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Does Medica Cover Dupixent

Learn about Medica's Dupixent coverage, reasons for denial, securing coverage, costs without insurance, and find answers in our FAQ.

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Does Medica Cover Dupixent

Medica often covers Dupixent for conditions like moderate-to-severe atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyps.

Coverage typically requires prior authorization, verifying that standard treatments were ineffective or inappropriate.

Criteria include diagnosis confirmation, detailed medical history, and previous treatment attempts.

Consult Medica's specific policy documents or contact them directly, as coverage terms can vary by plan and state regulations.

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

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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.

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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 Dupixent Coverage with Medica

Contact Medica Customer Service

Start by calling Medica's customer service number listed on your insurance card to inquire about coverage for Dupixent.

Ask for specifics regarding any documentation or prior authorizations needed for Dupixent.

Review Your Plan's Formulary

Log into your Medica member portal to view your plan's formulary. Confirm if Dupixent is listed as a covered medication.

If Dupixent is listed, check the tier category it falls under, which can affect your co-pay or coverage requirements.

Consult with Your Healthcare Provider

Discuss with your doctor about the medical necessity of Dupixent. Request that they prepare any necessary documentation to support why Dupixent is required for your treatment.

Ensure your healthcare provider is aware of Medica's requirements for prior authorization and can assist in handling any required paperwork.

Gather Required Documentation

Collect all relevant medical documentation, including past treatments and medical history, showing the necessity for Dupixent.

Prepare this documentation to be submitted to Medica, along with any forms they require.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request. This may include filling out specific forms provided by Medica.

Ensure all supporting medical documentation accompanies the request, clearly outlining why Dupixent is medically necessary.

Follow Up with Medica

After submission, follow up with Medica regularly to track the status of your prior authorization request.

Maintain records of any communications, reference numbers, and keep detailed notes on any response from Medica.

Appeal If Necessary

If your application is denied, review the reasons provided by Medica thoroughly.

File an appeal promptly, providing additional documentation or clarifications to counter any reasons for denial.

Consider Patient Assistance Programs

If coverage issues persist, research potential pharmaceutical assistance programs offered by the manufacturer of Dupixent for eligible patients.

Contact Dupixent MyWay, the manufacturer’s patient assistance program, for guidance and potential financial aid.

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FAQs

Does Medica Cover Dupixent

Learn about Medica's Dupixent coverage, reasons for denial, securing coverage, costs without insurance, and find answers in our FAQ.

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Is Dupixent Covered by Medica

Does Medica Cover Dupixent

Medica often covers Dupixent for conditions like moderate-to-severe atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyps.

Coverage typically requires prior authorization, verifying that standard treatments were ineffective or inappropriate.

Criteria include diagnosis confirmation, detailed medical history, and previous treatment attempts.

Consult Medica's specific policy documents or contact them directly, as coverage terms can vary by plan and state regulations.

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Medica's Approved Criteria for Dupixent Coverage

Coverage Criteria for Dupixent

Dupixent is covered for individuals diagnosed with moderate to severe atopic dermatitis who have not responded adequately to topical prescription treatments or when those treatments are not advisable.

Individuals with moderately to severely active eosinophilic esophagitis will be eligible for Dupixent coverage when the diagnosis is confirmed and there is evidence of persistent symptoms despite treatment.

To qualify, patients with chronic rhinosinusitis with nasal polyps must have evidence of recurrent symptoms and insufficient response to corticosteroids or other conventional therapies.

Coverage for Dupixent is approved for patients with severe asthma characterized by elevated eosinophil levels, who have shown inadequate control with high-dose inhaled corticosteroids and other controllers.

For patients diagnosed with prurigo nodularis, Dupixent is covered when conventional therapy options have failed to provide sufficient control over symptoms.

Patients with a confirmed diagnosis of moderate to severe chronic spontaneous urticaria that is not sufficiently controlled with H1-antihistamines will be eligible for Dupixent therapy.

