Does Horizon Blue Cross Blue Shield of New Jersey Cover Dulera

Explore Dulera coverage with Horizon BCBS NJ. Learn reasons for denial, ways to secure coverage, costs without insurance, and answers to common questions.
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Coverage Overview for Dulera

 

  • Horizon Blue Cross Blue Shield of New Jersey generally covers Dulera as part of its prescription drug benefits, depending on your specific plan tier and formulary status.
  •  

  • Coverage typically includes patients with diagnosed asthma or chronic obstructive pulmonary disease (COPD) and requires a prescription from a healthcare provider.

 

Basic Rules and Criteria

 

  • Prior authorization may be necessary, where your physician needs to submit medical justification for Dulera.
  •  

  • Step therapy might be required, meaning you may need to try other medications first before Dulera is approved.
  •  

  • Co-payments or co-insurance costs will vary based on your specific insurance plan; checking the medication tier and out-of-pocket costs is essential.

 

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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 Horizon Blue Cross Blue Shield of New Jersey

 

Review Your Insurance Plan

 

  • Start by logging into your Horizon Blue Cross Blue Shield of New Jersey member portal to review your current insurance plan details.
  •  

  • Check if prescription medications, particularly asthma inhalers like Dulera, are covered under your plan.
  •  

  • Look into your plan’s formulary, which lists covered prescription drugs. You can usually find it in your plan documents or online portal.

 

Verify Dulera Coverage

 

  • Contact Horizon Blue Cross Blue Shield's customer service for direct confirmation on Dulera coverage specifics. Have your plan number available to facilitate the process.
  •  

  • Inquire whether prior authorization or step therapy is needed for Dulera, as this information is crucial for coverage.
  •  

  • Ask about any possible copays or out-of-pocket costs associated with filling a Dulera prescription.

 

Consult With Your Healthcare Provider

 

  • Talk to your doctor about prescribing Dulera and ensure it is the right medication for you.
  •  

  • Request they provide any necessary documentation or justification if Dulera requires prior authorization for coverage.
  •  

  • Ask your healthcare provider to use the e-prescription service when possible to streamline the approval process with Horizon BCBSNJ.

 

Submit Required Documentation

 

  • If prior authorization is necessary, work with your doctor’s office to gather and submit all needed paperwork to Horizon BCBS NJ.
  •  

  • Make sure all information is submitted accurately to avoid coverage delays.
  •  

  • Keep copies of all documents and confirmation receipts for your records.

 

Follow Up on the Approval Process

 

  • Regularly check your member portal for updates on the status of your prior authorization or any necessary documentation approvals.
  •  

  • Contact Horizon BCBSNJ if you experience any delays or require additional information to avoid interruptions in receiving your medication.
  •  

  • Confirm once your prescription claim for Dulera is approved and understand how to proceed with filling it at your pharmacy.

 

Refill Pharmaceuticals

 

  • Once Dulera is approved, fill your prescription at an in-network pharmacy to ensure full coverage benefits.
  •  

  • Use a pharmacy where you can easily discuss any questions regarding copays and ensure the claim is processed correctly under your plan.
  •  

  • Consider setting up automatic refills if available, to ensure you consistently receive your medication without interruption.

 

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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Dulera

Explore Dulera coverage with Horizon BCBS NJ. Learn reasons for denial, ways to secure coverage, costs without insurance, and answers to common questions.
Curex allergy drops unboxing

Is Dulera Covered by Horizon Blue Cross Blue Shield of New Jersey

 

Coverage Overview for Dulera

 

  • Horizon Blue Cross Blue Shield of New Jersey generally covers Dulera as part of its prescription drug benefits, depending on your specific plan tier and formulary status.
  •  

  • Coverage typically includes patients with diagnosed asthma or chronic obstructive pulmonary disease (COPD) and requires a prescription from a healthcare provider.

 

Basic Rules and Criteria

 

  • Prior authorization may be necessary, where your physician needs to submit medical justification for Dulera.
  •  

  • Step therapy might be required, meaning you may need to try other medications first before Dulera is approved.
  •  

  • Co-payments or co-insurance costs will vary based on your specific insurance plan; checking the medication tier and out-of-pocket costs is essential.

