Does Harvard Pilgrim Health Care Cover Dulera

Explore Dulera coverage with Harvard Pilgrim. Learn about denials, methods to get coverage, costs without insurance, and get answers in our FAQ section.
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Coverage Criteria

 

  • Harvard Pilgrim Health Care may cover Dulera if it is deemed medically necessary for managing asthma.
  • Coverage often requires a prescription from a healthcare provider, indicating that Dulera is essential for the patient's treatment plan.

 

Authorization Requirements

 

  • Prior authorization might be required, ensuring Dulera is the most appropriate medication.
  • Providers may need to submit clinical information to justify the necessity of Dulera.

 

Formulary Guidelines

 

  • Dulera might be on a specific formulary tier that affects copayment or coinsurance levels.
  • Patients may need to try and fail cheaper alternatives before Dulera is approved.

 

Additional Considerations

 

  • Plans vary, so reviewing an individual’s specific benefits document or contacting customer service for details is advisable.
  • Each case is reviewed individually, and coverage is subject to the terms of the member's 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 Dulera Coverage with Harvard Pilgrim Health Care

 

Understanding Your Prescription Coverage with Harvard Pilgrim Health Care

 

  • Review your current Harvard Pilgrim Health Care plan documents. You can find these in the member portal or in any paperwork you received when your plan began.
  •  

  • Identify if Dulera is covered under your plan. Typically, prescription drugs are listed in the formulary, which is a list of medications covered by your insurance.
  •  

  • If you cannot find this information, consider reaching out to Harvard Pilgrim Health Care’s customer service for assistance.

 

 

Confirming Dulera Coverage

 

  • Contact Harvard Pilgrim’s customer service to confirm Dulera’s coverage. Have your plan information ready for a quick verification process.
  •  

  • Ask specific questions about what co-pays or coinsurance might apply for a Dulera prescription.
  •  

  • Inquire about any necessary prior authorizations or step therapy requirements. This information is crucial for ensuring your prescription is filled without delays.

 

 

Navigating Prior Authorization

 

  • If prior authorization is required, request the appropriate forms from your healthcare provider or directly from Harvard Pilgrim Health Care.
  •  

  • Coordinate with your healthcare provider to complete the required forms. Your provider may need to justify the necessity of Dulera in treating your condition.
  •  

  • Submit the completed forms to Harvard Pilgrim Health Care and follow up regularly to ensure a timely response.

 

 

Understanding Pharmacy Network & Co-Payments

 

  • Verify which pharmacies are in-network with Harvard Pilgrim Health Care. Using an in-network pharmacy can significantly reduce your out-of-pocket costs.
  •  

  • Discuss your co-payment responsibilities with the pharmacy. They can provide information based on your specific plan details.
    •  

       

      Utilize Resources and Assistance

       

      • Explore online resources provided by Harvard Pilgrim Health Care for further guidance on prescription benefits and how to maximize your coverage.
      •  

      • If encountering issues, consider consulting with a healthcare advocate who might offer additional ways to appeal for coverage if facing a denial.

       

       

      Keep Track of Renewals and Coverage Changes

       

      • Monitor any updates from Harvard Pilgrim Health Care regarding your prescription coverage. Insurance plans frequently update their formularies.
      •  

      • Ensure continuation of coverage by staying informed about any changes that may affect Dulera’s status on the formulary, especially during open enrollment periods.

       

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FAQs

Does Harvard Pilgrim Health Care Cover Dulera

Explore Dulera coverage with Harvard Pilgrim. Learn about denials, methods to get coverage, costs without insurance, and get answers in our FAQ section.
Curex allergy drops unboxing

Is Dulera Covered by Harvard Pilgrim Health Care

 

Coverage Criteria

 

  • Harvard Pilgrim Health Care may cover Dulera if it is deemed medically necessary for managing asthma.
  • Coverage often requires a prescription from a healthcare provider, indicating that Dulera is essential for the patient's treatment plan.

 

Authorization Requirements

 

  • Prior authorization might be required, ensuring Dulera is the most appropriate medication.
  • Providers may need to submit clinical information to justify the necessity of Dulera.

