Does Health Net Cover Dulera

Explore why Health Net may deny Dulera, how to secure coverage, cost without insurance, and answers to common questions in this detailed guide.
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Does Health Net Cover Dulera?

 

  • Health Net may provide coverage for Dulera, a medication commonly prescribed for asthma. Coverage details can vary based on your specific Health Net plan.
  •  

  • Typically, Dulera coverage is subject to meeting medical necessity criteria. Physicians may need to demonstrate that Dulera is required because other treatments were ineffective or unsuitable for the patient.
  •  

  • You may need to get prior authorization before receiving coverage for Dulera. This ensures the medication is approved as a part of a treatment plan under your Health Net policy.
  •  

  • It's advisable to check with Health Net directly or consult the plan’s formulary list to confirm if Dulera is covered under your specific plan. This will provide clarity on co-pays or any additional conditions.
  •  

  • Insurance plans, including Health Net, often update their formulary, so keeping track of any changes is crucial for continuous coverage of medications like Dulera.

 

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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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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 Health Net

 

Contact Health Net Customer Service

 

  • Call Health Net's customer service number located on the back of your insurance card to inquire about Dulera coverage specifics.
  •  
  • Ask about coverage procedures, necessary prior authorizations, or requirements specific to Dulera.
  •  
  • Take notes during the call, including the name of the representative and any reference numbers provided.

 

Review Your Current Health Plan

 

  • Log into your Health Net member account on their website to review the details of your current health plan.
  •  
  • Verify if your plan includes coverage for prescription medications like Dulera.
  •  
  • Check for any copayments, coinsurance, or deductible requirements for prescription drugs.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Dulera.
  •  
  • Ensure your provider is aware of any health plan restrictions or paperwork that might be needed for Health Net to cover Dulera.
  •  
  • Request that they provide any necessary documentation to Health Net, such as prescription justification or medical necessity forms.

 

Submit a Prescription Request

 

  • Ask your healthcare provider to send a prescription for Dulera directly to your pharmacy of choice, confirming it is covered by Health Net.
  •  
  • Alternatively, use Health Net's online system or app, if available, to manage prescription requests and confirm coverage.
  •  
  • Check that the pharmacy has received and processed the request according to Health Net's guidelines.

 

Explore Prior Authorization Needs

 

  • Some medications, including Dulera, may require prior authorization. Have your healthcare provider initiate this process, if necessary.
  •  
  • Ensure all forms and documentation are filled out completely and submitted to Health Net for approval.
  •  
  • Follow up with Health Net to confirm receipt and approval of the authorization request.

 

Appeal If Necessary

 

  • If your initial request for coverage is denied, gather the denial letter and any related documentation.
  •  
  • Contact Health Net to understand the reason for denial and ask about their appeals process.
  •  
  • Work with your healthcare provider to gather additional information or documentation to support your appeal.
  •  
  • Submit an appeal to Health Net according to their instructions, ensuring all required information is included for reconsideration.

 

Utilize Health Net Resources

 

  • Use online tools, such as the Health Net provider portal or mobile app, to manage prescriptions, track coverage, and access additional resources.
  •  
  • Stay informed about any changes in Health Net’s coverage policies or your personal health plan that might affect Dulera coverage.

 

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FAQs

Does Health Net Cover Dulera

Explore why Health Net may deny Dulera, how to secure coverage, cost without insurance, and answers to common questions in this detailed guide.
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Is Dulera Covered by Health Net

 

Does Health Net Cover Dulera?

 

  • Health Net may provide coverage for Dulera, a medication commonly prescribed for asthma. Coverage details can vary based on your specific Health Net plan.
  •  

  • Typically, Dulera coverage is subject to meeting medical necessity criteria. Physicians may need to demonstrate that Dulera is required because other treatments were ineffective or unsuitable for the patient.
  •  

  • You may need to get prior authorization before receiving coverage for Dulera. This ensures the medication is approved as a part of a treatment plan under your Health Net policy.
  •  

  • It's advisable to check with Health Net directly or consult the plan’s formulary list to confirm if Dulera is covered under your specific plan. This will provide clarity on co-pays or any additional conditions.
  •  

  • Insurance plans, including Health Net, often update their formulary, so keeping track of any changes is crucial for continuous coverage of medications like Dulera.

