Does Kaiser Permanente Cover Dulera

Explore Dulera coverage with Kaiser Permanente: reasons for denial, how to secure coverage, costs without insurance, and answers to common questions.
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Kaiser Permanente Coverage for Dulera

 

  • Kaiser Permanente may cover Dulera, a combination inhaler used for asthma control, depending on your specific plan and medical necessity.
  •  

  • Patients typically need a prescription from a Kaiser network healthcare provider indicating that Dulera is essential for managing their asthma.
  •  

  • Coverage might require prior authorization, where your doctor must show that Dulera is necessary and alternative treatments have been ineffective.
  •  

  • Co-pays or deductibles could apply based on your health plan's formulary tier system, which classifies medications into categories affecting out-of-pocket costs.
  •  

  • It’s advisable to review your policy details or consult Kaiser’s customer service to confirm the extent and conditions of coverage for Dulera.

 

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Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Dulera Coverage with Kaiser Permanente

 

Verify Your Coverage

 

  • Contact Kaiser Permanente's customer service to confirm if your current health plan includes prescription drug coverage.
  •  

  • Request specific information on Dulera coverage, including any potential restrictions or preferred drug lists (formularies).

 

Consult Your Physician

 

  • Schedule a visit with your Kaiser Permanente primary care physician to discuss your need for Dulera.
  •  

  • Ensure that your physician is aware of your medication history and any previous asthma treatments you have tried.

 

Prescription Submission

 

  • If your physician prescribes Dulera, they can typically submit the prescription electronically to a Kaiser Permanente pharmacy.
  •  

  • Verify with your physician that the prescription aligns with Kaiser's formulary for seamless coverage.

 

Pharmacy Coordination

 

  • Visit your designated Kaiser Permanente pharmacy or use their online pharmacy services to confirm the prescription fill process.
  •  

  • Inquire about any copayments, prior authorization requirements, or generic alternatives that can affect coverage.

 

Understand Your Benefits

 

  • Review your Kaiser Permanente benefits booklet or online account for detailed information on prescription costs and copayment structures.
  •  

  • Look out for any mailings or online notifications from Kaiser Permanente that might update you on changes to drug coverage.

 

Explore Financial Assistance

 

  • If Dulera costs are a concern, ask about Kaiser Permanente's financial assistance programs.
  •  

  • Consider discussing generic or therapeutic alternatives with your physician to reduce out-of-pocket expenses.

 

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FAQs

Does Kaiser Permanente Cover Dulera

Explore Dulera coverage with Kaiser Permanente: reasons for denial, how to secure coverage, costs without insurance, and answers to common questions.
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Is Dulera Covered by Kaiser Permanente

 

Kaiser Permanente Coverage for Dulera

 

  • Kaiser Permanente may cover Dulera, a combination inhaler used for asthma control, depending on your specific plan and medical necessity.
  •  

  • Patients typically need a prescription from a Kaiser network healthcare provider indicating that Dulera is essential for managing their asthma.
  •  

  • Coverage might require prior authorization, where your doctor must show that Dulera is necessary and alternative treatments have been ineffective.
  •  

  • Co-pays or deductibles could apply based on your health plan's formulary tier system, which classifies medications into categories affecting out-of-pocket costs.
  •  

  • It’s advisable to review your policy details or consult Kaiser’s customer service to confirm the extent and conditions of coverage for Dulera.

 

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Kaiser Permanente's Approved Criteria for Dulera Coverage

 

Eligibility Requirements for Dulera Coverage

 

  • Patient must have a documented diagnosis of asthma.
  •  

  • The asthma condition should be persistent, and previous treatment options must have been insufficient in adequately managing the symptoms.

 

Age Criteria

 

  • Dulera is approved for use in individuals aged 12 years and older.
  •  

  • Prior authorization may be required for patients under or over specific age ranges due to potential risk factors or lack of sufficient study data.

 

Previous Medication Trials

 

  • Documentation must show that the patient has tried and failed, or had an inadequate response to controller medications such as inhaled corticosteroids alone or in combination with a long-acting beta-agonist.
  •  

  • Evidence of adherence to previous asthma medications and asthma action plans is required.

 

Medication Appropriateness

 

  • Dulera is expected to be prescribed within the recommended dosing guidelines according to the manufacturer’s instructions.
  •  

  • Regular monitoring of asthma condition while on Dulera must be documented within the patient's medical records.

 

Physician Documentation

 

  • The prescribing physician must provide thorough clinical documentation supporting the need for Dulera, including recent objective measures such as spirometry or peak flow rate that support the asthma diagnosis and severity.
  •  

  • An asthma action plan tailored to the individual must be provided, reflecting the inclusion of Dulera in the management strategy.

 

Continued Coverage Criteria

 

  • For ongoing coverage of Dulera, there must be evidence of improvement or stabilization of the patient's condition with its use.
  •  

  • Follow-up visits with the prescribing physician should demonstrate compliance and effectiveness of the treatment regimen.

 

Why Kaiser Permanente Might Deny Dulera Coverage

 

Possible Reasons for Dulera Coverage Denial

 

  • **Non-Formulary Status**: Dulera may be classified as a non-formulary medication, meaning it is not included in the list of approved medications covered by Kaiser Permanente.
  •  

  • **Lack of Medical Necessity**: If the prescription of Dulera is determined not to meet the criteria for medical necessity, Kaiser Permanente may deny coverage. This includes situations where alternative, covered medications are deemed sufficient.
  •  

  • **Duplicate Therapy**: Coverage may be denied if Dulera is prescribed alongside other similar medications without clear justification, as it could be considered as duplicate therapy.
  •  

  • **Specific Health Plan Limitations**: Some Kaiser Permanente health plans might have specific limitations or exclusions regarding the coverage of certain asthma or COPD medications, including Dulera.
  •  

  • **Failure to Follow Pre-Authorization Process**: If there is a requirement for pre-authorization for Dulera and the process is not correctly followed, coverage can be denied.
  •  

  • **Off-Label Use**: If Dulera is being prescribed for a condition that is not FDA-approved or recognized by Kaiser Permanente for Dulera, the medication coverage might be refused.

 

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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 Kaiser Permanente

 

Verify Your Coverage

 

  • Contact Kaiser Permanente's customer service to confirm if your current health plan includes prescription drug coverage.
  •  

  • Request specific information on Dulera coverage, including any potential restrictions or preferred drug lists (formularies).

 

Consult Your Physician

 

  • Schedule a visit with your Kaiser Permanente primary care physician to discuss your need for Dulera.
  •  

  • Ensure that your physician is aware of your medication history and any previous asthma treatments you have tried.

 

Prescription Submission

 

  • If your physician prescribes Dulera, they can typically submit the prescription electronically to a Kaiser Permanente pharmacy.
  •  

  • Verify with your physician that the prescription aligns with Kaiser's formulary for seamless coverage.

 

Pharmacy Coordination

 

  • Visit your designated Kaiser Permanente pharmacy or use their online pharmacy services to confirm the prescription fill process.
  •  

  • Inquire about any copayments, prior authorization requirements, or generic alternatives that can affect coverage.

 

Understand Your Benefits

 

  • Review your Kaiser Permanente benefits booklet or online account for detailed information on prescription costs and copayment structures.
  •  

  • Look out for any mailings or online notifications from Kaiser Permanente that might update you on changes to drug coverage.

 

Explore Financial Assistance

 

  • If Dulera costs are a concern, ask about Kaiser Permanente's financial assistance programs.
  •  

  • Consider discussing generic or therapeutic alternatives with your physician to reduce out-of-pocket expenses.

 

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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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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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