 

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Horizon Blue Cross Blue Shield of New Jersey's Approved Criteria for Dulera Coverage

 

Horizon BCBSNJ Coverage Criteria for Dulera

 

  • **Medically Necessary Use:** Dulera is covered when prescribed for the treatment of asthma in patients aged 12 years and older who require combination therapy for sufficient control of persistent asthma.
  •  

  • **Age and Diagnosis Criteria:** Patients must be at least 12 years old and diagnosed with asthma as per standard diagnostic guidelines.
  •  

  • **Previous Treatment Requirement:** Coverage is available for patients whose asthma is not adequately controlled by inhaled corticosteroids alone, or when the severity of the disease clearly warrants treatment with both an inhaled corticosteroid and a long-acting beta-agonist.
  •  

  • **Maintenance Therapy Confirmation:** The patient should be on a stable maintenance regimen that requires a combination of inhaled corticosteroid and a long-acting beta2-agonist for asthma control.
  •  

  • **Prescription Documentation:** The healthcare provider must provide comprehensive documentation, including patient history, previous treatment regimens, and current prescription details, to confirm that Dulera is medically necessary.
  •  

  • **Continued Authorization:** Periodic reevaluation of the patient's condition and therapy effectiveness, supported by medical documentation, is required to maintain coverage authorization for Dulera.
  •  

  • **Healthcare Provider Qualification:** The prescribing healthcare provider should be a licensed professional with experience in managing asthma and should ensure that the treatment plan aligns with therapeutic guidelines.

 

Why Horizon Blue Cross Blue Shield of New Jersey Might Deny Dulera Coverage

 

Reasons for Denial of Dulera Coverage by Horizon Blue Cross Blue Shield of New Jersey

 

  • The medication is not listed in the plan's specific formulary, which is a list of covered drugs.
  •  

  • An alternative, preferred medication is available and deemed appropriate for the member's condition.
  •  

  • The prescribed dosage exceeds the limits established within the plan's approved guidelines.
  •  

  • The patient lacks the required prior authorization which verifies medical necessity for Dulera.
  •  

  • The condition being treated is not covered under the terms of the member's current insurance plan.
  •  

  • Dulera is being used for an off-label condition that is not supported by sufficient clinical evidence.
  •  

  • The prescriber is not within the network of approved physicians or lacks the necessary credentials according to Horizon's requirements.
  •  

  • The insurance policy is lapsed or not active, thus the benefits are not applicable.

 

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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 Horizon Blue Cross Blue Shield of New Jersey

 

Review Your Insurance Plan

 

  • Start by logging into your Horizon Blue Cross Blue Shield of New Jersey member portal to review your current insurance plan details.
  •  

  • Check if prescription medications, particularly asthma inhalers like Dulera, are covered under your plan.
  •  

  • Look into your plan’s formulary, which lists covered prescription drugs. You can usually find it in your plan documents or online portal.

 

Verify Dulera Coverage

 

  • Contact Horizon Blue Cross Blue Shield's customer service for direct confirmation on Dulera coverage specifics. Have your plan number available to facilitate the process.
  •  

  • Inquire whether prior authorization or step therapy is needed for Dulera, as this information is crucial for coverage.
  •  

  • Ask about any possible copays or out-of-pocket costs associated with filling a Dulera prescription.

 

Consult With Your Healthcare Provider

 

  • Talk to your doctor about prescribing Dulera and ensure it is the right medication for you.
  •  

  • Request they provide any necessary documentation or justification if Dulera requires prior authorization for coverage.
  •  

  • Ask your healthcare provider to use the e-prescription service when possible to streamline the approval process with Horizon BCBSNJ.

 

Submit Required Documentation

 

  • If prior authorization is necessary, work with your doctor’s office to gather and submit all needed paperwork to Horizon BCBS NJ.
  •  

  • Make sure all information is submitted accurately to avoid coverage delays.
  •  

  • Keep copies of all documents and confirmation receipts for your records.

 

Follow Up on the Approval Process

 

  • Regularly check your member portal for updates on the status of your prior authorization or any necessary documentation approvals.
  •  

  • Contact Horizon BCBSNJ if you experience any delays or require additional information to avoid interruptions in receiving your medication.
  •  

  • Confirm once your prescription claim for Dulera is approved and understand how to proceed with filling it at your pharmacy.

 

Refill Pharmaceuticals

 

  • Once Dulera is approved, fill your prescription at an in-network pharmacy to ensure full coverage benefits.
  •  

  • Use a pharmacy where you can easily discuss any questions regarding copays and ensure the claim is processed correctly under your plan.
  •  

  • Consider setting up automatic refills if available, to ensure you consistently receive your medication without interruption.

 

Premium Medication you can trust

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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