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Does Horizon Blue Cross Blue Shield of New Jersey Cover Dupixent

Discover if Horizon BCBS of NJ covers Dupixent. Learn potential coverage issues, how to secure approval, costs without insurance, and get FAQs answered.

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Coverage of Dupixent

Horizon Blue Cross Blue Shield of New Jersey may cover Dupixent for specific conditions such as moderate to severe atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis.

Coverage is contingent on medical necessity and prior authorization, often requiring detailed documentation from your healthcare provider.

Eligibility Criteria

Patients must typically have tried and failed other treatments before Dupixent is approved.

Prescription must be written by a specialist like a dermatologist, allergist, or pulmonologist, depending on the condition being treated.

Basic Rules

Initial authorization is usually for a 6-month period, with further approval requiring evidence of treatment effectiveness.

Step therapy, which entails trying other medications before Dupixent, might be necessary to qualify for coverage.

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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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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 Dupixent Coverage with Horizon Blue Cross Blue Shield of New Jersey

Start with Horizon Blue Cross Blue Shield of New Jersey

Contact Horizon Blue Cross Blue Shield of New Jersey by calling the customer service number on the back of your insurance card. This will be your starting point to inquire about coverage for Dupixent.

Visit the Horizon Blue Cross Blue Shield of New Jersey website and log in to your member account. This will give you access to your plan details and specific information about drug coverage.

Review Your Health Plan Details

Check your plan's formulary, which is a list of drugs covered by Horizon Blue Cross Blue Shield of New Jersey. It will tell you whether Dupixent is covered and under what tier it falls.

Look for specific coverage criteria or restrictions such as prior authorization, step therapy, or quantity limits. This information is key for understanding what paperwork is necessary for coverage approval.

Consult Your Healthcare Provider

Discuss with your healthcare provider about prescribing Dupixent. They need to provide clinical justification for its use, especially if there are specific medical policies or guidelines you must meet.

Obtain a letter of medical necessity from your healthcare provider. This letter should detail your medical condition and the necessity of Dupixent treatment, addressing any specific coverage criteria mentioned by your plan.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request. This request must include the prescription details and the letter of medical necessity.

Use the correct forms provided by Horizon Blue Cross Blue Shield of New Jersey. These forms can usually be found on their website or obtained by contacting their customer service.

Follow Up on Your Request

Contact Horizon Blue Cross Blue Shield of New Jersey to confirm they have received your prior authorization request. Keep a record of your communications.

Ask about the typical processing time for prior authorization requests. This helps you know when to expect a decision.

If additional information is required, make sure your healthcare provider supplies it promptly to avoid delays in the decision-making process.

Appeal if Necessary

If your initial request is denied, review the reason for denial provided by Horizon Blue Cross Blue Shield of New Jersey. This will help you prepare a more targeted appeal.

Work with your healthcare provider to gather additional evidence or documentation that supports the medical necessity of Dupixent for your condition.

Submit your appeal following Horizon Blue Cross Blue Shield of New Jersey's appeal process. Ensure all required forms and additional documents are completed accurately.

Explore Additional Assistance Programs

Investigate Dupixent's manufacturer assistance programs, which might offer financial support or additional help if you're facing difficulties obtaining coverage through Horizon Blue Cross Blue Shield of New Jersey.

Check whether Horizon Blue Cross Blue Shield of New Jersey offers any patient assistance programs or discounts that can help reduce the cost of Dupixent.

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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Dupixent

Discover if Horizon BCBS of NJ covers Dupixent. Learn potential coverage issues, how to secure approval, costs without insurance, and get FAQs answered.

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

Coverage of Dupixent

Horizon Blue Cross Blue Shield of New Jersey may cover Dupixent for specific conditions such as moderate to severe atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis.

Coverage is contingent on medical necessity and prior authorization, often requiring detailed documentation from your healthcare provider.

Eligibility Criteria

Patients must typically have tried and failed other treatments before Dupixent is approved.

Prescription must be written by a specialist like a dermatologist, allergist, or pulmonologist, depending on the condition being treated.

Basic Rules

Initial authorization is usually for a 6-month period, with further approval requiring evidence of treatment effectiveness.

Step therapy, which entails trying other medications before Dupixent, might be necessary to qualify for coverage.

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

Criteria for Dupixent Coverage

Dupixent is covered for patients diagnosed with moderate to severe atopic dermatitis (eczema) who have not adequately responded to topical prescription therapies or when those treatments are not medically advisable.

Dupixent is approved for individuals aged 6 years and older for the treatment of moderate to severe asthma with an eosinophilic phenotype, or for oral corticosteroid-dependent asthma as an add-on maintenance treatment.

For patients with chronic rhinosinusitis with nasal polyposis (CRSwNP), Dupixent is covered as add-on maintenance treatment for individuals aged 18 years and older who have inadequately responded to systemic corticosteroids or require nasal surgery.

Coverage is available for Dupixent in individuals aged 12 years and older for eosinophilic esophagitis who have failed to respond adequately to conventional treatment modalities.

Dupixent may be approved for individuals 12 years and older with prurigo nodularis who have had an inadequate response to topical therapies.

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

Situations Where Dupixent May Not Be Covered

Dupixent is being requested for an off-label use not recognized by Horizon's policy or unsupported by clinical evidence.

The prescribed use does not meet Horizon's medical necessity criteria, meaning the condition is either not severe enough or other treatments have not been adequately tried first.

The patient does not meet the age criteria specified for the drug, as Dupixent may be approved for certain age groups only.

Absence of required steps in the authorization process, such as missing documentation or failure to complete required forms.

