Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Symbicort

Explore if Florida Blue covers Symbicort, reasons for denial, steps to secure coverage, costs without insurance, and get answers to common questions.
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Coverage for Symbicort with Florida Blue

 

  • Florida Blue may cover Symbicort for patients with asthma or COPD, as part of their prescription drug benefits. Coverage is subject to the specific details of individual health plans.
  •  

  • Approval for Symbicort often requires prior authorization. This means your healthcare provider must demonstrate medical necessity based on your condition and treatment history.

 

Criteria and Rules for Coverage

 

  • Patients typically need to have a diagnosis that aligns with conditions Symbicort is approved to treat, such as asthma or chronic obstructive pulmonary disease.
  •  

  • Providers may need to submit detailed medical records or evidence of trial and failure of other medications before Symbicort's coverage is approved.
  •  

  • It is advised to check your specific Florida Blue plan for co-payments, formulary status, and any step therapy requirements related to Symbicort.

 

Next Steps

 

  • Contact Florida Blue customer service to ensure Symbicort is included in your plan's formulary and clarify any specific requirements.
  •  

  • Speak with your healthcare provider about the necessary documentation for prior authorization if needed.

 

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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 Florida Blue (Blue Cross Blue Shield of Florida)

 

Check Your Florida Blue Plan

 

  • Review your Florida Blue insurance plan documents to understand your coverage details, specifically related to prescription medications.
  •  
  • Contact Florida Blue customer service for information regarding pharmacy benefits and whether Symbicort is included in your current plan.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of using Symbicort for your condition. Your healthcare provider can help in providing the required documentation if necessary.
  •  
  • Ensure your doctor prescribes Symbicort if it is determined to be the right medication for you.

 

Check Florida Blue’s Formulary

 

  • Visit the Florida Blue website and access the formulary list to confirm whether Symbicort is listed as a covered medication.
  •  
  • Download the formulary PDF or use the online search tool to find the drug tier level for Symbicort, which determines copay amounts.

 

Obtain Prior Authorization

 

  • Contact Florida Blue to determine if Symbicort requires prior authorization. This step might be necessary for specific dosages or quantities.
  •  
  • If prior authorization is needed, your doctor will need to submit a request justifying the necessity of Symbicort for your treatment.

 

Fill Your Prescription

 

  • Choose a Florida Blue network pharmacy to fill your Symbicort prescription to ensure maximum coverage benefits.
  •  
  • Present your Florida Blue insurance card at the pharmacy when you pick up your medication to apply your coverage to the prescription cost.

 

Appeal Denied Claims

 

  • If your claim for Symbicort coverage is denied, review the denial notice from Florida Blue to understand the reasons behind the decision.
  •  
  • Contact Florida Blue to discuss the denial, and file an appeal if necessary, providing any additional information or documentation that supports your need for Symbicort.

 

Stay Informed on Coverage Changes

 

  • Regularly review updates from Florida Blue about changes in your prescription drug coverage, including any formulary changes affecting Symbicort.
  •  
  • Keep in contact with your healthcare provider for any required updates on prescriptions or coverage adjustments.

 

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FAQs

Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Symbicort

Explore if Florida Blue covers Symbicort, reasons for denial, steps to secure coverage, costs without insurance, and get answers to common questions.
Curex allergy drops unboxing

Is Symbicort Covered by Florida Blue (Blue Cross Blue Shield of Florida)

 

Coverage for Symbicort with Florida Blue

 

  • Florida Blue may cover Symbicort for patients with asthma or COPD, as part of their prescription drug benefits. Coverage is subject to the specific details of individual health plans.
  •  

  • Approval for Symbicort often requires prior authorization. This means your healthcare provider must demonstrate medical necessity based on your condition and treatment history.

 

Criteria and Rules for Coverage

 

  • Patients typically need to have a diagnosis that aligns with conditions Symbicort is approved to treat, such as asthma or chronic obstructive pulmonary disease.
  •  

  • Providers may need to submit detailed medical records or evidence of trial and failure of other medications before Symbicort's coverage is approved.
  •  

  • It is advised to check your specific Florida Blue plan for co-payments, formulary status, and any step therapy requirements related to Symbicort.

 

Next Steps

 

  • Contact Florida Blue customer service to ensure Symbicort is included in your plan's formulary and clarify any specific requirements.
  •  

  • Speak with your healthcare provider about the necessary documentation for prior authorization if needed.

