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Does Cigna Cover Dupixent

Explore Cigna's Dupixent coverage, reasons for denial, ways to secure approval, and cost without insurance in this comprehensive guide.

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Cigna's Coverage for Dupixent

Dupixent is typically covered by Cigna for conditions like moderate-to-severe atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis.

Cigna's coverage often requires prior authorization, meaning a healthcare provider must demonstrate medical necessity.

The patient may need to have tried and failed other treatments before Cigna approves Dupixent.

There are usually specific dosage and frequency limitations aligned with Dupixent's labeled use.

Co-pay and deductible requirements will vary based on the individual's health plan specifics.

Basic Criteria

Patients must have a confirmed diagnosis of the condition Dupixent is approved to treat.

Careful documentation from healthcare providers is necessary to meet prior authorization requirements.

Adherence to any step therapy protocols established by Cigna is essential for approval.

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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 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 Cigna

Contact Your Healthcare Provider

Speak to your healthcare provider about the necessity of Dupixent for your condition. Ensure they are aware of your insurance provider, Cigna, as this will be vital for any documentation required for coverage.

Verify Cigna Health Plan Coverage

Check your specific plan with Cigna to understand whether Dupixent is covered. Visit their official website or contact customer service for detailed information about your benefits.
Look for any specifics mentioned in your plan regarding the authorization process for Dupixent or specialty medications.

Secure Prior Authorization

Understand that Dupixent typically requires prior authorization. This means your healthcare provider must submit documentation proving the medical necessity of the medication.
Coordinate with your doctor to ensure they send the appropriate paperwork to Cigna. This usually includes your diagnosis, treatment history, and the reason Dupixent is recommended.

Provide Additional Information as Required

In some cases, Cigna may request additional information. Be ready to provide any extra details or documents needed to expedite the approval process.
Stay in contact with your healthcare provider to ensure timely submission of any requested materials.

Follow Up with Cigna

After submission, follow up with Cigna to check the status of your prior authorization request. This helps prevent unnecessary delays in receiving your medication.
Maintain a log of all communication with Cigna, including dates, times, and names of representatives you speak to, for future reference.

Address Denials or Appeals

If your request is denied, review the denial documentation to understand the reasons. Cigna should provide details on how to appeal the decision.
Work with your healthcare provider to gather additional documentation or clarification that might be required for a successful appeal.

Understand Cost-Saving Options

Inquire about any patient assistance programs for Dupixent. These might offer discounts or financial help directly through the drug manufacturer.
Ask Cigna if they provide special assistance programs for high-cost medications.

Stay Informed About Your Prescription Benefits

Keep yourself updated with any changes in your Cigna health plan that might affect Dupixent coverage in the future. Policies can change annually or with plan modifications.
Ensure that your healthcare provider and Cigna have your current contact information to avoid missing important notifications.

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Does Cigna Cover Dupixent

Explore Cigna's Dupixent coverage, reasons for denial, ways to secure approval, and cost without insurance in this comprehensive guide.

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Is Dupixent Covered by Cigna

Cigna's Coverage for Dupixent

Dupixent is typically covered by Cigna for conditions like moderate-to-severe atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis.

Cigna's coverage often requires prior authorization, meaning a healthcare provider must demonstrate medical necessity.

The patient may need to have tried and failed other treatments before Cigna approves Dupixent.

There are usually specific dosage and frequency limitations aligned with Dupixent's labeled use.

Co-pay and deductible requirements will vary based on the individual's health plan specifics.

Basic Criteria

Patients must have a confirmed diagnosis of the condition Dupixent is approved to treat.

Careful documentation from healthcare providers is necessary to meet prior authorization requirements.

Adherence to any step therapy protocols established by Cigna is essential for approval.

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Cigna's Approved Criteria for Dupixent Coverage

Cigna's Approved Criteria for Dupixent Coverage

**Diagnosis of Atopic Dermatitis:** Must be prescribed for the treatment of moderate to severe atopic dermatitis in patients who are candidates for systemic therapy.

