Does Oscar Health Cover Dulera

Explore Oscar Health's coverage for Dulera. Learn reasons for denial, how to secure coverage, costs without insurance, and find answers to your questions.
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Does Oscar Health Cover Dulera?

 

  • Dulera is typically covered by many health insurance plans, including Oscar Health, depending on the specific plan and its formulary.
  •  

  • Coverage usually includes situations where Dulera is prescribed for managing asthma to improve breathing.
  •  

  • Basic criteria for getting Dulera covered with Oscar Health generally involve a doctor's prescription specifically indicating its necessity for effective asthma management.
  •  

  • Patients might need to ensure their Oscar Health plan includes prescription drug coverage and verify Dulera is on the formulary list.
  •  

  • Pre-authorization from Oscar Health may be required, so checking with the provider before purchasing Dulera is advisable.

 

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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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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 Oscar Health

 

Understand Your Coverage Needs

 

  • Check if your current plan covers Dulera by reviewing your policy documents or logging into your Oscar Health member account.
  •  

  • Contact Oscar Health's customer service for clarification on prescription coverage related to Dulera.

 

Select the Right Health Plan

 

  • Research Oscar Health plans during the open enrollment period to find a plan that offers good prescription drug coverage.
  •  

  • Utilize the Oscar Health Plan Finder tool on their website to compare different plans and check if Dulera is included in the prescription drug coverage list.

 

Consult with Your Physician

 

  • Discuss with your healthcare provider about the importance of Dulera for your treatment and get a prescription.
  •  

  • Ensure your physician is within the Oscar Health network to keep costs lower and improve the chances of coverage approval.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request to Oscar Health, if needed. This may be required to justify the necessity of Dulera for your condition.
  •  

  • Attach any relevant medical documentation to support the need for Dulera in your treatment plan.

 

Use Oscar's Member Resources

 

  • Log into your Oscar Health member account to access resources like cost estimation tools and pharmacies that are part of the network for potentially lower rates.
  •  

  • Participate in Oscar Health's wellness programs and other incentives that may offer prescription benefits.

 

Appeal a Denial if Necessary

 

  • If your initial request for Dulera coverage is denied, contact Oscar Health to understand the denial reason.
  •  

  • File an appeal with supporting documentation if you believe Dulera should be covered under your plan.

 

Review Prescription Coverage Annually

 

  • During salary negotiation or plan renewal, confirm that your health plan continues to cover Dulera as your medical needs evolve.
  •  

  • Stay informed about any changes in your plan through emails or notifications from Oscar Health.

 

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FAQs

Does Oscar Health Cover Dulera

Explore Oscar Health's coverage for Dulera. Learn reasons for denial, how to secure coverage, costs without insurance, and find answers to your questions.
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Is Dulera Covered by Oscar Health

 

Does Oscar Health Cover Dulera?

 

  • Dulera is typically covered by many health insurance plans, including Oscar Health, depending on the specific plan and its formulary.
  •  

  • Coverage usually includes situations where Dulera is prescribed for managing asthma to improve breathing.
  •  

  • Basic criteria for getting Dulera covered with Oscar Health generally involve a doctor's prescription specifically indicating its necessity for effective asthma management.
  •  

  • Patients might need to ensure their Oscar Health plan includes prescription drug coverage and verify Dulera is on the formulary list.
  •  

  • Pre-authorization from Oscar Health may be required, so checking with the provider before purchasing Dulera is advisable.

