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Does Network Health Cover Dupixent

Explore why Network Health may deny Dupixent, how to get coverage, Dupixent costs without insurance, and FAQs for informed choices.

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Coverage for Dupixent by Network Health

Network Health may cover Dupixent for specific chronic conditions such as moderate-to-severe atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis.

Approval usually requires documented evidence that standard treatments were attempted and proved ineffective.

Dupixent coverage often mandates prior authorization. The prescribing healthcare provider must submit necessary documentation, including clinical notes and treatment history.

Eligibility criteria typically include patient age and confirmation of diagnosis according to medical guidelines.

Patients may need to meet certain health plan tier requirements, which could affect the out-of-pocket costs.

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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 Dupixent Coverage with Network Health

Start by Contacting Network Health

Reach out to Network Health's customer service. This can usually be done through a phone call or via their website contact form.
Ask for assistance in understanding the coverage options available for Dupixent under your specific Network Health plan.
Request detailed information on their specialty drug coverage policy if required.

Check Plan and Prescription Details

Review your Network Health plan to ensure that it includes prescription drug coverage.
If Dupixent is not listed in your plan's formulary, inquire about the possibility of an exception or alternative drug coverage.
Understand any specific steps or prerequisites needed to pursue coverage for Dupixent.

Coordinate with Your Healthcare Provider

Consult with your healthcare provider to discuss your medical need. Confirm that Dupixent is a recommended treatment option for you.
Ask your provider to provide necessary documentation or letters of medical necessity which may be required by Network Health.
Ensure your provider sends in a prescription to a network pharmacy if Network Health requires it to process claims.

Pre-authorization and Documentation

Complete any pre-authorization forms that Network Health requires for Dupixent. This is crucial as some medications require pre-approval before coverage is automatic.
Have your healthcare provider submit medical records or additional documentation that demonstrate the medical necessity for Dupixent.
Familiarize yourself with any specific Network Health policies about designees or agents who can assist with submitting documentation.

Follow Up on Authorization Status

Maintain regular contact with Network Health to check on the status of your pre-authorization request.
If there are delays, inquire about the reason and any additional information they may need to expedite the process.
Get a confirmation from Network Health once the authorization is approved to prevent any confusion at the pharmacy.

Fill Your Prescription

Once authorization is granted, proceed to fill your prescription at a Network Health affiliated pharmacy.
Ensure the pharmacy has updated records regarding your coverage for Dupixent to avoid any out-of-pocket surprises.
Inquire about any copay assistance programs or deductibles that apply to your Dupixent prescription.

Appeal if Necessary

If your coverage for Dupixent is denied, ask for a detailed explanation and the steps needed to appeal the decision.
Gather additional supporting documents with your healthcare provider to strengthen your appeal.
Follow Network Health's formal appeal process to contest the denial, ensuring all submissions are within their specified timelines.

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Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Network Health Cover Dupixent

Explore why Network Health may deny Dupixent, how to get coverage, Dupixent costs without insurance, and FAQs for informed choices.

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Is Dupixent Covered by Network Health

Coverage for Dupixent by Network Health

Network Health may cover Dupixent for specific chronic conditions such as moderate-to-severe atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis.

Approval usually requires documented evidence that standard treatments were attempted and proved ineffective.

Dupixent coverage often mandates prior authorization. The prescribing healthcare provider must submit necessary documentation, including clinical notes and treatment history.

Eligibility criteria typically include patient age and confirmation of diagnosis according to medical guidelines.

Patients may need to meet certain health plan tier requirements, which could affect the out-of-pocket costs.

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Network Health's Approved Criteria for Dupixent Coverage

Eligibility for Dupixent Coverage

Patient must have a confirmed diagnosis of moderate-to-severe atopic dermatitis, eosinophilic asthma, or chronic rhinosinusitis with nasal polyposis.

Must demonstrate an inadequate response, intolerance, or contraindication to at least one conventional systemic therapy.