 

Formulary Guidelines

 

  • Dulera might be on a specific formulary tier that affects copayment or coinsurance levels.
  • Patients may need to try and fail cheaper alternatives before Dulera is approved.

 

Additional Considerations

 

  • Plans vary, so reviewing an individual’s specific benefits document or contacting customer service for details is advisable.
  • Each case is reviewed individually, and coverage is subject to the terms of the member's plan.

 

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Harvard Pilgrim Health Care's Approved Criteria for Dulera Coverage

 

Approved Criteria for Dulera Coverage by Harvard Pilgrim Health Care

 

  • **Diagnosis Requirement**: The patient must have a confirmed diagnosis of asthma or a related chronic respiratory condition that is appropriate for Dulera treatment.
  •  

  • **Age Restriction**: Dulera is approved for use in patients aged 12 years or older for the treatment of asthma.
  •  

  • **Failed Prior Therapy**: The patient should have tried and failed, or have a contraindication or intolerance to, at least one other corticosteroid and long-acting beta-agonist (LABA) combination inhaler medication.
  •  

  • **Clinical Rationale**: There must be a clear clinical justification documented by the healthcare provider explaining why Dulera is necessary compared to alternative treatments.
  •  

  • **Dosage and Administration**: The prescribed Dulera treatment plan should follow FDA-approved dosing guidelines and appropriate administration as indicated for the patient's age and condition.
  •  

  • **Specialist Involvement**: The patient's asthma or related condition requiring Dulera should ideally be managed under the guidance of an asthma specialist or pulmonologist.
  •  

  • **Continuous Monitoring**: There must be evidence of ongoing monitoring and evaluation of the patient's response to Dulera, with adjustments or discontinuation as clinically necessary.
  •  

  • **Compliant Usage**: The patient must demonstrate compliance with prescribed treatment regimens and asthma action plans as part of their therapy management.

 

Why Harvard Pilgrim Health Care Might Deny Dulera Coverage

 

Dulera Exclusion Criteria

 

  • Dulera will not be covered if it is prescribed for conditions outside the FDA-approved indications, which primarily include management of asthma in patients 12 years and older.
  •  

  • Coverage will be denied if Dulera is requested in quantities that exceed typical dosing recommendations or those outlined in the policy guidelines.
  •  

  • Prescription of Dulera will not be covered if not prescribed by a healthcare provider specifically trained or specializing in the treatment of asthma or related pulmonary conditions.
  •  

  • Use of Dulera in combination with other medications or treatments deemed experimental or investigational according to Harvard Pilgrim’s health policy will result in denial of coverage.
  •  

  • Harvard Pilgrim may deny coverage for Dulera based on formulary exclusion, meaning the medication is not included in their list of covered drugs or preferred alternatives are available.
  •  

  • Prescription refills for Dulera that do not follow projected treatment timelines (early refill requests) may not be covered without additional justification.
  •  

  • Dulera coverage will be declined if the member has not met any required step therapy programs, such as failure to try and document other less expensive first-line treatment options.
  •  

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How Much Does Dulera Cost without Insurance?

 

Approximate Cost of Dulera Without Insurance

 

  • The cost of Dulera, which is used to help control symptoms of asthma, can vary depending on the pharmacy and location. However, the typical price for a one-month supply (inhaler) of Dulera without insurance is approximately $250 to $350.
  •  

  • This price may differ based on dosage strength, and whether you're purchasing a brand name or a generic version if available.
  •  

  • Prices can fluctuate, and it is advisable to check with different pharmacies or consider using discount cards or coupons that might be available to reduce the cost.
  •  

  • Additionally, some pharmaceutical companies offer patient assistance programs for those who qualify, which can significantly lower the cost of Dulera.

 

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 Dulera Coverage with Harvard Pilgrim Health Care

 

Understanding Your Prescription Coverage with Harvard Pilgrim Health Care

 

  • Review your current Harvard Pilgrim Health Care plan documents. You can find these in the member portal or in any paperwork you received when your plan began.
  •  

  • Identify if Dulera is covered under your plan. Typically, prescription drugs are listed in the formulary, which is a list of medications covered by your insurance.
  •  

  • If you cannot find this information, consider reaching out to Harvard Pilgrim Health Care’s customer service for assistance.

