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Does Horizon Blue Cross Blue Shield of New Jersey Cover Nexium

Explore Nexium coverage under Horizon BCBS of NJ. Learn why it's denied, how to secure coverage, costs without insurance, and get answers to common questions.
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Coverage for Nexium

 

  • Horizon Blue Cross Blue Shield of New Jersey may cover Nexium under its prescription drug plan, depending on the policy.

    •  

  • Coverage typically requires prior authorization, demonstrating medical necessity.

    •  

  • Generic alternatives might be preferred; esomeprazole is generally covered as a cost-effective alternative.

    •  

 

Criteria and Rules

 

  • Patients should have a history of tried or intolerant alternative therapies before approval.

    •  

  • Specific diagnosis details, like GERD or Zollinger-Ellison Syndrome, may be needed for coverage.

    •  

  • Providers need to submit appropriate documentation to satisfy criteria for medical necessity.

    •  

  • Copayments, deductibles, and plan limits will influence final out-of-pocket costs.

    •  

  • Check with Horizon’s customer service for specific policy details and prior authorization procedures.

 

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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

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 Nexium Coverage with Horizon Blue Cross Blue Shield of New Jersey

 

Check Your Health Plan

 

  • Examine your specific Horizon Blue Cross Blue Shield of New Jersey plan documents to identify prescription drug benefits. Check if Nexium is listed as a covered medication or if there are any restrictions associated with it.

    •  

  • Look for any formulary guides provided by Horizon to see where Nexium stands in terms of coverage tiers and required co-pays or co-insurances.

 

Consult Your Doctor

 

  • Discuss your need for Nexium with your healthcare provider. Your physician can verify the medical necessity and possibly provide alternatives that might have easier coverage under your plan.

    •  

  • If required, obtain a prescription for Nexium with all necessary medical justification documented.

 

Contact Horizon Member Services

 

  • Reach out to Horizon's Member Services for confirmation on Nexium coverage. You can call the number on the back of your insurance card to speak with a representative.

    •  

  • Inquire about any pre-authorization requirements or specific paperwork needed to ensure Nexium is covered.

 

Submit Prior Authorization

 

  • If prior authorization is needed, work with your doctor to complete and submit the required forms to Horizon Blue Cross Blue Shield of New Jersey.

    •  

  • Ensure the submission includes necessary medical records and documentation that support the need for Nexium.

 

Explore Generic or Alternative Options

 

  • If Nexium is not covered, or if the prior authorization is denied, discuss generic versions or alternative medications with your doctor. These might have fewer restrictions and may be covered more easily.

    •  

  • Request your doctor to prescribe the alternative or generic if it is medically acceptable, and check your plan for coverage on these options.

 

Appeal a Denial

 

  • If your initial request for Nexium is denied, review the denial letter carefully to understand the reasons.

    •  

  • Follow the appeal process outlined by Horizon Blue Cross Blue Shield. Gather additional documentation, consult your doctor for support, and submit an appeal explaining why Nexium is necessary for your health.

 

Check for Pharmacy Benefits

 

  • Utilize your Horizon plan’s designated pharmacy network, as using in-network pharmacies can significantly reduce personal costs.

    •  

  • Consult with your pharmacist about any discount programs or assistance programs for Nexium available through Horizon or other organizations.
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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Nexium

Explore Nexium coverage under Horizon BCBS of NJ. Learn why it's denied, how to secure coverage, costs without insurance, and get answers to common questions.
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Is Nexium Covered by Horizon Blue Cross Blue Shield of New Jersey

 

Coverage for Nexium

 

  • Horizon Blue Cross Blue Shield of New Jersey may cover Nexium under its prescription drug plan, depending on the policy.

    •  

  • Coverage typically requires prior authorization, demonstrating medical necessity.

    •  

  • Generic alternatives might be preferred; esomeprazole is generally covered as a cost-effective alternative.

    •  

 

Criteria and Rules

 

  • Patients should have a history of tried or intolerant alternative therapies before approval.

    •  

  • Specific diagnosis details, like GERD or Zollinger-Ellison Syndrome, may be needed for coverage.

    •  

  • Providers need to submit appropriate documentation to satisfy criteria for medical necessity.

    •  

  • Copayments, deductibles, and plan limits will influence final out-of-pocket costs.

    •  

  • Check with Horizon’s customer service for specific policy details and prior authorization procedures.

 

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

 

Coverage Criteria for Nexium Prescription

 

  • **Approved Medical Condition**: Nexium is covered for the treatment of gastroesophageal reflux disease (GERD), including erosive esophagitis, as confirmed by a medical diagnosis from a healthcare provider.

    •  

  • **Patient Age Requirements**: Patients must be 18 years of age or older to qualify for coverage of Nexium, unless otherwise specified by a healthcare provider for pediatric use.

    •  

  • **Dosage and Administration**: The prescribed dosage must align with the FDA-approved guidelines to ensure compliance with medical standards for the treatment of the approved conditions.

    •  

  • **Step Therapy Process**: If a patient has not previously attempted treatment with a generic equivalent or other proton pump inhibitors (PPIs), they may be required to undergo a trial of these medications before receiving coverage for Nexium.

    •  

  • **Prior Authorization**: Coverage may be subject to prior authorization to confirm that the use of Nexium is medically necessary based on the patient's specific health needs and treatment history.

    •  

  • **Documented Medical History**: Insurance may require documentation of the patient's medical history showing previous treatment attempts and outcomes to verify the need for Nexium.

 

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

 

Situations When Nexium Coverage Might Be Denied

 

  • The prescribed use of Nexium does not align with FDA-approved indications or guidelines set by Horizon Blue Cross Blue Shield of New Jersey.

