Does Molina Healthcare Cover Symbicort

Explore why Molina might deny Symbicort, how to secure coverage, costs without insurance, and frequently asked questions about Symbicort.
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Does Molina Healthcare Cover Symbicort?

 

  • Molina Healthcare may cover Symbicort, a medication for asthma and COPD, but coverage can vary by plan and location. To confirm, review the specific policy details or contact Molina directly.
  •  

  • Symbicort coverage might require prior authorization or be contingent on demonstrating medical necessity. This often involves documentation from your healthcare provider.
  •  

  • Patients typically need to have exhausted other medication options or have a physician's recommendation emphasizing the necessity of Symbicort for their condition.
  •  

  • Check for any formulary listings and determine which tier Symbicort is placed in, as higher tiers might result in increased out-of-pocket costs.
  •  

  • Co-pay assistance or participation in patient support programs may also affect the final cost, making it worthwhile to inquire about such options.

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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 Molina Healthcare

 

Verify Coverage with Molina Healthcare

 

  • Contact Molina Healthcare's customer service to confirm whether Symbicort is included in your plan's formulary. Have your member ID ready for a quicker response.
  •  

  • Visit the Molina Healthcare website and log into your member portal for information regarding prescription coverage and any updates specific to Symbicort.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Symbicort and obtain a prescription if clinically appropriate.
  •  

  • Ask your provider to check if there are any specific requirements or authorizations needed to ensure that Molina Healthcare covers the medication.

 

Check for Prior Authorization

 

  • Contact Molina Healthcare or check their formulary to see if Symbicort requires prior authorization.
  •  

  • If prior authorization is needed, have your healthcare provider submit a request detailing the medical necessity for Symbicort.

 

Review Deductibles and Copayment Options

 

  • Understand the costs associated with Symbicort under your plan by consulting the Molina Healthcare member services or reviewing your policy details.
  •  

  • Determine if any deductibles or copayments apply to your prescription for Symbicort.

 

Pharmacy Considerations

 

  • Use participating pharmacies within Molina Healthcare's network to fill your prescription. This will help you obtain the medication at the covered rate.
  •  

  • Verify with the pharmacy that they have processed the prescription with the correct authorization from Molina if needed.

 

Appeal Denials if Necessary

 

  • If your coverage for Symbicort is denied, request a formal explanation from Molina Healthcare and consult with your healthcare provider about the possibility of submitting an appeal.
  •  

  • Gather necessary documentation, including letters from your provider, and submit them in accordance with Molina's appeals process to contest the decision.

 

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FAQs

Does Molina Healthcare Cover Symbicort

Explore why Molina might deny Symbicort, how to secure coverage, costs without insurance, and frequently asked questions about Symbicort.
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Is Symbicort Covered by Molina Healthcare

 

Does Molina Healthcare Cover Symbicort?

 

  • Molina Healthcare may cover Symbicort, a medication for asthma and COPD, but coverage can vary by plan and location. To confirm, review the specific policy details or contact Molina directly.
  •  

  • Symbicort coverage might require prior authorization or be contingent on demonstrating medical necessity. This often involves documentation from your healthcare provider.
  •  

  • Patients typically need to have exhausted other medication options or have a physician's recommendation emphasizing the necessity of Symbicort for their condition.
  •  

  • Check for any formulary listings and determine which tier Symbicort is placed in, as higher tiers might result in increased out-of-pocket costs.
  •  

  • Co-pay assistance or participation in patient support programs may also affect the final cost, making it worthwhile to inquire about such options.

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Molina Healthcare's Approved Criteria for Symbicort Coverage

 

Criteria for Symbicort Coverage with Molina Healthcare

 

  • **Age and Diagnosis**: Coverage is provided for members who are 18 years of age or older with a diagnosis of asthma or chronic obstructive pulmonary disease (COPD).
  •  

  • **Asthma Management**: Coverage includes individuals with persistent asthma who require a combination therapy of a long-term inhaled corticosteroid and a long-acting beta-agonist, and have not achieved control with an inhaled corticosteroid alone.
  •  

  • **COPD Management**: Members with COPD who need improved symptom management not achieved with a single agent therapy are eligible for coverage of Symbicort.
  •  

  • **Documented Trial**: Prior prescription history should document a trial and failure, intolerance, or contraindication to alternative single or dual therapy asthma or COPD medications before Symbicort is approved.
  •  

  • **Provider Prescription**: Symbicort must be prescribed by a healthcare provider specializing in pulmonology, or a provider experienced in the treatment of asthma or COPD.
  •  

  • **Ongoing Evaluation**: Coverage is contingent upon regular follow-ups and evaluations by the prescribing healthcare provider to assess the effectiveness and necessity of continued Symbicort therapy.

 

Why Molina Healthcare Might Deny Symbicort Coverage

 

Symbicort Denial Situations by Molina Healthcare

 

  • Symbicort coverage may be denied if it is prescribed for off-label uses that are not approved by the FDA.
  •  

  • Molina Healthcare might not cover Symbicort if the prescriber does not provide sufficient documentation supporting its medical necessity.
  •  

  • A denial may occur if the patient has not tried and failed other formulary medications that are considered first-line therapy for their condition.
  •  

  • If the patient does not meet specific age requirements or health conditions outlined by Molina Healthcare's coverage policy for Symbicort, coverage may be refused.
  •  

  • Molina Healthcare may also deny Symbicort coverage if the medication does not adhere to step therapy protocols, which might require trying less expensive alternatives first.
  •  

  • Coverage might be denied if Symbicort is requested for a non-covered indication according to Molina Healthcare's formulary guidelines.
  •  

  • Symbicort could be excluded from coverage if it is not included in the patient's specific plan or formulary tier.
  •  

  • Molina Healthcare might deny coverage for Symbicort if the prescription exceeds the quantity limits set by the plan without prior authorization.
  •  

 

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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 Molina Healthcare

 

Verify Coverage with Molina Healthcare

 

  • Contact Molina Healthcare's customer service to confirm whether Symbicort is included in your plan's formulary. Have your member ID ready for a quicker response.
  •  

  • Visit the Molina Healthcare website and log into your member portal for information regarding prescription coverage and any updates specific to Symbicort.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Symbicort and obtain a prescription if clinically appropriate.
  •  

  • Ask your provider to check if there are any specific requirements or authorizations needed to ensure that Molina Healthcare covers the medication.

 

Check for Prior Authorization

 

  • Contact Molina Healthcare or check their formulary to see if Symbicort requires prior authorization.
  •  

  • If prior authorization is needed, have your healthcare provider submit a request detailing the medical necessity for Symbicort.

 

Review Deductibles and Copayment Options

 

  • Understand the costs associated with Symbicort under your plan by consulting the Molina Healthcare member services or reviewing your policy details.
  •  

  • Determine if any deductibles or copayments apply to your prescription for Symbicort.

 

Pharmacy Considerations

 

  • Use participating pharmacies within Molina Healthcare's network to fill your prescription. This will help you obtain the medication at the covered rate.
  •  

  • Verify with the pharmacy that they have processed the prescription with the correct authorization from Molina if needed.

 

Appeal Denials if Necessary

 

  • If your coverage for Symbicort is denied, request a formal explanation from Molina Healthcare and consult with your healthcare provider about the possibility of submitting an appeal.
  •  

  • Gather necessary documentation, including letters from your provider, and submit them in accordance with Molina's appeals process to contest the decision.

 

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

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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.

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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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