Does Highmark Cover Dulera

Explore Highmark's coverage for Dulera, reasons for denial, tips to secure coverage, Dulera's cost without insurance, and answers to common questions in our detailed guide.
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Overview of Dulera Coverage by Highmark

 

  • Highmark may cover Dulera under its prescription drug plans, contingent on specific criteria and plan benefits. Coverage policies can vary, so it's crucial to verify details with your specific plan.
  •  

  • Dulera is typically covered for the management of asthma in individuals whose symptoms aren't adequately controlled by their current asthma medication or who require a combination therapy.

 

Basic Rules and Criteria for Coverage

 

  • Prescription Requirement: The medication must be prescribed by a licensed healthcare provider.
  •  

  • Prior Authorization: Some plans might require prior authorization to confirm medical necessity before covering Dulera.
  •  

  • Tiered Formularies: Dulera may fall under a specific tier in Highmark's drug formulary, impacting copayment levels and approval processes. Understanding your plan’s tier system is essential.

 

Steps to Confirm Coverage

 

  • Contact Highmark: Call the number on the back of your insurance card to speak with a customer service representative for detailed coverage information.
  •  

  • Check Online: Use Highmark’s member portal to review your plan’s prescription drug coverage specifics.

 

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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.

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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 Dulera Coverage with Highmark

 

Contact Customer Service

 

  • Before starting the process, contact Highmark Customer Service to inquire about specific coverages related to Dulera under your policy.
  •  
  • Ask if there are any requirements you need to be aware of before filing for coverage.

 

Review Your Insurance Plan

 

  • Check your current Highmark insurance policy to understand the formularies and coverage details for prescription drugs.
  •  
  • Verify if Dulera is included in your plan's formulary. Check the tier level and understand any potential out-of-pocket costs.

 

Consult Your Healthcare Provider

 

  • Speak with your doctor about the necessity of Dulera for your condition.
  •  
  • Request a formal prescription and a detailed letter of medical necessity if required to strengthen your case for coverage.

 

Submit Prior Authorization

 

  • If Dulera requires prior authorization under your Highmark plan, ensure that your healthcare provider completes the necessary documentation.
  •  
  • Submit the prior authorization form along with your prescription directly to Highmark or through an online portal if available.

 

Follow Up on Your Application

 

  • Regularly check the status of your prior authorization application with Highmark customer service.
  •  
  • If additional documentation is needed, ensure it is provided promptly to avoid delays.

 

Appeal if Necessary

 

  • If your coverage for Dulera is denied, review the denial letter carefully to understand the reason.
  •  
  • Work with your healthcare provider to address any issues and submit an appeal with supporting documentation.

 

Utilize Highmark Digital Tools

 

  • Log in to your Highmark account online to use any digital tools and resources for managing your prescriptions.
  •  
  • Find and use the Highmark mobile app if available for easy tracking and updates on your prescriptions including Dulera.

 

Explore Savings Programs

 

  • Investigate any available Highmark savings programs or manufacturer coupons for Dulera that can reduce costs.
  •  
  • Check if you are eligible for any financial assistance through Highmark to help with covering the cost of Dulera.

 

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FAQs

Does Highmark Cover Dulera

Explore Highmark's coverage for Dulera, reasons for denial, tips to secure coverage, Dulera's cost without insurance, and answers to common questions in our detailed guide.
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Is Dulera Covered by Highmark

 

Overview of Dulera Coverage by Highmark

 

  • Highmark may cover Dulera under its prescription drug plans, contingent on specific criteria and plan benefits. Coverage policies can vary, so it's crucial to verify details with your specific plan.
  •  

  • Dulera is typically covered for the management of asthma in individuals whose symptoms aren't adequately controlled by their current asthma medication or who require a combination therapy.

 

Basic Rules and Criteria for Coverage

 

  • Prescription Requirement: The medication must be prescribed by a licensed healthcare provider.
  •  

  • Prior Authorization: Some plans might require prior authorization to confirm medical necessity before covering Dulera.
  •  

  • Tiered Formularies: Dulera may fall under a specific tier in Highmark's drug formulary, impacting copayment levels and approval processes. Understanding your plan’s tier system is essential.

 

Steps to Confirm Coverage

 

  • Contact Highmark: Call the number on the back of your insurance card to speak with a customer service representative for detailed coverage information.
  •  

  • Check Online: Use Highmark’s member portal to review your plan’s prescription drug coverage specifics.