    •  

  • The patient has not tried or completed a trial with a generic or preferred alternative that is covered before requesting Nexium.

    •  

  • There is a lack of documentation demonstrating that Nexium is medically necessary when cheaper, equivalent treatment options are available.

    •  

  • The prescription is outside of the plan’s dosage and frequency limitations without accompanying medical justification or prior authorization.

    •  

  • The individual’s policy specifically excludes coverage for certain medications, including Nexium, due to policy selections or employer-specific plan restrictions.

 

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How Much Does Nexium Cost without Insurance?

 

Cost of Nexium Without Insurance

 

  • The retail price of Nexium (esomeprazole) can vary depending on the pharmacy and location.

    •  

  • For a 30-pill supply of 20 mg Nexium, the cost can range from approximately $200 to $250.

    •  

  • For a similar supply of 40 mg Nexium, prices may be slightly higher, ranging from about $250 to $300.

    •  

  • Retail prices often vary, so it may be beneficial to check with different pharmacies or consider generic versions, like esomeprazole, which are usually more affordable.

    •  

  • Discount programs or pharmacy coupons may be available to lower the cost significantly, so it's advisable to explore such options.

 

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

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 Nexium Coverage with Horizon Blue Cross Blue Shield of New Jersey

 

Check Your Health Plan

 

  • Examine your specific Horizon Blue Cross Blue Shield of New Jersey plan documents to identify prescription drug benefits. Check if Nexium is listed as a covered medication or if there are any restrictions associated with it.

    •  

  • Look for any formulary guides provided by Horizon to see where Nexium stands in terms of coverage tiers and required co-pays or co-insurances.

 

Consult Your Doctor

 

  • Discuss your need for Nexium with your healthcare provider. Your physician can verify the medical necessity and possibly provide alternatives that might have easier coverage under your plan.

    •  

  • If required, obtain a prescription for Nexium with all necessary medical justification documented.

 

Contact Horizon Member Services

 

  • Reach out to Horizon's Member Services for confirmation on Nexium coverage. You can call the number on the back of your insurance card to speak with a representative.

    •  

  • Inquire about any pre-authorization requirements or specific paperwork needed to ensure Nexium is covered.

 

Submit Prior Authorization

 

  • If prior authorization is needed, work with your doctor to complete and submit the required forms to Horizon Blue Cross Blue Shield of New Jersey.

    •  

  • Ensure the submission includes necessary medical records and documentation that support the need for Nexium.

 

Explore Generic or Alternative Options

 

  • If Nexium is not covered, or if the prior authorization is denied, discuss generic versions or alternative medications with your doctor. These might have fewer restrictions and may be covered more easily.

    •  

  • Request your doctor to prescribe the alternative or generic if it is medically acceptable, and check your plan for coverage on these options.

 

Appeal a Denial

 

  • If your initial request for Nexium is denied, review the denial letter carefully to understand the reasons.

    •  

  • Follow the appeal process outlined by Horizon Blue Cross Blue Shield. Gather additional documentation, consult your doctor for support, and submit an appeal explaining why Nexium is necessary for your health.

 

Check for Pharmacy Benefits

 

  • Utilize your Horizon plan’s designated pharmacy network, as using in-network pharmacies can significantly reduce personal costs.

    •  

  • Consult with your pharmacist about any discount programs or assistance programs for Nexium available through Horizon or other organizations.

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.

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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.

Nexium FAQ

What are the side effects of Nexium?

 

Common Side Effects

 

  • Headache: A mild, frequently reported side effect.
  • Diarrhea: Can result from changes in stomach acid levels.
  • Nausea: Often subsides after continued use.
  • Flatulence: A possible gastrointestinal reaction.

 

Less Common Side Effects

 

  • Constipation: May occur, though not frequently.
  • Dizziness: Reported by some users.
  • Dry Mouth: An uncommon, but noted effect.

 

Serious Side Effects

 

  • Severe allergic reactions: Seek immediate medical help.
  • Bone Fractures: Long-term use may increase this risk.
  • Kidney Issues: Signs include changes in urine frequency.

 

How long does it take for Nexium to work?

 

Nexium Onset Time

 

  • Nexium (esomeprazole) typically begins relief within 1 hour, but full benefits for conditions like GERD may take up to 4 days.

    •  

  • For some individuals, noticeable improvement in symptoms might occur after several days of consistent use.

 

Factors Affecting Efficacy

 

  • Severity of symptoms and underlying condition can influence how quickly Nexium provides relief.

    •  

  • Dietary habits and adherence to recommended dosage also affect its performance.

 

Usage Tips

 

  • Take Nexium at least 1 hour before meals for optimal absorption.

    •  

  • Consistency in daily intake timing can enhance effectiveness.

 

Consult Healthcare Provider

 

  • If relief is not achieved within the expected timeframe, consult your healthcare provider for further evaluation and guidance.

 

Can I take Nexium with other medications?

 

Taking Nexium with Other Medications

 

  • Nexium (esomeprazole) may interact with other medications, altering their effectiveness. It's crucial to consult your healthcare provider before combining it with others.

    •  

  • Nexium can affect drugs metabolized by CYP2C19, like clopidogrel. It might reduce clopidogrel's effectiveness. Your doctor may adjust your treatment accordingly.

    •  

  • Other drug interactions may include certain antifungals, anticoagulants, and HIV medications. Always check with your pharmacist for potential interactions.

    •  

  • Inform your doctor about all medications you're taking, including prescriptions, over-the-counter drugs, and supplements, to ensure safe use of Nexium.

Have questions left?

‍

Get a personalized online consultation with a doctor at Curex

Learn More

Curex is one of America’s largest telehealth providers

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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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 (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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
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Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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