Does Highmark Cover Symbicort

Explore Highmark's Symbicort coverage, potential denial reasons, how to secure coverage, costs without insurance, and FAQs for informed decisions.
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Highmark Coverage for Symbicort

 

  • **Eligibility:** Highmark may cover Symbicort if it's deemed medically necessary. Patients often need a documented diagnosis of asthma or COPD.
  •  

  • **Formulary Status:** Symbicort is generally listed on Highmark's formulary, but it might be subject to specific tiers, influencing co-pays or coinsurance rates.
  •  

  • **Prior Authorization:** Often required. Physicians must demonstrate that Symbicort is necessary over other treatments, providing reasons for its preference.
  •  

  • **Provider Network:** Coverage depends on using in-network pharmacies, ensuring lower costs and adherence to plan rules.
  •  

  • **Quantity Limits:** Highmark may impose limits on the amount of Symbicort dispensed per refill, abiding by treatment guidelines.
  •  

  • **Step Therapy:** Patients might have to try alternative therapies before qualifying for Symbicort, reflecting cost-effective treatment protocols.

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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 Highmark

 

Check Your Plan Details

 

  • Log into the Highmark member portal or review your benefits booklet to determine if your plan covers Symbicort specifically.
  •  

  • Look for information about coverage tiers and whether Symbicort is listed under preferred medications.

 

Consult with Your Healthcare Provider

 

  • Discuss your necessity for Symbicort with your doctor and ensure it's the most appropriate medication for your condition.
  •  

  • Request your healthcare provider to write a prescription for Symbicort, prescribing the appropriate dosage based on your medical needs.

 

Verify Prescription Drug Coverage

 

  • Contact Highmark customer service for confirmation on whether Symbicort is covered under your prescription plan.
  •  

  • Ask about your plan's formulary list to verify if there may be a generic equivalent that is covered, which might be more cost-effective.

 

Explore Prior Authorization

 

  • If Symbicort is not readily covered, determine if it requires prior authorization by discussing with Highmark representatives or checking their online resources.
  •  

  • Work with your healthcare provider to submit any necessary prior authorization paperwork to justify the prescription's medical necessity.

 

Determine Out-of-Pocket Costs

 

  • Obtain detailed information regarding co-pays, deductibles, or coinsurance for Symbicort from Highmark, either via their online portal or customer service.
  •  

  • Investigate if there's any available financial assistance or pharmacy discount programs that could help minimize costs.

 

Fill Your Prescription

 

  • Choose a preferred network pharmacy recognized by Highmark to ensure you maximize benefits and potentially reduce costs.
  •  

  • Present your insurance card and prescription to the pharmacist and confirm how much you need to pay from your pocket based on your plan's specifics.

 

Follow Up and Appeal If Needed

 

  • If there are any coverage issues or denials, work with Highmark and your healthcare provider to provide additional information or documentation as needed.
  •  

  • Consider appealing a denial through Highmark's appeals process, ensuring you have all relevant medical records and doctor’s notes to support your case.

 

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FAQs

Does Highmark Cover Symbicort

Explore Highmark's Symbicort coverage, potential denial reasons, how to secure coverage, costs without insurance, and FAQs for informed decisions.
Curex allergy drops unboxing

Is Symbicort Covered by Highmark

 

Highmark Coverage for Symbicort

 

  • **Eligibility:** Highmark may cover Symbicort if it's deemed medically necessary. Patients often need a documented diagnosis of asthma or COPD.
  •  

  • **Formulary Status:** Symbicort is generally listed on Highmark's formulary, but it might be subject to specific tiers, influencing co-pays or coinsurance rates.
  •  

  • **Prior Authorization:** Often required. Physicians must demonstrate that Symbicort is necessary over other treatments, providing reasons for its preference.
  •  

  • **Provider Network:** Coverage depends on using in-network pharmacies, ensuring lower costs and adherence to plan rules.
  •  

  • **Quantity Limits:** Highmark may impose limits on the amount of Symbicort dispensed per refill, abiding by treatment guidelines.
  •  

  • **Step Therapy:** Patients might have to try alternative therapies before qualifying for Symbicort, reflecting cost-effective treatment protocols.

