Does Geisinger Health Plan Cover Symbicort

Explore if Geisinger Health Plan covers Symbicort, reasons for denial, how to secure coverage, Symbicort's cost without insurance, and more FAQs!
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Geisinger Health Plan Coverage for Symbicort

 

  • Geisinger Health Plan may cover Symbicort for members with asthma or COPD, given it's prescribed by a healthcare provider.
  •  

  • Coverage often requires prior authorization, confirming the necessity based on the patient's condition and medical history.
  •  

  • To be eligible, the patient must typically meet specific criteria such as prior treatment failure with other medications or severity of symptoms.
  •  

  • Some plans may have formulary restrictions or prefer generic alternatives, influencing coverage.
  •  

  • Co-pays or co-insurance may apply, depending on the member's specific plan details and pharmacy benefits.
  •  

  • It's advisable for members to check with Geisinger directly for their particular plan inclusions and necessary documentation for coverage.

 

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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 Geisinger Health Plan

 

Verify Your Prescription

 

  • Ensure that your healthcare provider has prescribed Symbicort and that it is necessary for your treatment plan.
  •  

  • Verify that Symbicort is covered under your Geisinger Health Plan by checking the formulary list or contacting customer service for confirmation.

 

Review the Geisinger Formulary

 

  • Visit the official Geisinger Health Plan website and navigate to the pharmacy or drug coverage section.
  •  

  • Search for "Symbicort" within the drug formulary tool to determine the specific coverage details, including any tier or copayment information.

 

Consult Your Healthcare Provider

 

  • If Symbicort has specific coverage requirements, like prior authorization, discuss with your healthcare provider.
  •  

  • Your provider may need to submit documentation or justification to Geisinger Health Plan to confirm the medical necessity of Symbicort.

 

Contact Member Services

 

  • Call Geisinger Health Plan's member services for personalized assistance and to ask any specific questions about your plan’s prescription drug benefits.
  •  

  • Request information on any additional steps you might need to complete to ensure Symbicort is covered under your plan.

 

Utilize an In-Network Pharmacy

 

  • Fill your Symbicort prescription at a pharmacy that is in-network with Geisinger Health Plan to avoid additional costs.
  •  

  • Pharmacists at in-network pharmacies can assist in clarifying your coverage and copayments related to the medication.

 

Address Coverage Issues

 

  • If you encounter any issues with Symbicort not being covered, contact Geisinger Health Plan directly to resolve them.
  •  

  • Consider appealing the coverage decision through the plan’s formal appeals process, if initially denied, ensuring all necessary paperwork and justifications are submitted.

 

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FAQs

Does Geisinger Health Plan Cover Symbicort

Explore if Geisinger Health Plan covers Symbicort, reasons for denial, how to secure coverage, Symbicort's cost without insurance, and more FAQs!
Curex allergy drops unboxing

Is Symbicort Covered by Geisinger Health Plan

 

Geisinger Health Plan Coverage for Symbicort

 

  • Geisinger Health Plan may cover Symbicort for members with asthma or COPD, given it's prescribed by a healthcare provider.
  •  

  • Coverage often requires prior authorization, confirming the necessity based on the patient's condition and medical history.
  •  

  • To be eligible, the patient must typically meet specific criteria such as prior treatment failure with other medications or severity of symptoms.
  •  

  • Some plans may have formulary restrictions or prefer generic alternatives, influencing coverage.
  •  

  • Co-pays or co-insurance may apply, depending on the member's specific plan details and pharmacy benefits.
  •  

  • It's advisable for members to check with Geisinger directly for their particular plan inclusions and necessary documentation for coverage.

 

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Geisinger Health Plan's Approved Criteria for Symbicort Coverage

 

Eligibility Criteria for Symbicort Coverage

 

  • The patient must have a confirmed diagnosis of asthma or chronic obstructive pulmonary disease (COPD) as documented in the medical record.

 

Prescription Requirements

 

  • Symbicort must be prescribed by a licensed healthcare provider—typically a pulmonologist or a specialist in respiratory disorders.

 

Step Therapy Protocols

 

  • The patient should have tried and failed treatment with at least one other inhaled corticosteroid or combination product unless contraindicated or not tolerated.

 

Documentation and Evaluation

 

  • A detailed medical history and chart notes must be provided to support the diagnosis and the need for Symbicort therapy.

 

Age Restrictions

 

  • Coverage may be limited to patients who meet certain age criteria as per clinical guidelines for the use of Symbicort in managing asthma or COPD.

 

Prior Authorization

 

  • Prior authorization is required to ensure the criteria are met; the healthcare provider must provide necessary medical justification as part of this process.

 

Renewal Requirements

 

  • For continued coverage, patients may need to demonstrate ongoing benefit from using Symbicort and compliance with the established treatment plan.

 

Why Geisinger Health Plan Might Deny Symbicort Coverage

 

Situations Where Geisinger Health Plan Does Not Cover Symbicort

 

  • If the medication does not meet the plan's medical necessity criteria, which typically includes clinical appropriateness, cost-effectiveness, and safety.
  •  

  • When there is a less expensive generic alternative available that has been determined to be therapeutically equivalent and appropriate for the member's condition.
  •  

  • If the patient has not tried or failed alternative treatments that are covered under the plan, adhering to step therapy protocols.
  •  

  • In cases where the prescription is not obtained from a network pharmacy or without prior authorization if required by the plan.
  •  

  • When the medication is prescribed for an off-label use that is not recognized in authoritative sources or approved by the plan.
  •  

  • If the patient's prescription exceeds the plan's dosage or duration limits without necessary documentation or justification provided by the prescribing healthcare provider.
  •  

  • When the medication is not included in the formulary and does not qualify for an exception process approved by the plan.
  •  

  • For members whose policy explicitly excludes coverage for brand-name medications when a generic equivalent is available and suitable.

 

Together with our partners we have changed the lives of over 300,000 patients.

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 Geisinger Health Plan

 

Verify Your Prescription

 

  • Ensure that your healthcare provider has prescribed Symbicort and that it is necessary for your treatment plan.
  •  

  • Verify that Symbicort is covered under your Geisinger Health Plan by checking the formulary list or contacting customer service for confirmation.

 

Review the Geisinger Formulary

 

  • Visit the official Geisinger Health Plan website and navigate to the pharmacy or drug coverage section.
  •  

  • Search for "Symbicort" within the drug formulary tool to determine the specific coverage details, including any tier or copayment information.

 

Consult Your Healthcare Provider

 

  • If Symbicort has specific coverage requirements, like prior authorization, discuss with your healthcare provider.
  •  

  • Your provider may need to submit documentation or justification to Geisinger Health Plan to confirm the medical necessity of Symbicort.

 

Contact Member Services

 

  • Call Geisinger Health Plan's member services for personalized assistance and to ask any specific questions about your plan’s prescription drug benefits.
  •  

  • Request information on any additional steps you might need to complete to ensure Symbicort is covered under your plan.

 

Utilize an In-Network Pharmacy

 

  • Fill your Symbicort prescription at a pharmacy that is in-network with Geisinger Health Plan to avoid additional costs.
  •  

  • Pharmacists at in-network pharmacies can assist in clarifying your coverage and copayments related to the medication.

 

Address Coverage Issues

 

  • If you encounter any issues with Symbicort not being covered, contact Geisinger Health Plan directly to resolve them.
  •  

  • Consider appealing the coverage decision through the plan’s formal appeals process, if initially denied, ensuring all necessary paperwork and justifications are submitted.

 

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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.

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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