**Diagnosis of Asthma:** Coverage is approved for patients with moderate to severe asthma provided they have an eosinophilic phenotype or are dependent on oral corticosteroids.

**Diagnosis of Chronic Rhinosinusitis with Nasal Polyps (CRSwNP):** Patient must have a history of CRSwNP inadequately controlled by medical therapy.

**Diagnosis of Eosinophilic Esophagitis:** Dupixent can be covered for the treatment of eosinophilic esophagitis in patients 12 years and older.

**Previous Treatment Attempts:** The patient must have tried and had an inadequate response, or intolerance, to previous treatments for the relevant condition.

**Prescription by Specialist:** Dupixent must be prescribed by a healthcare provider specializing in dermatology, allergy/immunology, otolaryngology, gastroenterology, or pulmonology.

**Age Requirements:** Eligibility depends on the condition being treated, with certain conditions requiring the patient to be within a specific age range.

**Documented Evidence of Medical Necessity:** Patient records must demonstrate the necessity of Dupixent based on patient history and diagnostic criteria.

Why Cigna Might Deny Dupixent Coverage

Reasons Cigna Might Deny Dupixent Coverage

Patient does not meet the specified criteria for diagnosis or severity of condition as outlined in coverage policies.

Dupixent is prescribed for off-label use that is not supported by sufficient clinical evidence or guidelines recognized by Cigna.

The patient has not tried and failed the required first-line treatments (e.g., topical corticosteroids or phototherapy for eczema) before advancing to Dupixent.

Prescribed dosage or treatment regimen does not conform to approved guidelines or exceeds recommended limits without documented medical necessity.

There is a lack of necessary documentation or incomplete information provided with the coverage request, such as missing clinical notes or lab results.

Dupixent is prescribed for a condition that is explicitly excluded from the individual’s health plan or policy.

The provider or facility administering Dupixent is out-of-network or not covered under the specifics of the member's insurance plan.

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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 Cigna

Contact Your Healthcare Provider

Speak to your healthcare provider about the necessity of Dupixent for your condition. Ensure they are aware of your insurance provider, Cigna, as this will be vital for any documentation required for coverage.

Verify Cigna Health Plan Coverage

Check your specific plan with Cigna to understand whether Dupixent is covered. Visit their official website or contact customer service for detailed information about your benefits.
Look for any specifics mentioned in your plan regarding the authorization process for Dupixent or specialty medications.

Secure Prior Authorization

Understand that Dupixent typically requires prior authorization. This means your healthcare provider must submit documentation proving the medical necessity of the medication.
Coordinate with your doctor to ensure they send the appropriate paperwork to Cigna. This usually includes your diagnosis, treatment history, and the reason Dupixent is recommended.

Provide Additional Information as Required

In some cases, Cigna may request additional information. Be ready to provide any extra details or documents needed to expedite the approval process.
Stay in contact with your healthcare provider to ensure timely submission of any requested materials.

Follow Up with Cigna

After submission, follow up with Cigna to check the status of your prior authorization request. This helps prevent unnecessary delays in receiving your medication.
Maintain a log of all communication with Cigna, including dates, times, and names of representatives you speak to, for future reference.

Address Denials or Appeals

If your request is denied, review the denial documentation to understand the reasons. Cigna should provide details on how to appeal the decision.
Work with your healthcare provider to gather additional documentation or clarification that might be required for a successful appeal.

Understand Cost-Saving Options

Inquire about any patient assistance programs for Dupixent. These might offer discounts or financial help directly through the drug manufacturer.
Ask Cigna if they provide special assistance programs for high-cost medications.

Stay Informed About Your Prescription Benefits

Keep yourself updated with any changes in your Cigna health plan that might affect Dupixent coverage in the future. Policies can change annually or with plan modifications.
Ensure that your healthcare provider and Cigna have your current contact information to avoid missing important notifications.

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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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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.

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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.

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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 Cigna Cover Dupixent

Explore Cigna's Dupixent coverage, reasons for denial, ways to secure approval, and cost without insurance in this comprehensive guide.

Achieve Your Goals Faster with Curex