Does Blue Cross Blue Shield of Texas Cover Symbicort

Explore if Blue Cross Blue Shield of Texas covers Symbicort, reasons for denial, getting coverage tips, costs without insurance, and FAQs.
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Coverage for Symbicort

 

  • Blue Cross Blue Shield of Texas (BCBSTX) may cover Symbicort, a prescription medication used for asthma and COPD, under certain plans. Coverage usually depends on the specifics of your insurance plan.
  •  

  • It’s generally classified as a Tier 2 or Tier 3 medication, impacting copayment or coinsurance rates. Confirm the drug’s tier by reviewing your insurance plan’s formulary.
  •  

    Criteria for Coverage

     

    • Prescriptions must be deemed medically necessary by a healthcare provider.
    •  

    • A prior authorization may be needed, requiring documentation from your doctor explaining why Symbicort is necessary over other alternatives.

     

    Steps to Confirm Coverage

     

    • Contact BCBSTX customer service with your policy details to verify coverage specifics.
    •  

    • Consult with your healthcare provider to ensure the required documentation is in place, should prior authorization be necessary.

     

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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 Texas

 

Verify Your Prescription Benefits

 

  • Log in to your Blue Cross Blue Shield of Texas (BCBSTX) member account online or through the mobile app. Make sure you have registered your account if you haven’t done so yet.
  •  

  • Locate the “Prescription Benefits” section to review your plan details and check if Symbicort is covered under your prescription drug benefits.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your need for Symbicort. Ensure that they are aware of your insurance plan with BCBSTX, so they prescribe accordingly.
  •  

  • Inquire if your doctor needs to provide any specific documentation or if there’s a preferred list of medications that require prior authorization under your plan.

 

Contact Blue Cross Blue Shield of Texas

 

  • Call the customer service number on the back of your insurance card to speak with a representative directly.
  •  

  • Ask if Symbicort requires prior authorization or if there are any specific requirements or restrictions for coverage under your plan.

 

Request Prior Authorization

 

  • If prior authorization is required, work with your healthcare provider to submit the necessary forms to BCBSTX. The provider typically handles this, but you may need to ensure forms are filled out completely and submitted promptly.
  •  

  • Follow up with BCBSTX to confirm they have received the prior authorization request and ask about the typical processing time.

 

Review Coverage Details

 

  • Once approved, verify the details of your coverage, such as copayment amounts, quantity limits, and any additional cost-saving opportunities like mail-order prescriptions.
  •  

  • Note all the information about refills and if there’s a particular pharmacy network you must use for the coverage to apply.

 

Fill Your Prescription

 

  • Visit the in-network pharmacy with your prescription for Symbicort. Present your insurance card to ensure the coverage is applied appropriately.
  •  

  • Consult with the pharmacist for any potential savings programs, like manufacturer's coupons, that can further reduce your out-of-pocket costs.

 

Monitor and Adjust as Necessary

 

  • Keep track of your usage and contact BCBSTX if anything changes in your prescription needs. Always inform them of provider changes or any issues you are facing with coverage.
  •  

  • Review your insurance benefits regularly to stay informed about any updates or changes in your prescription drug coverage plan.

 

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FAQs

Does Blue Cross Blue Shield of Texas Cover Symbicort

Explore if Blue Cross Blue Shield of Texas covers Symbicort, reasons for denial, getting coverage tips, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Symbicort Covered by Blue Cross Blue Shield of Texas

 

Coverage for Symbicort

 

  • Blue Cross Blue Shield of Texas (BCBSTX) may cover Symbicort, a prescription medication used for asthma and COPD, under certain plans. Coverage usually depends on the specifics of your insurance plan.
  •  

  • It’s generally classified as a Tier 2 or Tier 3 medication, impacting copayment or coinsurance rates. Confirm the drug’s tier by reviewing your insurance plan’s formulary.
  •  

    Criteria for Coverage

     

    • Prescriptions must be deemed medically necessary by a healthcare provider.
    •  

    • A prior authorization may be needed, requiring documentation from your doctor explaining why Symbicort is necessary over other alternatives.

     

    Steps to Confirm Coverage

     

    • Contact BCBSTX customer service with your policy details to verify coverage specifics.
    •  

    • Consult with your healthcare provider to ensure the required documentation is in place, should prior authorization be necessary.