 

 

Confirming Dulera Coverage

 

  • Contact Harvard Pilgrim’s customer service to confirm Dulera’s coverage. Have your plan information ready for a quick verification process.
  •  

  • Ask specific questions about what co-pays or coinsurance might apply for a Dulera prescription.
  •  

  • Inquire about any necessary prior authorizations or step therapy requirements. This information is crucial for ensuring your prescription is filled without delays.

 

 

Navigating Prior Authorization

 

  • If prior authorization is required, request the appropriate forms from your healthcare provider or directly from Harvard Pilgrim Health Care.
  •  

  • Coordinate with your healthcare provider to complete the required forms. Your provider may need to justify the necessity of Dulera in treating your condition.
  •  

  • Submit the completed forms to Harvard Pilgrim Health Care and follow up regularly to ensure a timely response.

 

 

Understanding Pharmacy Network & Co-Payments

 

  • Verify which pharmacies are in-network with Harvard Pilgrim Health Care. Using an in-network pharmacy can significantly reduce your out-of-pocket costs.
  •  

  • Discuss your co-payment responsibilities with the pharmacy. They can provide information based on your specific plan details.
    •  

       

      Utilize Resources and Assistance

       

      • Explore online resources provided by Harvard Pilgrim Health Care for further guidance on prescription benefits and how to maximize your coverage.
      •  

      • If encountering issues, consider consulting with a healthcare advocate who might offer additional ways to appeal for coverage if facing a denial.

       

       

      Keep Track of Renewals and Coverage Changes

       

      • Monitor any updates from Harvard Pilgrim Health Care regarding your prescription coverage. Insurance plans frequently update their formularies.
      •  

      • Ensure continuation of coverage by staying informed about any changes that may affect Dulera’s status on the formulary, especially during open enrollment periods.

       

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Dulera FAQ

What are the side effects of Dulera?

 

Common Side Effects of Dulera

 

  • Headache
  • Sore throat
  • Sinus pain
  • Nosebleed
  • Oral thrush (fungal infection)

 

Serious Side Effects

 

  • Wheezing or breathing problems
  • Severe allergic reactions (rash, itching/swelling)
  • Vision problems
  • Reduced bone density with long-term use

 

Monitoring and Precautions

 

  • Regularly check bone health and eye exams
  • Rinse mouth after inhalation to prevent oral infections
  • Consult your doctor if side effects worsen or persist

 

How does Dulera work for asthma?

 

Mechanism of Action

 

  • Dulera is a combination inhaler containing mometasone (a corticosteroid) and formoterol (a long-acting beta-agonist).
  •  

  • Mometasone reduces inflammation in the airways, minimizing swelling and irritation.
  •  

  • Formoterol relaxes bronchial muscles, improving airflow and easing breathing.

 

Benefits for Asthma

 

  • Helps prevent asthma attacks by maintaining open airways over long periods.
  •  

  • Decreases the usage frequency of rescue inhalers due to improved control of symptoms.

 

Usage Guidance

 

  • Use regularly as prescribed, even without current symptoms, for effective management.
  •  

  • Rinse mouth after inhalation to reduce risks of oral thrush from corticosteroid use.

 

Consultation Necessity

 

  • Discuss with healthcare provider if side effects occur or asthma symptoms do not improve.

 

Is Dulera a steroid inhaler?

 

Is Dulera a Steroid Inhaler?

 

  • Dulera is a combination inhaler used for asthma management, containing both formoterol, a long-acting beta-agonist (LABA), and mometasone furoate, which is a corticosteroid.
  •  

  • Corticosteroids in Dulera are used to reduce inflammation in the airways, helping to prevent and control asthma symptoms.
  •  

  • Formoterol helps in relaxing muscles around the airways, making breathing easier by widening the air passages.
  •  

  • It's essential to use Dulera regularly for it to be effective; it is not intended for relief of acute asthma attacks.
  •  

  • Patients should be aware of potential side effects like throat irritation or thrush due to the steroid component, and rinsing the mouth after use may help minimize these risks.

 

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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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