Does MDwise Cover Symbicort

Explore Symbicort coverage under MDwise, learn about potential denials, tips for coverage approval, out-of-pocket costs, and answers to common questions.
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MDwise Coverage for Symbicort

 

  • MDwise typically covers Symbicort with prior authorization. Members may need to meet certain medical criteria for coverage approval.
  •  

  • Coverage generally applies to individuals diagnosed with asthma or COPD who have tried other medications without adequate control.
  •  

  • A healthcare provider must demonstrate medical necessity through documentation and submit a request for authorization.
  •  

    Basic Rules and Criteria

     

    • The patient's medical history and previous medication trials should be documented to support the need for Symbicort.
    •  

    • Ensure the prescribed dosage aligns with established guidelines to avoid coverage issues.
    •  

    • Check if there are any step therapy requirements, where less expensive treatments must be tried first.
    •  

    • Maintain compliance with MDwise policies and any changes in formulary status to ensure continued coverage.

     

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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 Symbicort Coverage with MDwise

 

Determine Your Eligibility

 

  • Contact MDwise customer service to understand your eligibility for prescription drug coverage as part of their insurance plans.
  •  

  • Review your current MDwise plan documents to confirm whether Symbicort is covered under your plan.
  •  

  • Check if there are any specific requirements or pre-approvals needed to get Symbicort covered.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the necessity of Symbicort for your treatment plan.
  •  

  • Ensure that your doctor is aware of MDwise's coverage policies and any necessary steps to prescribe Symbicort under your plan.
  •  

  • Request that your healthcare provider submit any required documentation to MDwise that justifies the medical necessity of Symbicort.

 

Prescription Submission Process

 

  • Once your healthcare provider prescribes Symbicort, ensure that the prescription is sent to a pharmacy that accepts MDwise insurance.
  •  

  • Verify with your pharmacy whether they have received prior authorization from MDwise if required for Symbicort.
  •  

  • If prior authorization is needed, work with your healthcare provider and pharmacy to expedite the process.

 

Understand Your Benefits

 

  • Review your MDwise benefits information to understand the copay or coinsurance you may owe for Symbicort.
  •  

  • Identify any cost-saving options available through MDwise, such as mail-order pharmacies or preferred pharmacy networks, to reduce your out-of-pocket costs.
  •  

  • For additional financial assistance, inquire if MDwise offers any patient assistance programs for those struggling with medication costs.

 

Follow Up and Monitor

 

  • After obtaining Symbicort, continue to monitor your MDwise claims to ensure they have processed your prescription correctly.
  •  

  • If you encounter any issues, contact MDwise customer support as soon as possible for clarification or resolution.
  •  

  • Maintain records of all communications with MDwise, your healthcare provider, and pharmacy for future reference.

 

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FAQs

Does MDwise Cover Symbicort

Explore Symbicort coverage under MDwise, learn about potential denials, tips for coverage approval, out-of-pocket costs, and answers to common questions.
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Is Symbicort Covered by MDwise

 

MDwise Coverage for Symbicort

 

  • MDwise typically covers Symbicort with prior authorization. Members may need to meet certain medical criteria for coverage approval.
  •  

  • Coverage generally applies to individuals diagnosed with asthma or COPD who have tried other medications without adequate control.
  •  

  • A healthcare provider must demonstrate medical necessity through documentation and submit a request for authorization.
  •  

    Basic Rules and Criteria

     

    • The patient's medical history and previous medication trials should be documented to support the need for Symbicort.
    •  

    • Ensure the prescribed dosage aligns with established guidelines to avoid coverage issues.
    •  

    • Check if there are any step therapy requirements, where less expensive treatments must be tried first.
    •  

    • Maintain compliance with MDwise policies and any changes in formulary status to ensure continued coverage.

     

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MDwise's Approved Criteria for Symbicort Coverage

 

Eligibility Criteria for Symbicort Coverage

 

  • Members must be diagnosed with asthma or chronic obstructive pulmonary disease (COPD) by a healthcare provider.
  • Symbicort is considered when other treatments have failed, are contraindicated, or not tolerated by the member.
  • Coverage is based on a prescription from a licensed healthcare provider indicating the need for Symbicort as a part of chronic respiratory treatment.
  • Members should be at least 12 years old to receive coverage for Symbicort for asthma; adults are eligible for COPD.

 

Documentation Requirements

 

  • A completed prior authorization form must be submitted by the prescribing provider demonstrating medical necessity.
  • Clinical notes must include detailed documentation of the member's diagnosis referencing specific clinical guidelines.
  • Providers should include records of previous medications and treatments tried, with documented evidence of ineffectiveness or adverse reactions.

 

Continued Coverage

 

  • For continued coverage, follow-ups must be scheduled periodically, and the results should show the efficacy of Symbicort in managing the member's condition.
  • Providers need to submit documentation of improved symptom control or quality of life as a result of Symbicort use.
  • Renewal requests should demonstrate ongoing monitoring and assessment plans, including any adjustments to treatment strategies if necessary.

 

Pharmacy Network Restrictions

 

  • Symbicort must be dispensed through MDwise-approved pharmacies to ensure coverage.
  • Members should use MDwise's preferred pharmacy network, which may provide Symbicort at a reduced co-pay.
  • Specialty pharmacy services may be required for distribution, ensuring appropriate handling and monitoring.