     

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

 

Approved Criteria for Symbicort Coverage by Blue Cross Blue Shield of Texas

 

  • **Medical Necessity**: The prescription of Symbicort is deemed medically necessary for patients diagnosed with asthma or Chronic Obstructive Pulmonary Disease (COPD), requiring a combination of a long-term corticosteroid and long-acting beta-agonist inhaler.
  •  

  • **Age Limit**: Symbicort coverage is generally approved for patients 12 years and older. Exceptions may be evaluated on a case-by-case basis.
  •  

  • **Prescribing Physician**: The medication must be prescribed by a licensed healthcare provider, such as a pulmonologist or primary care physician, who specializes in the treatment of respiratory conditions.
  •  

  • **Documentation Requirement**: Prior to approval, documentation from the healthcare provider must be provided to demonstrate the medical necessity for Symbicort, including previous treatments and their results.
  •  

  • **Step Therapy Protocol**: Patients may need to have attempted treatment with alternative asthma medications, such as inhaled corticosteroids or other similar drugs, without adequate control of symptoms before being approved for Symbicort.
  •  

  • **Dosage and Administration**: Coverage approval specifies adherence to the Food and Drug Administration (FDA) labeling for dosage and administration guidelines, unless otherwise specified by a healthcare provider for medical necessity.
  •  

  • **Renewal Criteria**: Continued coverage for Symbicort may require evidence of efficacy from the prescriber, documenting improved control of respiratory symptoms or prevention of exacerbations over the coverage period.

 

Why Blue Cross Blue Shield of Texas Might Deny Symbicort Coverage

 

Situations Where Symbicort Coverage May Be Denied by Blue Cross Blue Shield of Texas

 

  • Symbicort may not be covered if it is not on the formulary list, as each insurance plan has a specific list of medications they cover under different tiers. If Symbicort is not included, it might not be covered.
  •  

  • Prescriptions written by out-of-network doctors might lead to denial of coverage for Symbicort. Blue Cross Blue Shield of Texas may require prescriptions to be from in-network providers to approve coverage.
  •  

  • Lack of prior authorization or failure to meet the step therapy requirements could result in the denial of coverage. Blue Cross Blue Shield of Texas might require documented evidence of a medical necessity or previous treatments before approving Symbicort.
  •  

  • If cheaper alternative treatments are available and deemed effective by the insurance plan, they may deny coverage in favor of the lower-cost options.
  •  

  • Coverage may be denied if the provided prescription does not align with FDA-approved indications or standard guidelines for the use of Symbicort.
  •  

  • If a patient's health plan does not have prescription drug coverage, Symbicort expenses may not be covered.

 

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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 Texas

 

Verify Your Prescription Benefits

 

  • Log in to your Blue Cross Blue Shield of Texas (BCBSTX) member account online or through the mobile app. Make sure you have registered your account if you haven’t done so yet.
  •  

  • Locate the “Prescription Benefits” section to review your plan details and check if Symbicort is covered under your prescription drug benefits.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your need for Symbicort. Ensure that they are aware of your insurance plan with BCBSTX, so they prescribe accordingly.
  •  

  • Inquire if your doctor needs to provide any specific documentation or if there’s a preferred list of medications that require prior authorization under your plan.

 

Contact Blue Cross Blue Shield of Texas

 

  • Call the customer service number on the back of your insurance card to speak with a representative directly.
  •  

  • Ask if Symbicort requires prior authorization or if there are any specific requirements or restrictions for coverage under your plan.

 

Request Prior Authorization

 

  • If prior authorization is required, work with your healthcare provider to submit the necessary forms to BCBSTX. The provider typically handles this, but you may need to ensure forms are filled out completely and submitted promptly.
  •  

  • Follow up with BCBSTX to confirm they have received the prior authorization request and ask about the typical processing time.

 

Review Coverage Details

 

  • Once approved, verify the details of your coverage, such as copayment amounts, quantity limits, and any additional cost-saving opportunities like mail-order prescriptions.
  •  

  • Note all the information about refills and if there’s a particular pharmacy network you must use for the coverage to apply.

 

Fill Your Prescription

 

  • Visit the in-network pharmacy with your prescription for Symbicort. Present your insurance card to ensure the coverage is applied appropriately.
  •  

  • Consult with the pharmacist for any potential savings programs, like manufacturer's coupons, that can further reduce your out-of-pocket costs.

 

Monitor and Adjust as Necessary

 

  • Keep track of your usage and contact BCBSTX if anything changes in your prescription needs. Always inform them of provider changes or any issues you are facing with coverage.
  •  

  • Review your insurance benefits regularly to stay informed about any updates or changes in your prescription drug coverage plan.

 

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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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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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