 

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Health Net's Approved Criteria for Dulera Coverage

 

Dulera Coverage Criteria offered by Health Net

 

  • Dulera is covered for patients who have a documented diagnosis of asthma that is uncontrolled by previous medications. Patients must have tried and failed or have intolerance to other inhaled corticosteroid and long-acting beta-agonist combinations.
  •  

  • Candidates must be aged 12 years or older since Dulera is approved for use in this age group. Prescribers need to provide evidence or document the age criterion adherence.
  •  

  • The prescription must be written for a patient by a healthcare provider who specializes in respiratory diseases, such as asthma. This ensures the medication is used appropriately in directed asthmatic treatment plans.
  •  

  • Prior authorization is required to ensure that all above criteria are met. The process must include submission of documented patient information that justifies the necessity for Dulera over alternative therapies.
  •  

  • The diagnosis should be backed by tests such as spirometry or peak flow measurements that show continuous poor asthma control, despite adherence to a suitable medication plan.
  •  

  • Patients must be enrolled in or participate in a comprehensive asthma management program to ensure best practices are implemented, improving overall treatment effectiveness and safety.
  •  

 

Why Health Net Might Deny Dulera Coverage

 

Situations Where Health Net Might Deny Dulera Coverage

 

  • The prescribed use of Dulera is not in accordance with FDA-approved indications or the specifically listed medical guidelines for coverage.
  •  

  • A lack of demonstration of medical necessity for Dulera, meaning the condition could be treated effectively with a preferred or lower-cost alternative.
  •  

  • Filing errors, such as incorrect or incomplete documentation accompanying the claims for Dulera coverage.
  •  

  • The prescription does not comply with Health Net's formulary requirements or the provider's authorization process was not properly followed.
  •  

  • Ineligibility due to non-compliance with Health Net's step therapy requirements, where the patient has not first tried covered, less costly alternatives.
  •  

  • The coverage request for Dulera falls outside of the patient's policy terms or exceeds plan limits, such as quantity or dosage restrictions.
  •  

  • Exclusion based on plan-specific guidelines, where Dulera is not covered for certain conditions or demographic groups as outlined by the policy terms.

 

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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 Health Net

 

Contact Health Net Customer Service

 

  • Call Health Net's customer service number located on the back of your insurance card to inquire about Dulera coverage specifics.
  •  
  • Ask about coverage procedures, necessary prior authorizations, or requirements specific to Dulera.
  •  
  • Take notes during the call, including the name of the representative and any reference numbers provided.

 

Review Your Current Health Plan

 

  • Log into your Health Net member account on their website to review the details of your current health plan.
  •  
  • Verify if your plan includes coverage for prescription medications like Dulera.
  •  
  • Check for any copayments, coinsurance, or deductible requirements for prescription drugs.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Dulera.
  •  
  • Ensure your provider is aware of any health plan restrictions or paperwork that might be needed for Health Net to cover Dulera.
  •  
  • Request that they provide any necessary documentation to Health Net, such as prescription justification or medical necessity forms.

 

Submit a Prescription Request

 

  • Ask your healthcare provider to send a prescription for Dulera directly to your pharmacy of choice, confirming it is covered by Health Net.
  •  
  • Alternatively, use Health Net's online system or app, if available, to manage prescription requests and confirm coverage.
  •  
  • Check that the pharmacy has received and processed the request according to Health Net's guidelines.

 

Explore Prior Authorization Needs

 

  • Some medications, including Dulera, may require prior authorization. Have your healthcare provider initiate this process, if necessary.
  •  
  • Ensure all forms and documentation are filled out completely and submitted to Health Net for approval.
  •  
  • Follow up with Health Net to confirm receipt and approval of the authorization request.

 

Appeal If Necessary

 

  • If your initial request for coverage is denied, gather the denial letter and any related documentation.
  •  
  • Contact Health Net to understand the reason for denial and ask about their appeals process.
  •  
  • Work with your healthcare provider to gather additional information or documentation to support your appeal.
  •  
  • Submit an appeal to Health Net according to their instructions, ensuring all required information is included for reconsideration.

 

Utilize Health Net Resources

 

  • Use online tools, such as the Health Net provider portal or mobile app, to manage prescriptions, track coverage, and access additional resources.
  •  
  • Stay informed about any changes in Health Net’s coverage policies or your personal health plan that might affect Dulera coverage.

 

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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.

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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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