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Does Centene Corporation Cover Dulera

Explore why Centene might deny Dulera, tips for obtaining coverage, costs without insurance, and answers to common questions in our comprehensive guide.
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Coverage Overview

 

  • Dulera, an asthma maintenance medication, may be covered by Centene Corporation plans depending on your specific policy. Coverage typically falls under the pharmacy benefit section.

 

Eligibility Criteria

 

  • Prior authorization might be required, ensuring the medication is medically necessary, especially if it's a higher-cost brand-name drug.
  • Prescribers may need to provide evidence of ineffective response or intolerance to other treatments before Dulera can be approved.

 

Coverage Situations

 

  • Centene generally covers Dulera when prescribed for asthma not controlled with single therapy or requiring combination therapy to reduce exacerbations.
  • Specific plans within Centene may have variations, and formulary checks are recommended.

 

Basic Rules

 

  • Always verify individual policy details with Centene or consult with your healthcare provider to navigate the coverage process efficiently.
  • Regular reviews of prior authorization status may be necessary to maintain ongoing coverage of Dulera.

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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 Dulera Coverage with Centene Corporation

 

Check Your Plan Details

 

  • Begin by reviewing your current health insurance policy with Centene Corporation to determine if Dulera is already covered.

    •  

  • Log in to your member account on the Centene Corporation website to access your plan details and drug coverage list.

    •  

  • Contact Centene customer service for clarification on your plan's pharmaceutical coverage if needed.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of Dulera for your treatment plan.

    •  

  • Have your provider document the medical necessity for Dulera, as this may be required for insurance approval.

    •  

  • Ensure your provider is aware of Centene's formularies and any required prior authorizations.

 

Submit a Prior Authorization Request

 

  • If Dulera is not initially covered, work with your healthcare provider to submit a prior authorization request to Centene.

    •  

  • Gather necessary documentation supporting the medical need for Dulera, including your provider's notes and any relevant test results.

    •  

  • Follow the instructions provided by Centene for submitting the request, ensuring all forms are complete and accurate.

 

Explore Alternative Options

 

  • If prior authorization is denied, inquire about alternative medications that may be covered under your plan and could serve as substitutes for Dulera.

    •  

  • Consult with your healthcare provider about possible modifications to your treatment if an alternative medication is necessary.

    •  

  • Evaluate possible eligibility for patient assistance programs or rebates from the medication manufacturer for additional cost savings.

 

Appeal Denial Decisions

 

  • If your initial request or prior authorization gets denied, review the denial letter for insights into the decision rationale.

    •  

  • Work with your healthcare provider to collect additional evidence or documentation to strengthen your case.

    •  

  • Follow Centene's appeal process guidelines to formally contest the denial, ensuring adherence to any indicated timelines and documentation requirements.

 

Maintain Communication with Centene

 

  • Regularly follow up with Centene to track the status of your requests or appeals regarding Dulera coverage.

    •  

  • Ensure you document all interactions, including dates, times, and details of conversations with Centene representatives.

    •  

  • Utilize Centene's online member portal for updates and communication when possible, to keep a clear record of your efforts and submissions.

 

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FAQs

Does Centene Corporation Cover Dulera

Explore why Centene might deny Dulera, tips for obtaining coverage, costs without insurance, and answers to common questions in our comprehensive guide.
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Is Dulera Covered by Centene Corporation

 

Coverage Overview

 

  • Dulera, an asthma maintenance medication, may be covered by Centene Corporation plans depending on your specific policy. Coverage typically falls under the pharmacy benefit section.

 

Eligibility Criteria

 

  • Prior authorization might be required, ensuring the medication is medically necessary, especially if it's a higher-cost brand-name drug.
  • Prescribers may need to provide evidence of ineffective response or intolerance to other treatments before Dulera can be approved.

 

Coverage Situations

 

  • Centene generally covers Dulera when prescribed for asthma not controlled with single therapy or requiring combination therapy to reduce exacerbations.
  • Specific plans within Centene may have variations, and formulary checks are recommended.

 

Basic Rules

 

  • Always verify individual policy details with Centene or consult with your healthcare provider to navigate the coverage process efficiently.
  • Regular reviews of prior authorization status may be necessary to maintain ongoing coverage of Dulera.

