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Does Geisinger Health Plan Cover Dupixent

Explore Geisinger Health Plan's coverage for Dupixent, potential denial reasons, coverage tips, costs without insurance, and FAQs.

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Geisinger Health Plan Coverage for Dupixent

Geisinger Health Plan may cover Dupixent (dupilumab) for conditions such as moderate-to-severe eczema (atopic dermatitis), asthma, and chronic rhinosinusitis with nasal polyps.

Prior authorization is typically required to ensure coverage. Healthcare providers must demonstrate that the patient meets specific clinical criteria for Dupixent use.

The criteria may include a documented history of inadequate response or intolerance to conventional therapies. Patient age and condition severity are also considered.

Providers need to submit relevant medical documentation, including previous treatment outcomes and current disease severity assessments, to support the case for needing Dupixent.

It's advisable for patients to review specific plan benefits and consult Geisinger Health Plan directly for detailed coverage information and approval procedures.

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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 Geisinger Health Plan

Check Your Health Plan Benefits

Log into the Geisinger Health Plan member portal to review your current benefits. Determine if Dupixent is included in your prescription drug coverage.

Download or request a copy of your plan's Summary of Benefits and Coverage (SBC) for detailed information.

Contact Geisinger Health Plan's customer service for any clarifications regarding your current plan and Dupixent coverage.

Consult Your Healthcare Provider

Schedule a consultation with your healthcare provider to discuss your need for Dupixent as a treatment option.

Request a medical necessity letter from your provider that explains why Dupixent is required for your specific medical condition.

Obtain a Prescription

Ensure your healthcare provider writes a prescription for Dupixent, complete with dosage instructions and length of treatment.

Verify that your healthcare provider sends the prescription to a pharmacy that is in-network with Geisinger Health Plan.

Pre-Authorization Process

Check with Geisinger Health Plan if Dupixent requires a pre-authorization. This is often necessary for specialty drugs.

Have your healthcare provider complete and submit any pre-authorization forms required by your health plan.

Follow up with the insurance company to confirm that the pre-authorization was received and is being processed.

Contact a Pharmacy

Choose a specialty pharmacy that works with Geisinger Health Plan for medications like Dupixent.

Have the pharmacy contact Geisinger Health Plan directly to verify your coverage benefits for Dupixent.

Coordinate with your pharmacy to determine if there are any co-pays or additional costs that you will be responsible for upon receiving the medication.

Financial Assistance

Inquire about financial assistance programs for Dupixent if you face high out-of-pocket costs. Some pharmaceutical companies offer patient assistance programs.

Contact DuMore – the manufacturer of Dupixent – to ask about any available rebates or savings programs.

Monitor Your Benefits and Renewal

Keep track of your insurance plan's validity and renewal period to ensure continued coverage.

Monitor any changes to your health plan options during open enrollment periods that could affect your Dupixent coverage.

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FAQs

Does Geisinger Health Plan Cover Dupixent

Explore Geisinger Health Plan's coverage for Dupixent, potential denial reasons, coverage tips, costs without insurance, and FAQs.

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Is Dupixent Covered by Geisinger Health Plan

Geisinger Health Plan Coverage for Dupixent

Geisinger Health Plan may cover Dupixent (dupilumab) for conditions such as moderate-to-severe eczema (atopic dermatitis), asthma, and chronic rhinosinusitis with nasal polyps.

Prior authorization is typically required to ensure coverage. Healthcare providers must demonstrate that the patient meets specific clinical criteria for Dupixent use.

The criteria may include a documented history of inadequate response or intolerance to conventional therapies. Patient age and condition severity are also considered.

Providers need to submit relevant medical documentation, including previous treatment outcomes and current disease severity assessments, to support the case for needing Dupixent.

It's advisable for patients to review specific plan benefits and consult Geisinger Health Plan directly for detailed coverage information and approval procedures.

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Geisinger Health Plan's Approved Criteria for Dupixent Coverage

Criteria for Dupixent Coverage

**Patient Eligibility:** Coverage is available for patients who have been diagnosed with moderate-to-severe atopic dermatitis, eosinophilic asthma, or chronic rhinosinusitis with nasal polyposis.

