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Does Christiana Care Health System Cover Stelara

Explore Stelara coverage with Christiana Care, reasons for denial, steps to secure coverage, costs without insurance, and answers to common questions.

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Stelara Coverage under Christiana Care Health System

**Coverage Situations**: Stelara, a biologic medication, is generally covered for conditions like moderate to severe plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. Coverage is typically contingent upon these diagnoses.

**Basic Rules**: Patients must have documented medical necessity, often requiring a dermatology or rheumatology specialist's evaluation. Prior authorization may be necessary to confirm eligibility and appropriateness of Stelara.

**Criteria for Coverage**: Patients might need to show previous treatment inefficacy with conventional therapy before Stelara is approved. Insurance plans with Christiana Care may require cost-sharing or co-pays.

**Additional Considerations**: Continuous coverage is likely contingent on periodic evaluation of treatment efficacy and compliance with the prescribed regimen.

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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.

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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.

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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 Stelara Coverage with Christiana Care Health System

Initial Consultation and Referrals

Contact Christiana Care Health System to schedule an initial consultation with a primary care physician or specialist who can provide a diagnosis and treatment plan involving Stelara.

If you are currently seeing a dermatologist, rheumatologist, or gastroenterologist within Christiana Care Health System, discuss Stelara as a treatment option.

Insurance Verification and Benefits Inquiry

Reach out to Christiana Care Health System's patient financial services. They can assist in verifying your insurance benefits and coverage specifics for Stelara.

Contact your health insurance provider directly to understand your coverage for Stelara, ensuring you know about any copays, deductibles, or prior authorization requirements.

Prior Authorization Process

Work with your healthcare provider at Christiana Care to submit a prior authorization request, if required by your insurance plan. This typically includes detailed documentation of your medical necessity for Stelara.

Be prepared to provide additional information or documentation if your insurance requests it to approve coverage for Stelara.

Financial Assistance Options

Explore any financial assistance programs offered by Christiana Care Health System. They may provide support for patients who encounter high out-of-pocket costs for medications like Stelara.

Check with pharmaceutical assistance programs or manufacturer-sponsored initiatives that might offer Stelara at a reduced cost or even for free, based on eligibility criteria.

Coordinating Stelara Treatments

Once insurance approval is obtained, work with Christiana Care Health System to schedule your Stelara treatments.

Ensure ongoing communication with both your healthcare provider and the insurance company to manage any potential issues with coverage throughout your treatment.

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Does Christiana Care Health System Cover Stelara

Explore Stelara coverage with Christiana Care, reasons for denial, steps to secure coverage, costs without insurance, and answers to common questions.

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Is Stelara Covered by Christiana Care Health System

Stelara Coverage under Christiana Care Health System

**Coverage Situations**: Stelara, a biologic medication, is generally covered for conditions like moderate to severe plaque psoriasis, psoriatic arthritis, Crohn's disease, and ulcerative colitis. Coverage is typically contingent upon these diagnoses.

**Basic Rules**: Patients must have documented medical necessity, often requiring a dermatology or rheumatology specialist's evaluation. Prior authorization may be necessary to confirm eligibility and appropriateness of Stelara.

**Criteria for Coverage**: Patients might need to show previous treatment inefficacy with conventional therapy before Stelara is approved. Insurance plans with Christiana Care may require cost-sharing or co-pays.

**Additional Considerations**: Continuous coverage is likely contingent on periodic evaluation of treatment efficacy and compliance with the prescribed regimen.

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Christiana Care Health System's Approved Criteria for Stelara Coverage

Criteria for Stelara Coverage

**Diagnosis of a Covered Condition:** Individuals must have a confirmed diagnosis of a condition that is included in Christiana Care Health System's approved list for Stelara coverage, such as moderate to severe plaque psoriasis, active psoriatic arthritis, or Crohn's disease.

**Previous Treatment Requirements:** Patients are expected to have a documented history showing either an inadequate response or intolerance to conventional therapies for their specific condition. These therapies may include topical treatments, methotrexate, or phototherapy in the case of psoriasis, or traditional disease-modifying antirheumatic drugs (DMARDs) for psoriatic arthritis and Crohn's disease.

**Prescription by a Specialist:** A qualified healthcare professional specializing in dermatology, rheumatology, or gastroenterology must prescribe Stelara, depending on the condition being treated.

**Age and Weight Criteria:** Patients should meet specific age and weight criteria as outlined in the treatment guidelines for Stelara. This includes appropriate adjustments in dosing based on body weight for pediatric patients diagnosed with Crohn’s disease.

**Documentation of Symptoms and Impact:** The prescribing physician must provide detailed medical records illustrating the severity of the patient's condition, including the impact on daily living and overall quality of life. Documentation should include photographic evidence in certain cases, especially for cutaneous manifestations like psoriasis.

**Regular Follow-Up Plan:** There should be a clearly documented plan for patient follow-up and ongoing assessment to monitor effectiveness and adjust therapy as needed. This includes tracking symptom progression and any adverse effects.

**Prior Authorization Process:** Completion of Christiana Care Health System's prior authorization form, with all required supporting documentation, to confirm that the criteria for Stelara coverage are met. This process ensures coverage extends only to those patients who align with established guidelines and recommendations.