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Highmark's Approved Criteria for Symbicort Coverage

 

Criteria for Symbicort Coverage by Highmark

 

  • Symbicort is approved for individuals diagnosed with asthma, where symptoms are not adequately controlled by inhaled corticosteroids alone, and require additional therapy with long-acting beta-agonists.
  •  

  • Coverage is available for patients diagnosed with chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema, where it is indicated as a maintenance treatment to control symptoms.
  •  

  • For the approval of Symbicort, the patient must have a history of two or more exacerbations of asthma or COPD that required corticosteroid treatment or hospitalization in the past year.
  •  

  • Symbicort may be authorized for individuals who are intolerant or have contraindications to other long-term maintenance therapies.
  •  

  • Patients should have had an inadequate response or intolerance to other combination inhalation therapies or should require a specific treatment tailored to their condition for optimal management.
  •  

  • Highmark covers Symbicort as part of a step therapy protocol, meaning the patient should have tried and not adequately responded to other preferred formulary alternatives before Symbicort is authorized.
  •  

 

Why Highmark Might Deny Symbicort Coverage

 

Situations Where Highmark Might Deny Symbicort Coverage

 

  • Symbicort is prescribed for a condition not approved by the FDA or not recognized as a medically necessary condition as per Highmark's guidelines.
  •  

  • The member has not tried or failed to respond to less expensive alternative medications, such as a generic inhaled corticosteroid or bronchodilator, before seeking Symbicort coverage.
  •  

  • Insufficient documentation is provided to justify the need for Symbicort, or the documentation does not meet Highmark's prior authorization requirements.
  •  

  • The prescribed dosage or treatment duration does not align with Highmark's standard plan limits or exceeds the quantity deemed necessary and appropriate.
  •  

  • Symbicort is used for off-label purposes that Highmark does not recognize or cover under its current drug formulary guidelines.
  •  

  • There is a failure to follow Highmark's step therapy protocol, which might require the member to try and fail other medications in a specific sequence before progressing to Symbicort.
  •  

  • The patient is not in a coverage tier or lacks the specific plan that includes Symbicort in its formulary, particularly if Symbicort is categorized as a non-preferred or specialty tier drug.
  •  

 

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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 Highmark

 

Check Your Plan Details

 

  • Log into the Highmark member portal or review your benefits booklet to determine if your plan covers Symbicort specifically.
  •  

  • Look for information about coverage tiers and whether Symbicort is listed under preferred medications.

 

Consult with Your Healthcare Provider

 

  • Discuss your necessity for Symbicort with your doctor and ensure it's the most appropriate medication for your condition.
  •  

  • Request your healthcare provider to write a prescription for Symbicort, prescribing the appropriate dosage based on your medical needs.

 

Verify Prescription Drug Coverage

 

  • Contact Highmark customer service for confirmation on whether Symbicort is covered under your prescription plan.
  •  

  • Ask about your plan's formulary list to verify if there may be a generic equivalent that is covered, which might be more cost-effective.

 

Explore Prior Authorization

 

  • If Symbicort is not readily covered, determine if it requires prior authorization by discussing with Highmark representatives or checking their online resources.
  •  

  • Work with your healthcare provider to submit any necessary prior authorization paperwork to justify the prescription's medical necessity.

 

Determine Out-of-Pocket Costs

 

  • Obtain detailed information regarding co-pays, deductibles, or coinsurance for Symbicort from Highmark, either via their online portal or customer service.
  •  

  • Investigate if there's any available financial assistance or pharmacy discount programs that could help minimize costs.

 

Fill Your Prescription

 

  • Choose a preferred network pharmacy recognized by Highmark to ensure you maximize benefits and potentially reduce costs.
  •  

  • Present your insurance card and prescription to the pharmacist and confirm how much you need to pay from your pocket based on your plan's specifics.

 

Follow Up and Appeal If Needed

 

  • If there are any coverage issues or denials, work with Highmark and your healthcare provider to provide additional information or documentation as needed.
  •  

  • Consider appealing a denial through Highmark's appeals process, ensuring you have all relevant medical records and doctor’s notes to support your case.

 

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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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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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