditions being treated.

    •  

  • **Documentation of Patient Response**: An ongoing demonstration of effective response to Symbicort, which may include improved symptoms or pulmonary function test results.

    •  

  • **Defined benefit conditions**: Coverage is provided as per the plan's standard drug benefit at network pharmacies unless a prior authorization or formulary restriction applies.

 

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

 

Reasons for Denial of Symbicort Coverage

 

  • The prescription of Symbicort does not meet Blue Cross Blue Shield of North Carolina (BCBSNC) formulary guidelines, which may specify preferred medications over Symbicort for treating certain conditions.

    •  

  • The medication is used for a condition or diagnosis that is not approved for coverage under BCBSNC’s policy stipulations or clinical guidelines.

    •  

  • The prescribed dosage or frequency of Symbicort does not align with BCBSNC's established safety and efficacy standards or recommended guidelines.

    •  

  • There is insufficient medical documentation or evidence from healthcare providers supporting the necessity of Symbicort in the treatment plan.

    •  

  • There is a failure to demonstrate that alternative cheaper treatments have been ineffective, which may be required under the step therapy or prior authorization rules.

    •  

  • The patient's prescription is for an off-label use of Symbicort that has not been recognized as medically necessary by BCBSNC.

    •  

  • BCBSNC classifies Symbicort under a non-preferred tier in their formulary, wherein they have determined alternatives are more cost-effective or clinically appropriate.

    •  

  • The individual’s specific plan or policy with BCBSNC explicitly excludes coverage for Symbicort or inhaled corticosteroids of its type.

 

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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.

 

Clinical Support

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 North Carolina

 

Check Current Coverage

 

  • Begin by reviewing your current insurance policy. Log into your Blue Cross Blue Shield of North Carolina member portal to see details of your prescription drug coverage.

    •  

  • Refer to your policy’s formulary, which lists medications covered under your plan. Confirm if Symbicort is included and under which tier it falls.

 

Consult Your Healthcare Provider

 

  • Discuss Symbicort with your healthcare provider to ensure it is an appropriate medication for your condition.

    •  

  • Request your provider to write a prescription for Symbicort if they agree it's necessary for your treatment plan.

 

Contact Blue Cross Blue Shield Customer Service

 

  • Call the Blue Cross Blue Shield of North Carolina customer service number found on the back of your insurance card.

    •  

  • Inquire specifically about coverage for Symbicort and any requirements such as prior authorization, step therapy, or quantity limits.

 

Obtain Prior Authorization

 

  • If prior authorization is needed, ask your healthcare provider to submit the necessary documentation to Blue Cross Blue Shield of North Carolina.

    •  

  • Follow up with both your provider and insurance to ensure all paperwork is submitted and processed promptly.

 

Utilize Mail Order Pharmacy

 

  • Consider using Blue Cross Blue Shield's mail order pharmacy services, which may offer reduced co-pays and ease of access.

    •  

  • Check the prescription details and register for mail order if available and beneficial for your prescription requirements.

 

Review and Appeal Denials

 

  • If coverage for Symbicort is denied, review the explanation of benefits for the reason provided by Blue Cross Blue Shield.

    •  

  • Work with your healthcare provider to submit an appeal if necessary, providing justification and additional medical evidence as needed.

 

Regularly Check for Changes

 

  • Periodically revisit your policy’s formulary to stay informed of any updates or changes to medication coverage.

    •  

  • Reassess your insurance plan during open enrollment periods to ensure your medications continue to be covered or explore alternative options if changes have occurred.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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.

 

Have questions left?

‍

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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A weight management program tailored to you

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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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