Does Gateway Health Plan Cover Symbicort

Learn if Gateway Health Plan covers Symbicort, reasons for denial, how to get coverage, costs without insurance, and answers to common questions.
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Does Gateway Health Plan Cover Symbicort?

 

  • Gateway Health Plan typically covers Symbicort, but coverage may vary based on specific plan details and state Medicaid rules.
  • For coverage, Symbicort must be deemed medically necessary. This usually requires a prescription from a healthcare provider indicating its need for conditions like asthma or COPD.
  • Prior authorization might be required. This involves your healthcare provider submitting specific documentation to justify the need for Symbicort.
  • There may be limits on the quantity that can be prescribed per month, aligning with standard dosing guidelines.
  • Coverage might be subject to formulary restrictions, so it's wise to check if Symbicort belongs to a tier with higher co-pays.

 

Basic Criteria for Coverage

 

  • Enrollment in a Gateway Health Plan that includes pharmaceutical benefits.
  • Compliance with step therapy protocols, if applicable, where cheaper alternatives are tried first.
  • Fulfilling any age or condition-specific prerequisites outlined by the plan.

 

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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 Gateway Health Plan

 

Contact Gateway Health Plan Customer Service

 

  • Call Gateway Health Plan's customer service to inquire about coverage details for Symbicort.
  •  

  • Request information on the documentation or pre-authorization required for Symbicort coverage.

 

Verify Your Plan's Formulary

 

  • Check the formulary list of your specific Gateway Health Plan to ensure Symbicort is covered under your plan.
  •  

  • Look for any Tier details and understand what it means for your coverage, co-pays, or prior authorizations.

 

Consult With Your Doctor

 

  • Discuss with your healthcare provider about Symbicort and get a prescription if it's deemed necessary for your treatment.
  •  

  • Ask your doctor to provide any necessary documentation or letters of medical necessity that Gateway Health Plan might require.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit any required prior authorization forms to Gateway Health Plan.
  •  

  • Include all supporting documentation and ensure that all forms are filled out completely and accurately.

 

Follow Up on Your Request

 

  • Regularly check the status of your prior authorization request with Gateway Health Plan.
  •  

  • Contact their customer support if there are delays or additional information is requested.

 

Understand Your Appeal Rights

 

  • If your request is denied, ask Gateway Health Plan for the reason and understand the process for appeal.
  •  

  • Gather any additional documents or evidence needed and resubmit as per the appeal guidance provided by the plan.

 

Explore Alternative Assistance Programs

 

  • If coverage is still unavailable, consider asking your healthcare provider about patient assistance programs for Symbicort.
  •  

  • Research additional resources or discounts that might be offered directly by the drug manufacturer.

 

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FAQs

Does Gateway Health Plan Cover Symbicort

Learn if Gateway Health Plan covers Symbicort, reasons for denial, how to get coverage, costs without insurance, and answers to common questions.
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Is Symbicort Covered by Gateway Health Plan

 

Does Gateway Health Plan Cover Symbicort?

 

  • Gateway Health Plan typically covers Symbicort, but coverage may vary based on specific plan details and state Medicaid rules.
  • For coverage, Symbicort must be deemed medically necessary. This usually requires a prescription from a healthcare provider indicating its need for conditions like asthma or COPD.
  • Prior authorization might be required. This involves your healthcare provider submitting specific documentation to justify the need for Symbicort.
  • There may be limits on the quantity that can be prescribed per month, aligning with standard dosing guidelines.
  • Coverage might be subject to formulary restrictions, so it's wise to check if Symbicort belongs to a tier with higher co-pays.

 

Basic Criteria for Coverage

 

  • Enrollment in a Gateway Health Plan that includes pharmaceutical benefits.
  • Compliance with step therapy protocols, if applicable, where cheaper alternatives are tried first.
  • Fulfilling any age or condition-specific prerequisites outlined by the plan.