Why Christiana Care Health System Might Deny Stelara Coverage

Criterias and Situations for Stelara Denial by Christiana Care Health System

**Non-FDA Approved Uses**: Stelara may be denied if it is prescribed for conditions that are not approved by the FDA.

**Experimental or Investigational Use**: Denial can occur if Stelara is deemed experimental or investigational for the requested treatment.

**Lack of Medical Necessity**: Coverage might be denied if there is insufficient documentation to demonstrate the medical necessity of Stelara for the patient’s specific condition.

**Non-adherence to Step Therapy Protocols**: If protocols require patients to attempt other treatment options first, a denial may occur if Stelara is requested prior to trying these alternatives.

**Incomplete Authorization Requests**: If pre-authorization requests lack necessary documentation or information regarding the patient's medical history and prior treatments, Stelara coverage might be denied.

**Outside Approved Age Range**: Stelara could be denied if prescribed to patients outside the approved age range specified by the healthcare system or FDA guidelines.

**Duplicate Therapy**: Coverage may be denied if Stelara is requested concurrently with other biologic agents treating the same condition without sufficient justification.

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How Much Does Stelara Cost without Insurance?

Approximate Cost of Stelara without Insurance

The price of Stelara, a medication used primarily for treating conditions such as psoriasis and Crohn's disease, can vary based on the pharmacy and other location-based factors, but without insurance, it typically costs around $20,000 to $40,000 per year.

Individual dosage needs and treatment plans can affect the total cost, as Stelara injections are spaced differently depending on treatment guidelines for specific conditions.

Pricing can also vary depending on the dosage strength; the standard doses are 45 mg and 90 mg, with the 90 mg dose generally being more expensive.

Patients can sometimes find manufacturer coupons or patient assistance programs that help reduce the cost of Stelara. These programs usually require an application process and eligibility criteria.

Additionally, discount pharmacy programs or third-party coupon providers might offer savings, although these are often limited and may vary in percentage or availability.

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 Stelara Coverage with Christiana Care Health System

Initial Consultation and Referrals

Contact Christiana Care Health System to schedule an initial consultation with a primary care physician or specialist who can provide a diagnosis and treatment plan involving Stelara.

If you are currently seeing a dermatologist, rheumatologist, or gastroenterologist within Christiana Care Health System, discuss Stelara as a treatment option.

Insurance Verification and Benefits Inquiry

Reach out to Christiana Care Health System's patient financial services. They can assist in verifying your insurance benefits and coverage specifics for Stelara.

Contact your health insurance provider directly to understand your coverage for Stelara, ensuring you know about any copays, deductibles, or prior authorization requirements.

Prior Authorization Process

Work with your healthcare provider at Christiana Care to submit a prior authorization request, if required by your insurance plan. This typically includes detailed documentation of your medical necessity for Stelara.

Be prepared to provide additional information or documentation if your insurance requests it to approve coverage for Stelara.

Financial Assistance Options

Explore any financial assistance programs offered by Christiana Care Health System. They may provide support for patients who encounter high out-of-pocket costs for medications like Stelara.

Check with pharmaceutical assistance programs or manufacturer-sponsored initiatives that might offer Stelara at a reduced cost or even for free, based on eligibility criteria.

Coordinating Stelara Treatments

Once insurance approval is obtained, work with Christiana Care Health System to schedule your Stelara treatments.

Ensure ongoing communication with both your healthcare provider and the insurance company to manage any potential issues with coverage throughout your treatment.

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Stelara FAQ

What are the common side effects of Stelara?

Common Side Effects of Stelara

**Infections:** Increased susceptibility to infections such as upper respiratory infections and strep throat.
**Headache:** This is a frequently reported side effect among patients who use Stelara.
**Tiredness:** Many individuals may experience fatigue or tiredness while on this medication.
**Redness at Injection Site:** Skin irritation, including redness, itching, or swelling, can occur at the site of injection.
**Nausea:** Some patients report feeling mildly nauseated after taking the medication.

How does Stelara work for psoriasis?

Mechanism of Action

Stelara is a monoclonal antibody that targets interleukin-12 (IL-12) and interleukin-23 (IL-23), which are proteins involved in inflammatory processes associated with psoriasis.

Impact on the Immune System

By inhibiting IL-12 and IL-23, Stelara reduces the activity of specific immune cells (T-cells) that contribute to the inflammation and rapid skin cell production characteristic of psoriasis.

Clinical Efficacy

Many patients experience significant reductions in psoriasis symptoms, including skin clearance, with improvements often visible within weeks after initial treatment.

Administration and Dosage

Stelara is administered via subcutaneous injection, starting with a loading dose followed by maintenance doses every 12 weeks thereafter.

How often do you need Stelara injections?

Stelara Injection Schedule

Initial Doses: After the first dose is administered, a second dose follows four weeks later.

Maintenance Doses: Subsequent injections are given every 12 weeks.

Special Cases: Depending on specific conditions like Crohn's disease, the frequency may vary under a physician's guidance.

Administration: Stelara is typically administered as a subcutaneous injection which can be performed in a healthcare setting or self-administered after proper training.

Consult Your Doctor: Always consult with your healthcare provider to tailor the schedule to your medical needs.

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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 Christiana Care Health System Cover Stelara

Explore Stelara coverage with Christiana Care, reasons for denial, steps to secure coverage, costs without insurance, and answers to common questions.

Achieve Your Goals Faster with Curex