Does Horizon Blue Cross Blue Shield of New Jersey Cover Enbrel

Discover Enbrel coverage details with Horizon BCBS NJ, reasons for denial, tips to obtain coverage, and cost insights. Find answers to common Enbrel questions.
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“Curex is changing the landscape of allergies in 2024”
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Horizon Blue Cross Blue Shield NJ Enbrel Coverage

 

  • Horizon Blue Cross Blue Shield of New Jersey may cover Enbrel for conditions such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
  •  

  • Coverage is typically subject to prior authorization, confirming that the medication is medically necessary.
  •  

  • Patients must have a documented trial and failure of earlier treatments as per plan guidelines.
  •  

  • Coverage often requires prescribing by a specialist who is directly treating the condition.
  •  

  • Prescription copays and terms may vary based on plan specifics.

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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 Enbrel Coverage with Horizon Blue Cross Blue Shield of New Jersey

 

Contact Horizon Blue Cross Blue Shield of New Jersey

 

  • Call the customer service number on the back of your member ID card. This will connect you with a representative who can provide information specific to your coverage.
  •  

  • Visit the Horizon BCBSNJ website and log into your member account to access plan details and contact support through their messaging system.

 

Verify Your Prescription Coverage

 

  • Inquire whether Enbrel is covered under your current health plan by accessing your policy documents or speaking directly with a representative.
  •  

  • Ask about any specific plan requirements or limitations regarding the prescription, such as preferred pharmacies or necessary approvals.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Enbrel with your healthcare provider. Providers can offer medical justification and ensure all necessary medical documentation is prepared.
  •  

  • Ensure the prescription is submitted to a pharmacy recognized by your health plan to minimize delays.

 

Submit a Prior Authorization Request

 

  • Determine if prior authorization is required for Enbrel coverage. Many insurance plans need this step to review and approve drug coverage based on medical necessity.
  •  

  • Have your healthcare provider submit the prior authorization form to Horizon BCBSNJ, including all required medical information and rationale for the prescription.

 

Follow Up on the Authorization

 

  • Check the status of your prior authorization request by contacting Horizon BCBSNJ customer service or through your online member portal.
  •  

  • If you encounter any issues or denials, work with your healthcare provider to provide additional documentation or submit an appeal.

 

Understand Your Financial Responsibility

 

  • Review your plan benefits to understand any copayments, deductibles, or out-of-pocket costs associated with Enbrel.
  •  

  • Ask about assistance programs or payment plans that may be available to reduce your financial burden.

 

Pick Up Your Prescription

 

  • Once approval is obtained, ensure your prescription is ready at the pharmacy by confirming receipt and processing of the prior authorization.
  •  

  • Discuss with the pharmacist any concerns about the medication to ensure correct usage and adherence.

 

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Does Horizon Blue Cross Blue Shield of New Jersey Cover Enbrel

Discover Enbrel coverage details with Horizon BCBS NJ, reasons for denial, tips to obtain coverage, and cost insights. Find answers to common Enbrel questions.
Curex allergy drops unboxing

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

 

Horizon Blue Cross Blue Shield NJ Enbrel Coverage

 

  • Horizon Blue Cross Blue Shield of New Jersey may cover Enbrel for conditions such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
  •  

  • Coverage is typically subject to prior authorization, confirming that the medication is medically necessary.
  •  

  • Patients must have a documented trial and failure of earlier treatments as per plan guidelines.
  •  

  • Coverage often requires prescribing by a specialist who is directly treating the condition.
  •  

  • Prescription copays and terms may vary based on plan specifics.

A weight management program tailored to you

Start with Curex

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

 

Coverage Criteria for Enbrel

 

  • Enbrel is covered for adult patients with moderate to severe rheumatoid arthritis who have tried other disease-modifying antirheumatic drugs (DMARDs) without adequate response.
  •  

  • Patients with psoriatic arthritis are eligible if they have active and progressive disease and have not adequately responded to other DMARDs.
  •  

  • For ankylosing spondylitis, Enbrel coverage is approved for patients with active disease who have not had success with traditional therapies.
  •  

  • Coverage is provided for patients with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy and have not responded adequately to other medications.
  •  

  • Enbrel is covered for children aged 2 years and older with juvenile idiopathic arthritis who have had insufficient response to one or more DMARDs.