 

Why MDwise Might Deny Symbicort Coverage

 

Reasons Why MDwise Might Deny Symbicort Coverage

 

  • The prescription does not meet the plan's medical necessity criteria or lacks required documentation to support its necessity.
  •  

  • The requested dosage or quantity of Symbicort exceeds MDwise's allowable limits, and there is no prior authorization approved to override these limits.
  •  

  • The patient has not complied with MDwise’s step therapy program, which requires trying and failing less expensive alternatives before considering Symbicort.
  •  

  • Symbicort is not included in the MDwise preferred drug list or formulary, and no exceptions are granted or approved appeal made.
  •  

  • A duplicate or concurrent therapy is identified, meaning another similar medication has already been covered for the patient during the same treatment period.
  •  

  • The patient is not enrolled in an eligible plan that provides coverage for Symbicort, thereby falling outside the coverage parameters for this medication.

 

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How Much Does Symbicort Cost without Insurance?

 

Cost of Symbicort without Insurance

 

  • Symbicort is a prescription medication commonly used to treat asthma and chronic obstructive pulmonary disease (COPD). Without insurance, its cost can be quite high, varying largely due to factors such as dosage, pharmacy, and location. On average, the out-of-pocket cost for a 30-day supply of Symbicort (160/4.5 mcg) inhaler is around $250 to $350.
  •  

  • Prices can vary significantly from one pharmacy to another. Some big-box or discount pharmacies might offer slightly lower prices, while smaller local pharmacies may have higher rates without insurance discounts.
  •  

  • Patients can also explore manufacturer coupons or patient assistance programs, which might help reduce the overall cost. Additionally, online resources and discount cards may offer ways to slightly lower the cash price at participating pharmacies.
  •  

  • It's advisable for patients to check various pharmacies to ensure they are getting the best possible price. Comparing online pharmacy prices and visiting discount retailers could help mitigate high costs when paying out-of-pocket.

 

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 Symbicort Coverage with MDwise

 

Determine Your Eligibility

 

  • Contact MDwise customer service to understand your eligibility for prescription drug coverage as part of their insurance plans.
  •  

  • Review your current MDwise plan documents to confirm whether Symbicort is covered under your plan.
  •  

  • Check if there are any specific requirements or pre-approvals needed to get Symbicort covered.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the necessity of Symbicort for your treatment plan.
  •  

  • Ensure that your doctor is aware of MDwise's coverage policies and any necessary steps to prescribe Symbicort under your plan.
  •  

  • Request that your healthcare provider submit any required documentation to MDwise that justifies the medical necessity of Symbicort.

 

Prescription Submission Process

 

  • Once your healthcare provider prescribes Symbicort, ensure that the prescription is sent to a pharmacy that accepts MDwise insurance.
  •  

  • Verify with your pharmacy whether they have received prior authorization from MDwise if required for Symbicort.
  •  

  • If prior authorization is needed, work with your healthcare provider and pharmacy to expedite the process.

 

Understand Your Benefits

 

  • Review your MDwise benefits information to understand the copay or coinsurance you may owe for Symbicort.
  •  

  • Identify any cost-saving options available through MDwise, such as mail-order pharmacies or preferred pharmacy networks, to reduce your out-of-pocket costs.
  •  

  • For additional financial assistance, inquire if MDwise offers any patient assistance programs for those struggling with medication costs.

 

Follow Up and Monitor

 

  • After obtaining Symbicort, continue to monitor your MDwise claims to ensure they have processed your prescription correctly.
  •  

  • If you encounter any issues, contact MDwise customer support as soon as possible for clarification or resolution.
  •  

  • Maintain records of all communications with MDwise, your healthcare provider, and pharmacy for future reference.

 

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Symbicort FAQ

1. What are the side effects of Symbicort?

 

Common Side Effects of Symbicort

 

  • Headache: Frequently reported and usually mild.
  • Throat irritation: Can occur due to inhalation route.
  • Hoarseness: Temporary voice changes may be noticed.
  • Cough: Occasional, linked to inhaler use.

 

Less Common Side Effects

 

  • Nausea: A less frequent side effect.
  • Increased blood pressure: Monitor regularly.
  • Palpitations: Uncommon but notable.
  • Muscle cramps: May occur in some patients.

 

Rare but Serious Side Effects

 

  • Allergic reactions: Rash, itching, or difficulty breathing.
  • Worsening of asthma: Requires immediate attention.
  • Pneumonia: Particularly in COPD patients.
  • Cardiac arrhythmias: Monitor heart rhythm.

 

2. How does Symbicort work for asthma?

 

How Symbicort Works

 

  • Combination Therapy: Symbicort contains budesonide, a corticosteroid, and formoterol, a long-acting beta-agonist. Together, they manage asthma by reducing inflammation and opening airways.
  •  

  • Inflammation Control: Budesonide targets the inflammatory process in the lungs, decreasing swelling and irritation to prevent asthma symptoms.
  •  

  • Bronchodilation: Formoterol relaxes muscles around the airways, quickly improving breathing and reducing wheezing.
  •  

  • Maintenance and Relief: While primarily for maintenance, Symbicort provides relief from symptoms and reduces the frequency of asthma attacks.

 

3. Is Symbicort a steroid inhaler?

 

Is Symbicort a Steroid Inhaler?

 

  • Yes, Symbicort is a combination inhaler that contains a steroid. It combines budesonide, a corticosteroid, and formoterol, a long-acting beta agonist (LABA).
  •  

  • Corticosteroids like budesonide help to reduce inflammation in the airways, which is crucial for managing asthma and chronic obstructive pulmonary disease (COPD).
  •  

  • Formoterol helps in relaxing the muscles around the airways to make breathing easier.
  •  

  • Symbicort is prescribed for long-term management and not for immediate relief of acute symptoms.
  •  

  • Regular use is essential to decrease the chance of flare-ups and improve overall lung function.

 

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Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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