 

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Florida Blue (Blue Cross Blue Shield of Florida)'s Approved Criteria for Symbicort Coverage

 

Criteria for Symbicort Coverage by Florida Blue

 

  • **Diagnosis Verification**: The patient must have a documented diagnosis of asthma or chronic obstructive pulmonary disease (COPD) confirmed through appropriate clinical evaluation.
  •  

  • **Age Requirement**: The patient must be of the age group approved for Symbicort usage as per FDA guidelines.
  •  

  • **Previous Treatments**: The patient should have a trial history of short-acting beta agonists (SABAs) or other forms of treatments, unless contraindicated or clinically inappropriate.
  •  

  • **Chronic Management Necessity**: The patient must demonstrate a medical requirement for daily maintenance medication to manage their chronic respiratory condition effectively.
  •  

  • **Physician Documentation**: A licensed physician must provide comprehensive documentation supporting the necessity for Symbicort as a part of the prescribed treatment plan.
  •  

  • **Adherence to Treatment Protocols**: Evidence of adherence to inhaled corticosteroids or other maintenance therapies is required to substantiate the need for combination therapy involving Symbicort.
  •  

  • **Plan-Specific Requirements**: Any additional criteria or documentation as specified by the patient’s individual Florida Blue plan must be met.

 

Why Florida Blue (Blue Cross Blue Shield of Florida) Might Deny Symbicort Coverage

 

Reasons for Symbicort Coverage Denial by Florida Blue

 

  • Florida Blue may deny coverage for Symbicort if the medication is being prescribed for a condition not approved by the FDA. Ensuring that the prescription aligns with approved therapeutic uses is crucial.
  •  

  • Coverage can be denied if the patient does not meet the specific medical necessity criteria set by Florida Blue, which may include insufficient evidence of chronic obstructive pulmonary disease (COPD) or asthma severity requiring Symbicort.
  •  

  • If a generic equivalent is available and appropriate for the patient, Florida Blue may not cover Symbicort to encourage the use of lower-cost alternatives unless otherwise justified by the prescribing physician.
  •  

  • Failure to comply with step therapy protocols where Florida Blue requires a trial of a preferred medication before approving Symbicort can result in coverage denial.
  •  

  • Coverage may be denied if the prescription exceeds the maximum allowable quantity limit as determined by Florida Blue without prior authorization or medical justification.
  •  

  • Patients lacking proper documentation of previous unsuccessful treatments or therapies requisite before confirming Symbicort use might find themselves denied coverage.
  •  

  • Florida Blue might refuse coverage if the prescription was filled at a non-participating pharmacy, emphasizing the importance of using in-network services to ensure coverage.

 

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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 Florida Blue (Blue Cross Blue Shield of Florida)

 

Check Your Florida Blue Plan

 

  • Review your Florida Blue insurance plan documents to understand your coverage details, specifically related to prescription medications.
  •  
  • Contact Florida Blue customer service for information regarding pharmacy benefits and whether Symbicort is included in your current plan.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of using Symbicort for your condition. Your healthcare provider can help in providing the required documentation if necessary.
  •  
  • Ensure your doctor prescribes Symbicort if it is determined to be the right medication for you.

 

Check Florida Blue’s Formulary

 

  • Visit the Florida Blue website and access the formulary list to confirm whether Symbicort is listed as a covered medication.
  •  
  • Download the formulary PDF or use the online search tool to find the drug tier level for Symbicort, which determines copay amounts.

 

Obtain Prior Authorization

 

  • Contact Florida Blue to determine if Symbicort requires prior authorization. This step might be necessary for specific dosages or quantities.
  •  
  • If prior authorization is needed, your doctor will need to submit a request justifying the necessity of Symbicort for your treatment.

 

Fill Your Prescription

 

  • Choose a Florida Blue network pharmacy to fill your Symbicort prescription to ensure maximum coverage benefits.
  •  
  • Present your Florida Blue insurance card at the pharmacy when you pick up your medication to apply your coverage to the prescription cost.

 

Appeal Denied Claims

 

  • If your claim for Symbicort coverage is denied, review the denial notice from Florida Blue to understand the reasons behind the decision.
  •  
  • Contact Florida Blue to discuss the denial, and file an appeal if necessary, providing any additional information or documentation that supports your need for Symbicort.

 

Stay Informed on Coverage Changes

 

  • Regularly review updates from Florida Blue about changes in your prescription drug coverage, including any formulary changes affecting Symbicort.
  •  
  • Keep in contact with your healthcare provider for any required updates on prescriptions or coverage adjustments.

 

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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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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.

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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 (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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