 

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Gateway Health Plan's Approved Criteria for Symbicort Coverage

 

Eligibility Criteria for Symbicort Coverage

 

  • Members must have a documented diagnosis of asthma or Chronic Obstructive Pulmonary Disease (COPD) by a healthcare provider.
  •  

  • Symbicort may be covered for members who are 12 years of age or older.
  •  

  • Members must have experienced a trial and documented failure, contraindication, or intolerance to other preferred formulary alternatives, such as inhaled corticosteroids or long-acting beta agonists.

 

Documented Clinical Information Required

 

  • Patient's medical history including current and past medications used to manage asthma or COPD.
  •  

  • Documentation of previous treatments and responses, particularly if they were unsuccessful.
  •  

  • Current treatment plan from the healthcare provider, indicating the need for Symbicort.

 

Prescription Requirements

 

  • A valid prescription from a licensed healthcare provider detailing the appropriate dosage and frequency of Symbicort for the member's condition.
  •  

  • Prescriptions should align with FDA-approved labeling for Symbicort use related to asthma or COPD management.

 

Duration and Renewal of Coverage

 

  • Initial coverage may be provided for a period of up to 12 months, subject to review.
  •  

  • Renewal of coverage requires updated clinical assessment from the healthcare provider reaffirming the necessity of continuing Symbicort treatment.

 

Additional Considerations

 

  • Coverage aligns with FDA recommendations and standard professional guidelines for asthma or COPD treatment.
  •  

  • Members are encouraged to participate in routine follow-ups with their healthcare providers to assess the efficacy and safety of Symbicort.

 

Why Gateway Health Plan Might Deny Symbicort Coverage

 

Reasons for Denial of Symbicort Coverage by Gateway Health Plan

 

  • Symbicort is prescribed for an off-label use that is not approved by the FDA or supported by gateway's healthcare guidelines.
  •  

  • The patient does not meet the specific age-related criteria for Symbicort coverage as outlined by Gateway Health Plan's policy.
  •  

  • There is insufficient documentation to prove that other, less costly asthma or COPD treatments have been tried and found ineffective.
  •  

  • The patient has exceeded the predetermined limit of Symbicort coverage within a specified period according to the plan's policy.
  •  

  • Symbicort is requested as part of combination therapy without medical justification as required by the health plan.
  •  

  • A lack of prior authorization or failure to adhere to the pre-authorization process can result in denial of coverage for Symbicort.
  •  

  • The prescription for Symbicort does not demonstrate medical necessity based on the patient's health history and condition severity, as required by Gateway Health Plan.
  •  

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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 Gateway Health Plan

 

Contact Gateway Health Plan Customer Service

 

  • Call Gateway Health Plan's customer service to inquire about coverage details for Symbicort.
  •  

  • Request information on the documentation or pre-authorization required for Symbicort coverage.

 

Verify Your Plan's Formulary

 

  • Check the formulary list of your specific Gateway Health Plan to ensure Symbicort is covered under your plan.
  •  

  • Look for any Tier details and understand what it means for your coverage, co-pays, or prior authorizations.

 

Consult With Your Doctor

 

  • Discuss with your healthcare provider about Symbicort and get a prescription if it's deemed necessary for your treatment.
  •  

  • Ask your doctor to provide any necessary documentation or letters of medical necessity that Gateway Health Plan might require.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit any required prior authorization forms to Gateway Health Plan.
  •  

  • Include all supporting documentation and ensure that all forms are filled out completely and accurately.

 

Follow Up on Your Request

 

  • Regularly check the status of your prior authorization request with Gateway Health Plan.
  •  

  • Contact their customer support if there are delays or additional information is requested.

 

Understand Your Appeal Rights

 

  • If your request is denied, ask Gateway Health Plan for the reason and understand the process for appeal.
  •  

  • Gather any additional documents or evidence needed and resubmit as per the appeal guidance provided by the plan.

 

Explore Alternative Assistance Programs

 

  • If coverage is still unavailable, consider asking your healthcare provider about patient assistance programs for Symbicort.
  •  

  • Research additional resources or discounts that might be offered directly by the drug manufacturer.

 

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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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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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