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Centene Corporation's Approved Criteria for Dulera Coverage

 

Approved Criteria for Dulera Coverage by Centene Corporation

 

  • Applicant is diagnosed with asthma and requires maintenance treatment for asthma control.

    •  

  • Dulera is prescribed as a combination therapy where both inhaled corticosteroid and long-acting beta-agonist are indicated.

    •  

  • Candidates must provide evidence of improvement in asthma control with Dulera according to the physician's assessment.

    •  

  • Confirmation that Dulera is used solely for maintenance therapy and not for relief of acute bronchospasm.

    •  

  • Documentation proving that the patient has tried and failed, or has a contraindication to, other inhaled corticosteroids and long-acting beta-agonists, or has a history of prior use showing better outcomes with Dulera.

    •  

  • Physician attestation that other underlying health conditions have been assessed and managed, ensuring asthma is the key condition being treated.

    •  

  • Verification that Dulera is being used in patients over the age of 12 years to comply with the FDA-approved age indications for the treatment.

    •  

 

Why Centene Corporation Might Deny Dulera Coverage

 

Reasons for Denial of Dulera Coverage by Centene Corporation

 

  • Medical Necessity: Centene Corporation may deny coverage for Dulera if it determines that the medication is not medically necessary for the patient based on their specific health condition and medical history.

    •  

  • Formulary Restrictions: If Dulera is not listed on Centene's preferred formulary, the prescription may not be covered unless there is a documented failure of formulary-preferred alternatives.

    •  

  • Prior Authorization: If prior authorization is not obtained or denied, Centene may refuse coverage. This process requires the prescribing physician to justify the medical need for Dulera over other treatments.

    •  

  • Quantity Limits: Dulera prescriptions that exceed specified quantity limits without proper authorization or medical justification might face denial from Centene.

    •  

  • Off-Label Use: Centene may deny coverage if Dulera is prescribed for an off-label use that is not supported by sufficient clinical evidence or guidelines recognized by the corporation.

    •  

  • Incomplete Documentation: Lack of necessary medical records or incomplete documentation supporting the need for Dulera can result in a denial of coverage.

 

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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.

 

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 Dulera Coverage with Centene Corporation

 

Check Your Plan Details

 

  • Begin by reviewing your current health insurance policy with Centene Corporation to determine if Dulera is already covered.

    •  

  • Log in to your member account on the Centene Corporation website to access your plan details and drug coverage list.

    •  

  • Contact Centene customer service for clarification on your plan's pharmaceutical coverage if needed.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of Dulera for your treatment plan.

    •  

  • Have your provider document the medical necessity for Dulera, as this may be required for insurance approval.

    •  

  • Ensure your provider is aware of Centene's formularies and any required prior authorizations.

 

Submit a Prior Authorization Request

 

  • If Dulera is not initially covered, work with your healthcare provider to submit a prior authorization request to Centene.

    •  

  • Gather necessary documentation supporting the medical need for Dulera, including your provider's notes and any relevant test results.

    •  

  • Follow the instructions provided by Centene for submitting the request, ensuring all forms are complete and accurate.

 

Explore Alternative Options

 

  • If prior authorization is denied, inquire about alternative medications that may be covered under your plan and could serve as substitutes for Dulera.

    •  

  • Consult with your healthcare provider about possible modifications to your treatment if an alternative medication is necessary.

    •  

  • Evaluate possible eligibility for patient assistance programs or rebates from the medication manufacturer for additional cost savings.

 

Appeal Denial Decisions

 

  • If your initial request or prior authorization gets denied, review the denial letter for insights into the decision rationale.

    •  

  • Work with your healthcare provider to collect additional evidence or documentation to strengthen your case.

    •  

  • Follow Centene's appeal process guidelines to formally contest the denial, ensuring adherence to any indicated timelines and documentation requirements.

 

Maintain Communication with Centene

 

  • Regularly follow up with Centene to track the status of your requests or appeals regarding Dulera coverage.

    •  

  • Ensure you document all interactions, including dates, times, and details of conversations with Centene representatives.

    •  

  • Utilize Centene's online member portal for updates and communication when possible, to keep a clear record of your efforts and submissions.

 

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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.

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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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.
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