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Does Centene Corporation Cover Dupixent

Explore why Centene might deny Dupixent coverage, tips to secure it, understand costs without insurance, and answers to common Dupixent questions.

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Coverage of Dupixent by Centene Corporation

Centene Corporation may cover Dupixent for FDA-approved indications such as moderate-to-severe atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis.

Approval usually requires that the patient has tried and failed other treatments before considering Dupixent.

Patient must meet specific medical necessity criteria laid out in the coverage policy, including diagnosis confirmation and disease severity documentation.

Coverage is often contingent upon prior authorization, necessitating a healthcare provider to submit a detailed request outlining the medical necessity of Dupixent for the patient.

Patient's policy may have different requirements, so it's essential to verify specific plan details with Centene Corporation directly.

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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 Dupixent Coverage with Centene Corporation

Research Dupixent Coverage Under Centene

Review your specific Centene insurance plan to understand coverage terms related to medications. This information is usually available in your policy documents or the Centene online member portal.

Check the formulary list provided by Centene to ensure Dupixent is included and determine if prior authorization is required.

Consult Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Dupixent. Ensure they support your case and are willing to assist with any necessary paperwork.

Request your healthcare provider to prepare a detailed prescription and medical necessity letter for Dupixent if required by Centene.

Contact Centene Member Services

Reach out to Centene's member services to confirm all steps necessary for Dupixent coverage under your insurance plan. Inquire specifically about required documentation and approval timelines.

Ask if there are any specific forms or additional information needed to process your Dupixent coverage request.

Submit a Prior Authorization Request

Work with your healthcare provider to complete any required prior authorization forms needed by Centene. Ensure all forms are filled out accurately and comprehensively.

Submit the completed prior authorization and any supporting documents (e.g., doctor’s note) to Centene for review.

Follow Up on Your Request

Regularly check the status of your prior authorization request by contacting Centene or checking your member portal. Approval can take some time, and timely follow-ups can help expedite the process.

If additional information is requested, provide it as quickly as possible to avoid delays.

Appeal if Necessary

If your request for Dupixent coverage is denied, review the denial letter carefully to understand the reason provided by Centene.

Prepare an appeal with the help of your healthcare provider, including any additional medical information or documentation supporting the necessity of Dupixent.

Submit the appeal in accordance with Centene's guidelines and track its progress to ensure a timely resolution.

Explore Financial Assistance Options

If you encounter financial difficulties obtaining Dupixent even with coverage, consider reaching out to Dupixent MyWay, a support program offering financial assistance and resources for those eligible.

Discuss available options with both Centene and Dupixent MyWay to minimize out-of-pocket expenses.

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FAQs

Does Centene Corporation Cover Dupixent

Explore why Centene might deny Dupixent coverage, tips to secure it, understand costs without insurance, and answers to common Dupixent questions.

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Is Dupixent Covered by Centene Corporation

Coverage of Dupixent by Centene Corporation

Centene Corporation may cover Dupixent for FDA-approved indications such as moderate-to-severe atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis.

Approval usually requires that the patient has tried and failed other treatments before considering Dupixent.

Patient must meet specific medical necessity criteria laid out in the coverage policy, including diagnosis confirmation and disease severity documentation.

Coverage is often contingent upon prior authorization, necessitating a healthcare provider to submit a detailed request outlining the medical necessity of Dupixent for the patient.

Patient's policy may have different requirements, so it's essential to verify specific plan details with Centene Corporation directly.

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Centene Corporation's Approved Criteria for Dupixent Coverage

Criteria for Dupixent Coverage by Centene Corporation

**Indication for Atopic Dermatitis**:
- Dupixent is covered for individuals 6 months and older who have been diagnosed with moderate-to-severe atopic dermatitis.
- Patients must have an inadequate response to topical prescription therapies or those for whom topical treatments are medically inadvisable.

**Indication for Asthma**:
- Dupixent is indicated for patients 6 years and older with moderate-to-severe asthma with an eosinophilic phenotype or with oral corticosteroid-dependent asthma.
- Coverage requires prior trials and failures, or contraindications, to a combination of high-dose inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA).

**Indication for Chronic Rhinosinusitis with Nasal Polyps**:
- Dupixent is approved for adults with a diagnosis of chronic rhinosinusitis with nasal polyps who have had inadequate response to systemic corticosteroids or surgery.
- Confirmation of the need for a biologic in managing ongoing severe symptomatology is necessary.

**Indication for Eosinophilic Esophagitis**:
- Applicable for individuals 12 years and older diagnosed with eosinophilic esophagitis, where Dupixent is deemed medically necessary.
- Patients must show inadequate response or unsuitability to standard treatment options.

**Indication for Prurigo Nodularis**:
- Dupixent coverage for adults with prurigo nodularis, where there is a documented diagnosis and persistence of symptoms despite conventional therapy.
- Documentation should highlight the severity and chronic nature of the condition requiring Dupixent intervention.

Why Centene Corporation Might Deny Dupixent Coverage

Situations Where Centene Corporation Might Deny Dupixent Coverage

The prescribed use of Dupixent is not for an FDA-approved indication. Centene may require documentation that the prescription aligns with approved indications.