**Age Requirement:** Dupixent is covered for patients who are 6 years of age or older for atopic dermatitis, 12 years or older for asthma, and 18 years or older for chronic rhinosinusitis with nasal polyposis.

**Previous Treatments:** Candidates must have tried and failed, or have a contraindication or intolerance to, appropriate prescription therapies, such as topical corticosteroids for dermatitis or inhaled corticosteroids for asthma.

**Specialist Recommendation:** The medication must be prescribed by, or in consultation with, a dermatologist, allergist, or pulmonologist depending on the condition being treated.

**Documentation Required:** A documented medical necessity for Dupixent should be provided, demonstrating efficacy and necessity for the specific condition when other treatments have not yielded satisfactory results.

**Continuation Criteria:** Continued coverage is contingent upon regular review of a patient's response to Dupixent, including improvement in symptoms and quality of life metrics as outlined by medical guidelines or the attending medical specialist.

Why Geisinger Health Plan Might Deny Dupixent Coverage

Geisinger Health Plan Dupixent Non-Coverage Criteria

Dupixent is not covered when prescribed for conditions outside FDA-approved indications.

Geisinger Health Plan may deny coverage if Dupixent is used off-label without sufficient documentation or research supporting its efficacy and safety.

Lack of prior authorization: If the necessary prior authorization for Dupixent is not obtained before treatment begins, coverage might be denied.

Failure to meet specific clinical criteria: Coverage may be denied if the patient's medical records do not meet Geisinger Health Plan's clinical criteria for Dupixent use.

Non-compliance with step therapy: If the patient has not tried and failed required alternative therapies before Dupixent, coverage could be denied due to non-compliance with the step therapy protocol.

Incomplete or missing documentation: Geisinger may deny coverage if there is insufficient documentation verifying the necessity for Dupixent, including past treatment history and responses.

Insurance policy exclusions: Dupixent might be excluded from coverage if it falls under specific exclusions in the patient's insurance policy with Geisinger.

Cost-sharing requirements not met: If certain cost-sharing or co-payment requirements stipulated by the plan are not fulfilled, Dupixent coverage could be denied.

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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 Geisinger Health Plan

Check Your Health Plan Benefits

Log into the Geisinger Health Plan member portal to review your current benefits. Determine if Dupixent is included in your prescription drug coverage.

Download or request a copy of your plan's Summary of Benefits and Coverage (SBC) for detailed information.

Contact Geisinger Health Plan's customer service for any clarifications regarding your current plan and Dupixent coverage.

Consult Your Healthcare Provider

Schedule a consultation with your healthcare provider to discuss your need for Dupixent as a treatment option.

Request a medical necessity letter from your provider that explains why Dupixent is required for your specific medical condition.

Obtain a Prescription

Ensure your healthcare provider writes a prescription for Dupixent, complete with dosage instructions and length of treatment.

Verify that your healthcare provider sends the prescription to a pharmacy that is in-network with Geisinger Health Plan.

Pre-Authorization Process

Check with Geisinger Health Plan if Dupixent requires a pre-authorization. This is often necessary for specialty drugs.

Have your healthcare provider complete and submit any pre-authorization forms required by your health plan.

Follow up with the insurance company to confirm that the pre-authorization was received and is being processed.

Contact a Pharmacy

Choose a specialty pharmacy that works with Geisinger Health Plan for medications like Dupixent.

Have the pharmacy contact Geisinger Health Plan directly to verify your coverage benefits for Dupixent.

Coordinate with your pharmacy to determine if there are any co-pays or additional costs that you will be responsible for upon receiving the medication.

Financial Assistance

Inquire about financial assistance programs for Dupixent if you face high out-of-pocket costs. Some pharmaceutical companies offer patient assistance programs.

Contact DuMore – the manufacturer of Dupixent – to ask about any available rebates or savings programs.

Monitor Your Benefits and Renewal

Keep track of your insurance plan's validity and renewal period to ensure continued coverage.

Monitor any changes to your health plan options during open enrollment periods that could affect your Dupixent coverage.

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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 Geisinger Health Plan Cover Dupixent

Explore Geisinger Health Plan's coverage for Dupixent, potential denial reasons, coverage tips, costs without insurance, and FAQs.

Achieve Your Goals Faster with Curex