Why Medica Might Deny Dupixent Coverage

Reasons Medica Might Deny Dupixent Coverage

**Non-Approved Indications**: Medica may deny Dupixent if it is prescribed for an indication not approved by the FDA. The medication must be used strictly within the approved uses to qualify for coverage.

**Lack of Medical Necessity**: If Medica assesses that Dupixent is not medically necessary based on the patient's specific condition, they might deny coverage. Comprehensive medical documentation is often required to establish necessity.

**Incomplete Prior Authorization**: Dupixent requires prior authorization. If this process is not completed correctly or lacks the necessary supporting documents, coverage might be denied.

**Failure to Meet Step Therapy Requirements**: Medica may require patients to try other, less expensive treatments before approving Dupixent. If these requirements are not fulfilled, coverage can be denied.

**Exclusion of Specific Conditions**: Coverage may be denied if the patient's condition is explicitly excluded from Dupixent's coverage criteria as per Medica's policy guidelines.

**Non-Compliance with Guidelines**: Use of Dupixent that does not align with Medica's clinical guidelines or protocols might lead to coverage denial.

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How Much Does Dupixent Cost without Insurance?

Approximate Cost of Dupixent Without Insurance

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

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

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

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

Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

Kayla Mardaga, NP

How to Get Dupixent Coverage with Medica

Contact Medica Customer Service

Start by calling Medica's customer service number listed on your insurance card to inquire about coverage for Dupixent.

Ask for specifics regarding any documentation or prior authorizations needed for Dupixent.

Review Your Plan's Formulary

Log into your Medica member portal to view your plan's formulary. Confirm if Dupixent is listed as a covered medication.

If Dupixent is listed, check the tier category it falls under, which can affect your co-pay or coverage requirements.

Consult with Your Healthcare Provider

Discuss with your doctor about the medical necessity of Dupixent. Request that they prepare any necessary documentation to support why Dupixent is required for your treatment.

Ensure your healthcare provider is aware of Medica's requirements for prior authorization and can assist in handling any required paperwork.

Gather Required Documentation

Collect all relevant medical documentation, including past treatments and medical history, showing the necessity for Dupixent.

Prepare this documentation to be submitted to Medica, along with any forms they require.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request. This may include filling out specific forms provided by Medica.

Ensure all supporting medical documentation accompanies the request, clearly outlining why Dupixent is medically necessary.

Follow Up with Medica

After submission, follow up with Medica regularly to track the status of your prior authorization request.

Maintain records of any communications, reference numbers, and keep detailed notes on any response from Medica.

Appeal If Necessary

If your application is denied, review the reasons provided by Medica thoroughly.

File an appeal promptly, providing additional documentation or clarifications to counter any reasons for denial.

Consider Patient Assistance Programs

If coverage issues persist, research potential pharmaceutical assistance programs offered by the manufacturer of Dupixent for eligible patients.

Contact Dupixent MyWay, the manufacturer’s patient assistance program, for guidance and potential financial aid.

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Dupixent FAQ

1. What are the common side effects of Dupixent?

Common Side Effects of Dupixent

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

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

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

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

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

2. How does Dupixent work for eczema?

How Dupixent Works for Eczema

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

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

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

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

3. Is Dupixent used for asthma treatment?

Dupixent for Asthma

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

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

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

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

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

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Initial Dosage

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

Titration

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

Additional Treatments

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

Got questions? We have answers.

Do your plans include prescriptions and medications?

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

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

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

What medications do your providers prescribe?

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

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

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

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

Will I be prescribed semaglutide?

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

What is compounded medication?

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

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

Is compounded medication the same as generic medication?

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

Is insurance required?

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

Can I pay with an FSA or HSA card?

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

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

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

What states do you serve?

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

Does Medica Cover Dupixent

Learn about Medica's Dupixent coverage, reasons for denial, securing coverage, costs without insurance, and find answers in our FAQ.

Achieve Your Goals Faster with Curex