Dupixent usage is considered experimental or investigational for the requested treatment. The corporation might reject coverage if the medical use does not have sufficient scientific evidence supporting its effectiveness for the condition.

The patient does not meet established clinical criteria such as severity of condition or previous unsuccessful treatments, as specified in the policy guidelines.

A lack of documentation supporting the necessity of Dupixent in the patient's course of treatment. This could include missing prior treatment history or incomplete clinical information.

Dupixent is prescribed at a dosage or frequency that does not comply with FDA-approved labeling or established clinical guidelines, unless suitable medical justification is furnished.

The health plan has surpassed its annual or lifetime limits for Dupixent, as per the patient's policy terms.

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How Much Does Dupixent Cost without Insurance?

Approximate Cost of Dupixent Without Insurance

The cost of Dupixent without insurance can be quite high, usually ranging between $3,200 to $3,500 per month. This cost is for the standard dose, which consists of two pre-filled syringes or injection pens, each containing 300 mg of medication.

Prices can vary depending on the pharmacy, location, and any potential deals or discounts offered by specific pharmacies or third-party services.

Patients are encouraged to explore manufacturer copay cards, patient assistance programs, or discount cards which might be available to help reduce out-of-pocket expenses.

For those requiring treatment for conditions like eczema, asthma, or other approved uses, Dupixent is often administered bi-weekly after an initial loading dose, which should be taken into consideration when calculating monthly or annual expenses.

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

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

Kayla Mardaga, NP

How to Get Dupixent Coverage with Centene Corporation

Research Dupixent Coverage Under Centene

Review your specific Centene insurance plan to understand coverage terms related to medications. This information is usually available in your policy documents or the Centene online member portal.

Check the formulary list provided by Centene to ensure Dupixent is included and determine if prior authorization is required.

Consult Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Dupixent. Ensure they support your case and are willing to assist with any necessary paperwork.

Request your healthcare provider to prepare a detailed prescription and medical necessity letter for Dupixent if required by Centene.

Contact Centene Member Services

Reach out to Centene's member services to confirm all steps necessary for Dupixent coverage under your insurance plan. Inquire specifically about required documentation and approval timelines.

Ask if there are any specific forms or additional information needed to process your Dupixent coverage request.

Submit a Prior Authorization Request

Work with your healthcare provider to complete any required prior authorization forms needed by Centene. Ensure all forms are filled out accurately and comprehensively.

Submit the completed prior authorization and any supporting documents (e.g., doctor’s note) to Centene for review.

Follow Up on Your Request

Regularly check the status of your prior authorization request by contacting Centene or checking your member portal. Approval can take some time, and timely follow-ups can help expedite the process.

If additional information is requested, provide it as quickly as possible to avoid delays.

Appeal if Necessary

If your request for Dupixent coverage is denied, review the denial letter carefully to understand the reason provided by Centene.

Prepare an appeal with the help of your healthcare provider, including any additional medical information or documentation supporting the necessity of Dupixent.

Submit the appeal in accordance with Centene's guidelines and track its progress to ensure a timely resolution.

Explore Financial Assistance Options

If you encounter financial difficulties obtaining Dupixent even with coverage, consider reaching out to Dupixent MyWay, a support program offering financial assistance and resources for those eligible.

Discuss available options with both Centene and Dupixent MyWay to minimize out-of-pocket expenses.

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Dupixent FAQ

1. What are the common side effects of Dupixent?

Common Side Effects of Dupixent

Injection site reactions: redness, swelling, and pain at the injection site are frequently reported. These reactions usually subside shortly after injection.

Conjunctivitis: Some patients experience symptoms like red, itchy, or watery eyes.

Blepharitis: Inflammation of the eyelids, leading to symptoms such as redness, swelling, and itching, may occur.

Oral herpes: A mild increase in probabilities of cold sores has been noted in some cases.

Sore throat: Some individuals may develop pharyngitis, which manifests as throat discomfort or pain.

2. How does Dupixent work for eczema?

How Dupixent Works for Eczema

Dupixent is a monoclonal antibody that targets interleukin-4 receptor alpha (IL-4Rα).

By blocking IL-4Rα, it inhibits the signaling pathways of IL-4 and IL-13, key cytokines involved in the inflammatory response in eczema.

This leads to a reduction in the overactive immune response, which is characterized by inflammation and itchiness in atopic dermatitis.

As a result, Dupixent helps alleviate symptoms like redness, itch, and skin thickening by modulating the immune response.

3. Is Dupixent used for asthma treatment?

Dupixent for Asthma

Dupixent (dupilumab) is approved for use in the treatment of moderate-to-severe asthma in adults and adolescents (12 years and older).

It is particularly beneficial for patients with eosinophilic asthma or those dependent on oral corticosteroids.

Dupixent acts by targeting and inhibiting the signaling of interleukins IL-4 and IL-13, which play central roles in the inflammatory response involved in asthma.

The medication is administered via subcutaneous injection, typically every two weeks after an initial loading dose.

Clinical trials have shown Dupixent to reduce asthma exacerbations and improve lung function, thereby potentially reducing the need for oral corticosteroids.

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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. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does Centene Corporation Cover Dupixent

Explore why Centene might deny Dupixent coverage, tips to secure it, understand costs without insurance, and answers to common Dupixent questions.

Achieve Your Goals Faster with Curex