 

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Oscar Health's Approved Criteria for Dulera Coverage

 

Oscar Health's Approved Criteria for Dulera Coverage

 

  • **Patient Diagnosis:** The patient must be diagnosed with asthma. Documentation from the healthcare provider should confirm this diagnosis as part of the initial assessment.
  •  

  • **Age Requirement:** Dulera is approved for patients aged 12 years and older. This age specification ensures the medicine is given to an appropriate age group as per medical guidelines.
  •  

  • **Previous Treatment:** The patient must have a trial and failure or contraindication/intolerance to a medium-dose inhaled corticosteroid plus a long-acting beta-agonist (LABA), such as Advair or Symbicort, unless such treatment is not appropriate based on the patient's medical history.
  •  

  • **Prescribing Physician:** The medication must be prescribed by a board-certified allergist, immunologist, pulmonologist, or a physician specializing in asthma management.
  •  

  • **Asthma Severity:** The patient needs to have a documented history of asthma severity that necessitates the use of Dulera, typically moderate to severe persistent asthma not well controlled on other medications.
  •  

  • **Monitoring:** The patient should agree to regular follow-ups with their healthcare provider to monitor asthma control and medication efficacy, ensuring Dulera remains the optimal choice for ongoing treatment.
  •  

  • **Combination Therapy:** Coverage is typically for Dulera when prescribed as part of a combination therapy plan alongside routine asthma management practices according to standard care protocols.
  •  

  • **Plan Requirements:** The patient's treatment plan must satisfy all current Oscar Health insurance policy requirements and guidelines for prescription coverage and must be consistent with FDA-approved indications.

 

Why Oscar Health Might Deny Dulera Coverage

 

Reasons for Dulera Coverage Denial by Oscar Health

 

  • **Non-Formulary Status**: Dulera might not be on Oscar Health's formulary list of covered drugs, leading to denial of coverage if there is no prior authorization or exception.
  •  

  • **Lack of Medical Necessity**: Coverage may be denied if Oscar Health determines that Dulera is not medically necessary based on the patient's diagnosis or medical history.
  •  

  • **Failure to Meet Prior Authorization Requirements**: Oscar Health may require prior authorization for Dulera, and failure to obtain this approval could result in denial of coverage.
  •  

  • **Existence of Therapeutic Alternatives**: If there are less expensive or equally effective therapeutic alternatives available, coverage for Dulera might be denied.
  •  

  • **Medication Usage Outside Approved Indications**: Using Dulera for conditions not listed in its FDA-approved indications might lead to a denial of coverage.
  •  

  • **Non-Compliance with Step Therapy Protocols**: Insurance may require trying other medications first (step therapy). Not following these steps might result in denial.
  •  

  • **Plan-Specific Exclusions**: Some specific Oscar Health plans might exclude coverage for certain medications, including Dulera, outright.

 

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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 Oscar Health

 

Understand Your Coverage Needs

 

  • Check if your current plan covers Dulera by reviewing your policy documents or logging into your Oscar Health member account.
  •  

  • Contact Oscar Health's customer service for clarification on prescription coverage related to Dulera.

 

Select the Right Health Plan

 

  • Research Oscar Health plans during the open enrollment period to find a plan that offers good prescription drug coverage.
  •  

  • Utilize the Oscar Health Plan Finder tool on their website to compare different plans and check if Dulera is included in the prescription drug coverage list.

 

Consult with Your Physician

 

  • Discuss with your healthcare provider about the importance of Dulera for your treatment and get a prescription.
  •  

  • Ensure your physician is within the Oscar Health network to keep costs lower and improve the chances of coverage approval.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request to Oscar Health, if needed. This may be required to justify the necessity of Dulera for your condition.
  •  

  • Attach any relevant medical documentation to support the need for Dulera in your treatment plan.

 

Use Oscar's Member Resources

 

  • Log into your Oscar Health member account to access resources like cost estimation tools and pharmacies that are part of the network for potentially lower rates.
  •  

  • Participate in Oscar Health's wellness programs and other incentives that may offer prescription benefits.

 

Appeal a Denial if Necessary

 

  • If your initial request for Dulera coverage is denied, contact Oscar Health to understand the denial reason.
  •  

  • File an appeal with supporting documentation if you believe Dulera should be covered under your plan.

 

Review Prescription Coverage Annually

 

  • During salary negotiation or plan renewal, confirm that your health plan continues to cover Dulera as your medical needs evolve.
  •  

  • Stay informed about any changes in your plan through emails or notifications from Oscar Health.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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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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.

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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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