The patient's plan explicitly excludes coverage for Dupixent, perhaps due to plan design or specific exclusions.

Dupixent is requested for a condition not yet approved by major registries like the FDA for that specific usage.

In cases where a more cost-effective alternative treatment must be tried and failed before Dupixent is approved.

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How Much Does Dupixent Cost without Insurance?

Approximate Cost of Dupixent Without Insurance

The cost of Dupixent without insurance can be quite high, usually ranging between $3,200 to $3,500 per month. This cost is for the standard dose, which consists of two pre-filled syringes or injection pens, each containing 300 mg of medication.

Prices can vary depending on the pharmacy, location, and any potential deals or discounts offered by specific pharmacies or third-party services.

Patients are encouraged to explore manufacturer copay cards, patient assistance programs, or discount cards which might be available to help reduce out-of-pocket expenses.

For those requiring treatment for conditions like eczema, asthma, or other approved uses, Dupixent is often administered bi-weekly after an initial loading dose, which should be taken into consideration when calculating monthly or annual expenses.

Clinical Support

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

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

Kayla Mardaga, NP

How to Get Dupixent Coverage with Horizon Blue Cross Blue Shield of New Jersey

Start with Horizon Blue Cross Blue Shield of New Jersey

Contact Horizon Blue Cross Blue Shield of New Jersey by calling the customer service number on the back of your insurance card. This will be your starting point to inquire about coverage for Dupixent.

Visit the Horizon Blue Cross Blue Shield of New Jersey website and log in to your member account. This will give you access to your plan details and specific information about drug coverage.

Review Your Health Plan Details

Check your plan's formulary, which is a list of drugs covered by Horizon Blue Cross Blue Shield of New Jersey. It will tell you whether Dupixent is covered and under what tier it falls.

Look for specific coverage criteria or restrictions such as prior authorization, step therapy, or quantity limits. This information is key for understanding what paperwork is necessary for coverage approval.

Consult Your Healthcare Provider

Discuss with your healthcare provider about prescribing Dupixent. They need to provide clinical justification for its use, especially if there are specific medical policies or guidelines you must meet.

Obtain a letter of medical necessity from your healthcare provider. This letter should detail your medical condition and the necessity of Dupixent treatment, addressing any specific coverage criteria mentioned by your plan.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request. This request must include the prescription details and the letter of medical necessity.

Use the correct forms provided by Horizon Blue Cross Blue Shield of New Jersey. These forms can usually be found on their website or obtained by contacting their customer service.

Follow Up on Your Request

Contact Horizon Blue Cross Blue Shield of New Jersey to confirm they have received your prior authorization request. Keep a record of your communications.

Ask about the typical processing time for prior authorization requests. This helps you know when to expect a decision.

If additional information is required, make sure your healthcare provider supplies it promptly to avoid delays in the decision-making process.

Appeal if Necessary

If your initial request is denied, review the reason for denial provided by Horizon Blue Cross Blue Shield of New Jersey. This will help you prepare a more targeted appeal.

Work with your healthcare provider to gather additional evidence or documentation that supports the medical necessity of Dupixent for your condition.

Submit your appeal following Horizon Blue Cross Blue Shield of New Jersey's appeal process. Ensure all required forms and additional documents are completed accurately.

Explore Additional Assistance Programs

Investigate Dupixent's manufacturer assistance programs, which might offer financial support or additional help if you're facing difficulties obtaining coverage through Horizon Blue Cross Blue Shield of New Jersey.

Check whether Horizon Blue Cross Blue Shield of New Jersey offers any patient assistance programs or discounts that can help reduce the cost of Dupixent.

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Dupixent FAQ

1. What are the common side effects of Dupixent?

Common Side Effects of Dupixent

Injection site reactions: redness, swelling, and pain at the injection site are frequently reported. These reactions usually subside shortly after injection.

Conjunctivitis: Some patients experience symptoms like red, itchy, or watery eyes.

Blepharitis: Inflammation of the eyelids, leading to symptoms such as redness, swelling, and itching, may occur.

Oral herpes: A mild increase in probabilities of cold sores has been noted in some cases.

Sore throat: Some individuals may develop pharyngitis, which manifests as throat discomfort or pain.

2. How does Dupixent work for eczema?

How Dupixent Works for Eczema

Dupixent is a monoclonal antibody that targets interleukin-4 receptor alpha (IL-4Rα).

By blocking IL-4Rα, it inhibits the signaling pathways of IL-4 and IL-13, key cytokines involved in the inflammatory response in eczema.

This leads to a reduction in the overactive immune response, which is characterized by inflammation and itchiness in atopic dermatitis.

As a result, Dupixent helps alleviate symptoms like redness, itch, and skin thickening by modulating the immune response.

3. Is Dupixent used for asthma treatment?

Dupixent for Asthma

Dupixent (dupilumab) is approved for use in the treatment of moderate-to-severe asthma in adults and adolescents (12 years and older).

It is particularly beneficial for patients with eosinophilic asthma or those dependent on oral corticosteroids.

Dupixent acts by targeting and inhibiting the signaling of interleukins IL-4 and IL-13, which play central roles in the inflammatory response involved in asthma.

The medication is administered via subcutaneous injection, typically every two weeks after an initial loading dose.

Clinical trials have shown Dupixent to reduce asthma exacerbations and improve lung function, thereby potentially reducing the need for oral corticosteroids.

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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. 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?

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.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. 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.

Does Horizon Blue Cross Blue Shield of New Jersey Cover Dupixent

Discover if Horizon BCBS of NJ covers Dupixent. Learn potential coverage issues, how to secure approval, costs without insurance, and get FAQs answered.

Achieve Your Goals Faster with Curex