 

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

 

Criteria for Denial of Enbrel Coverage by Horizon Blue Cross Blue Shield of New Jersey

 

  • The patient's condition does not meet the specific FDA-approved indications for which Enbrel is approved.
  •  

  • Enbrel is not deemed medically necessary by Horizon Blue Cross Blue Shield for the patient's specific condition or symptoms.
  •  

  • The patient has not tried and failed on or has contraindications for more cost-effective medications that are typically prescribed before Enbrel.
  •  

  • The prescribed dosage or frequency does not adhere to the recommended guidelines or exceeds the limits established by Horizon Blue Cross Blue Shield's coverage policy.
  •  

  • The patient does not meet the required clinical criteria specific to their diagnosis, such as particular blood test results or documented history of disease progression or severity.
  •  

  • Enbrel is being prescribed for off-label uses that have not been supported by sound clinical evidence or studies.
  •  

  • The prescription is found to lack proper documentation or prior authorization from a healthcare provider outlining the necessity of Enbrel for the patient’s treatment.
  •  

  • There is a lack of response or positive clinical outcome to Enbrel usage after a trial period as defined by Horizon Blue Cross Blue Shield policy.
  •  

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Enbrel Cost without Insurance?

 

Approximate Cost of Enbrel Without Insurance

 

  • The approximate cost of Enbrel, an injection used to treat autoimmune conditions such as rheumatoid arthritis and psoriasis, is generally around $5,000 to $7,000 per month without insurance.
  •  

  • This monthly cost can vary depending on the dosage prescribed and the specific pharmacy location.
  •  

  • Patients may be able to find some cost reduction through manufacturer discounts or assistance programs, but these are typically separate from traditional insurance coverage.
  •  

  • Comparing pharmacy prices through services or websites that provide drug price comparisons may help in finding the lowest available price.

 

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 Enbrel Coverage with Horizon Blue Cross Blue Shield of New Jersey

 

Contact Horizon Blue Cross Blue Shield of New Jersey

 

  • Call the customer service number on the back of your member ID card. This will connect you with a representative who can provide information specific to your coverage.
  •  

  • Visit the Horizon BCBSNJ website and log into your member account to access plan details and contact support through their messaging system.

 

Verify Your Prescription Coverage

 

  • Inquire whether Enbrel is covered under your current health plan by accessing your policy documents or speaking directly with a representative.
  •  

  • Ask about any specific plan requirements or limitations regarding the prescription, such as preferred pharmacies or necessary approvals.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Enbrel with your healthcare provider. Providers can offer medical justification and ensure all necessary medical documentation is prepared.
  •  

  • Ensure the prescription is submitted to a pharmacy recognized by your health plan to minimize delays.

 

Submit a Prior Authorization Request

 

  • Determine if prior authorization is required for Enbrel coverage. Many insurance plans need this step to review and approve drug coverage based on medical necessity.
  •  

  • Have your healthcare provider submit the prior authorization form to Horizon BCBSNJ, including all required medical information and rationale for the prescription.

 

Follow Up on the Authorization

 

  • Check the status of your prior authorization request by contacting Horizon BCBSNJ customer service or through your online member portal.
  •  

  • If you encounter any issues or denials, work with your healthcare provider to provide additional documentation or submit an appeal.

 

Understand Your Financial Responsibility

 

  • Review your plan benefits to understand any copayments, deductibles, or out-of-pocket costs associated with Enbrel.
  •  

  • Ask about assistance programs or payment plans that may be available to reduce your financial burden.

 

Pick Up Your Prescription

 

  • Once approval is obtained, ensure your prescription is ready at the pharmacy by confirming receipt and processing of the prior authorization.
  •  

  • Discuss with the pharmacist any concerns about the medication to ensure correct usage and adherence.

 

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.

Enbrel FAQ

What conditions does Enbrel treat?

 

Conditions Treated by Enbrel

 

  • Rheumatoid Arthritis: Enbrel is commonly used for treating moderate to severe rheumatoid arthritis in adults, helping to reduce joint pain and swelling.
  • Juvenile Idiopathic Arthritis: Effective for kids aged 2 and older, Enbrel helps manage symptoms of juvenile idiopathic arthritis.
  • Psoriatic Arthritis: Patients with psoriatic arthritis can benefit from Enbrel, as it alleviates joint and skin symptoms.
  • Ankylosing Spondylitis: It aids in managing stiffness and inflammation linked to ankylosing spondylitis.
  • Plaque Psoriasis: Enbrel is used for treating moderate to severe plaque psoriasis in adult patients, reducing skin lesions.

 

What are common side effects of Enbrel?