 

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Highmark's Approved Criteria for Dulera Coverage

 

Approved Criteria for Dulera Coverage

 

  • **Diagnosis Requirement**: Dulera is covered for individuals diagnosed with asthma that necessitates inhaled corticosteroids and long-acting beta-agonists as part of their treatment plan.
  •  

  • **Age Requirement**: Coverage applies to patients who are 5 years of age or older, following the dosage specifications approved by regulatory authorities.
  •  

  • **Physician Prescription**: A prescription from a licensed physician who specializes in managing respiratory conditions is mandatory to ensure that the use of Dulera aligns with medical necessity and best practice standards.
  •  

  • **Lack of Response to Alternatives**: Patients must have shown inadequate response to alternative treatment options such as inhaled corticosteroids alone or other combination inhalers. Documentation of these trials may be required.
  •  

  • **Asthma Severity**: The coverage is intended for patients with moderate to severe persistent asthma. Medical records should reflect this level of severity, confirmed by clinical assessments.
  •  

  • **Step Therapy**: Patients may need to adhere to a step therapy protocol, indicating they have attempted other medications in the formulary tier before progressing to Dulera when those options did not yield sufficient management of symptoms.
  •  

  • **Continued Therapy**: Ongoing coverage is contingent upon regular follow-up visits with the prescribing physician to evaluate the effectiveness of Dulera in managing asthma and to adjust treatment plans as necessary.
  •  

  • **Adherence to Treatment**: Patients must demonstrate adherence to the prescribed treatment regimen, supported by pharmacy fill records or physician documentation, to qualify for continued coverage approval.

 

Why Highmark Might Deny Dulera Coverage

 

Exclusions for Dulera Coverage by Highmark

 

  • Dulera is not covered if there is no prior authorization from a healthcare provider, as its use requires medical necessity verification.
  •  

  • Coverage is denied if the patient does not meet the age requirements for which Dulera is approved, typically aimed at specific age groups for safe administration.
  •  

  • Highmark might deny coverage if the patient is using Dulera for an off-label use that is not approved within their formulary guidelines.
  •  

  • If a patient has not tried and shown a failure or intolerance to standard therapies that are considered first-line for their asthma, Dulera may not be covered.
  •  

  • Usage of Dulera in instances that do not align with FDA-approved indications, such as non-prescription use or misuse, can lead to denial of coverage.
  •  

  • Highmark may exclude coverage if the requested frequency or dosage of Dulera exceeds recommended guidelines without sufficient justification.
  •  

  • If there is documented non-compliance or abuse of Dulera by the patient in their medical record, coverage might be denied.

 

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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 Highmark

 

Contact Customer Service

 

  • Before starting the process, contact Highmark Customer Service to inquire about specific coverages related to Dulera under your policy.
  •  
  • Ask if there are any requirements you need to be aware of before filing for coverage.

 

Review Your Insurance Plan

 

  • Check your current Highmark insurance policy to understand the formularies and coverage details for prescription drugs.
  •  
  • Verify if Dulera is included in your plan's formulary. Check the tier level and understand any potential out-of-pocket costs.

 

Consult Your Healthcare Provider

 

  • Speak with your doctor about the necessity of Dulera for your condition.
  •  
  • Request a formal prescription and a detailed letter of medical necessity if required to strengthen your case for coverage.

 

Submit Prior Authorization

 

  • If Dulera requires prior authorization under your Highmark plan, ensure that your healthcare provider completes the necessary documentation.
  •  
  • Submit the prior authorization form along with your prescription directly to Highmark or through an online portal if available.

 

Follow Up on Your Application

 

  • Regularly check the status of your prior authorization application with Highmark customer service.
  •  
  • If additional documentation is needed, ensure it is provided promptly to avoid delays.

 

Appeal if Necessary

 

  • If your coverage for Dulera is denied, review the denial letter carefully to understand the reason.
  •  
  • Work with your healthcare provider to address any issues and submit an appeal with supporting documentation.

 

Utilize Highmark Digital Tools

 

  • Log in to your Highmark account online to use any digital tools and resources for managing your prescriptions.
  •  
  • Find and use the Highmark mobile app if available for easy tracking and updates on your prescriptions including Dulera.

 

Explore Savings Programs

 

  • Investigate any available Highmark savings programs or manufacturer coupons for Dulera that can reduce costs.
  •  
  • Check if you are eligible for any financial assistance through Highmark to help with covering the cost of Dulera.

 

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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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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 (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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