Age Requirements

Patients must be 6 years of age or older for atopic dermatitis coverage.

For eosinophilic asthma, patients must be 12 years of age or older.

For chronic rhinosinusitis with nasal polyposis, patients must be 18 years of age or older.

Physician Documentation

Physician records must demonstrate confirmed diagnosis supported by appropriate clinical findings.

Documented history of treatments and responses to previous therapies is required.

Prior Authorization Requirements

A prior authorization from a healthcare provider is mandatory and must include all relevant clinical information.

Reasons for considering Dupixent over other therapies must be clearly stated in the authorization request.

Continuation and Monitoring

Status of symptoms must be monitored regularly to assess therapeutic effectiveness.

Continuation of coverage requires documented improvement in condition as assessed by the healthcare provider.

Why Network Health Might Deny Dupixent Coverage

Reasons for Dupixent Coverage Denial by Network Health

Dupixent is prescribed for an off-label use that is not supported by sufficient clinical evidence.

The patient does not meet the specific diagnostic criteria required for coverage of Dupixent, such as confirmed diagnosis of a condition approved by Network Health guidelines.

The medication is being requested for a condition that is explicitly excluded from Network Health's coverage policies.

Previous treatments have not been tried and documented as required by the Network Health step therapy protocol.

There is a lack of documented medical necessity or insufficient clinical justification in the physician's submission.

Dupixent is requested for a condition for which there are more cost-effective alternatives that the patient has not yet tried.

The request does not comply with Network Health’s quantity limitations or dosing restrictions for Dupixent.

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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 Network Health

Start by Contacting Network Health

Reach out to Network Health's customer service. This can usually be done through a phone call or via their website contact form.
Ask for assistance in understanding the coverage options available for Dupixent under your specific Network Health plan.
Request detailed information on their specialty drug coverage policy if required.

Check Plan and Prescription Details

Review your Network Health plan to ensure that it includes prescription drug coverage.
If Dupixent is not listed in your plan's formulary, inquire about the possibility of an exception or alternative drug coverage.
Understand any specific steps or prerequisites needed to pursue coverage for Dupixent.

Coordinate with Your Healthcare Provider

Consult with your healthcare provider to discuss your medical need. Confirm that Dupixent is a recommended treatment option for you.
Ask your provider to provide necessary documentation or letters of medical necessity which may be required by Network Health.
Ensure your provider sends in a prescription to a network pharmacy if Network Health requires it to process claims.

Pre-authorization and Documentation

Complete any pre-authorization forms that Network Health requires for Dupixent. This is crucial as some medications require pre-approval before coverage is automatic.
Have your healthcare provider submit medical records or additional documentation that demonstrate the medical necessity for Dupixent.
Familiarize yourself with any specific Network Health policies about designees or agents who can assist with submitting documentation.

Follow Up on Authorization Status

Maintain regular contact with Network Health to check on the status of your pre-authorization request.
If there are delays, inquire about the reason and any additional information they may need to expedite the process.
Get a confirmation from Network Health once the authorization is approved to prevent any confusion at the pharmacy.

Fill Your Prescription

Once authorization is granted, proceed to fill your prescription at a Network Health affiliated pharmacy.
Ensure the pharmacy has updated records regarding your coverage for Dupixent to avoid any out-of-pocket surprises.
Inquire about any copay assistance programs or deductibles that apply to your Dupixent prescription.

Appeal if Necessary

If your coverage for Dupixent is denied, ask for a detailed explanation and the steps needed to appeal the decision.
Gather additional supporting documents with your healthcare provider to strengthen your appeal.
Follow Network Health's formal appeal process to contest the denial, ensuring all submissions are within their specified timelines.

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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 Network Health Cover Dupixent

Explore why Network Health may deny Dupixent, how to get coverage, Dupixent costs without insurance, and FAQs for informed choices.

Achieve Your Goals Faster with Curex