 

Common Side Effects of Enbrel

 

  • Injection Site Reactions: Pain, redness, and swelling at the injection site are quite common.
  •  

  • Infections: Users may experience an increased risk of infections, including upper respiratory tract infections.
  •  

  • Headache: Some patients report headaches following administration.
  •  

  • Nausea and Vomiting: These gastrointestinal issues can occur.
  •  

  • Rash: Skin reactions such as rashes are noted in some individuals.
  •  

  • Heartburn: Stomach discomfort and heartburn are possible.

 

Be sure to consult your healthcare provider for any concerning symptoms or persistent side effects.

How is Enbrel administered?

 

Administration of Enbrel

 

  • Enbrel is administered via subcutaneous injection.
  • It is typically provided in a prefilled syringe, autoinjector (SureClick), or a vial requiring reconstitution.
  • Injections are usually administered on the thigh, abdomen, or outer area of the upper arm.
  • It's crucial to rotate the injection sites to avoid irritation.

 

Preparation and Injection

 

  • Check the solution for particles or discoloration before use.
  • If needed, allow the solution to reach room temperature for about 15–30 minutes.
  • Wash your hands thoroughly before handling the medication.
  • Use an alcohol swab to clean the injection site.
  • Inject Enbrel by angling the needle at 90 degrees for optimal delivery.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

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 Enbrel

Discover Enbrel coverage details with Horizon BCBS NJ, reasons for denial, tips to obtain coverage, and cost insights. Find answers to common Enbrel questions.
Curex allergy drops unboxing

Does Horizon Blue Cross Blue Shield of New Jersey Cover Enbrel

 

Horizon Blue Cross Blue Shield NJ Enbrel Coverage

 

  • Horizon Blue Cross Blue Shield of New Jersey may cover Enbrel for conditions such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
  •  

  • Coverage is typically subject to prior authorization, confirming that the medication is medically necessary.
  •  

  • Patients must have a documented trial and failure of earlier treatments as per plan guidelines.
  •  

  • Coverage often requires prescribing by a specialist who is directly treating the condition.
  •  

  • Prescription copays and terms may vary based on plan specifics.

A weight management program tailored to you

Start with Curex

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

 

Coverage Criteria for Enbrel

 

  • Enbrel is covered for adult patients with moderate to severe rheumatoid arthritis who have tried other disease-modifying antirheumatic drugs (DMARDs) without adequate response.
  •  

  • Patients with psoriatic arthritis are eligible if they have active and progressive disease and have not adequately responded to other DMARDs.
  •  

  • For ankylosing spondylitis, Enbrel coverage is approved for patients with active disease who have not had success with traditional therapies.
  •  

  • Coverage is provided for patients with chronic moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy and have not responded adequately to other medications.
  •  

  • Enbrel is covered for children aged 2 years and older with juvenile idiopathic arthritis who have had insufficient response to one or more DMARDs.

 

Together with our partners we have changed the lives of over 300,000 patients.

Enbrel FAQ

 

Criteria for Denial of Enbrel Coverage by Horizon Blue Cross Blue Shield of New Jersey

 

  • The patient's condition does not meet the specific FDA-approved indications for which Enbrel is approved.
  •  

  • Enbrel is not deemed medically necessary by Horizon Blue Cross Blue Shield for the patient's specific condition or symptoms.
  •  

  • The patient has not tried and failed on or has contraindications for more cost-effective medications that are typically prescribed before Enbrel.
  •  

  • The prescribed dosage or frequency does not adhere to the recommended guidelines or exceeds the limits established by Horizon Blue Cross Blue Shield's coverage policy.
  •  

  • The patient does not meet the required clinical criteria specific to their diagnosis, such as particular blood test results or documented history of disease progression or severity.
  •  

  • Enbrel is being prescribed for off-label uses that have not been supported by sound clinical evidence or studies.
  •  

  • The prescription is found to lack proper documentation or prior authorization from a healthcare provider outlining the necessity of Enbrel for the patient’s treatment.
  •  

  • There is a lack of response or positive clinical outcome to Enbrel usage after a trial period as defined by Horizon Blue Cross Blue Shield policy.
  •  

 

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 Much Does Enbrel Cost without Insurance?

 

Approximate Cost of Enbrel Without Insurance

 

  • The approximate cost of Enbrel, an injection used to treat autoimmune conditions such as rheumatoid arthritis and psoriasis, is generally around $5,000 to $7,000 per month without insurance.
  •  

  • This monthly cost can vary depending on the dosage prescribed and the specific pharmacy location.
  •  

  • Patients may be able to find some cost reduction through manufacturer discounts or assistance programs, but these are typically separate from traditional insurance coverage.
  •  

  • Comparing pharmacy prices through services or websites that provide drug price comparisons may help in finding the lowest available price.

 

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.

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

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.