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Does Oscar Health Cover Dupixent

Explore how Oscar Health covers Dupixent, ways to secure coverage, cost breakdown, and answers to FAQs in this insightful guide.

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Oscar Health Coverage for Dupixent

Oscar Health typically covers Dupixent for eligible members when it's prescribed for FDA-approved indications such as moderate-to-severe eczema, asthma, or chronic rhinosinusitis with nasal polyposis.

Coverage often requires prior authorization to ensure the medication is medically necessary.

Patients may need to show results of prior treatments or therapies to qualify for coverage of Dupixent.

Consistent communication with healthcare providers and the insurance company is essential for understanding specific plan requirements and restrictions.

Patients should check their specific Oscar Health plan details to understand the full criteria and process for obtaining coverage for Dupixent.

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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 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 Oscar Health

Initiate Coverage Inquiry

Contact Oscar Health customer service to inquire about coverage options for Dupixent. You can find contact details on their official website or your insurance card.

Explain your medical needs and why Dupixent is necessary for your treatment. Have your doctor's prescription details ready for reference.

Verify Prescription Drug Plan

Check your current Oscar Health plan details to see if Dupixent is included in the prescription drug formulary.

Utilize the member portal on the Oscar Health website to view and manage your planned benefits, specifically exploring the pharmacy benefits section.

Consult with Your Healthcare Provider

Discuss with your healthcare provider about the medical necessity of Dupixent and obtain any required documentation to support your need for this medication, such as prior authorization forms.

Ask your provider to issue a formal letter explaining the medical necessity of Dupixent, if required by your insurance plan.

Submit Required Documentation

Gather all necessary documentation including the authorized prescription form, the letter of necessity, and any prior authorizations.

Submit these documents to Oscar Health using their specified submission process, which could involve fax, email, or uploading via their member portal.

Follow Up and Confirmation

Regularly follow up with Oscar Health after submission to ensure your documents have been received and are being processed.

Once the review is complete, confirm if Dupixent is covered under your insurance plan and understand any copay or reimbursement details.

Explore Alternative Options if Necessary

If Dupixent is not immediately covered, discuss alternative solutions with your healthcare provider, including applying through patient assistance programs.

Consider appeal options with Oscar Health by understanding and following their processes for coverage denial appeals.

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FAQs

Does Oscar Health Cover Dupixent

Explore how Oscar Health covers Dupixent, ways to secure coverage, cost breakdown, and answers to FAQs in this insightful guide.

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Is Dupixent Covered by Oscar Health

Oscar Health Coverage for Dupixent

Oscar Health typically covers Dupixent for eligible members when it's prescribed for FDA-approved indications such as moderate-to-severe eczema, asthma, or chronic rhinosinusitis with nasal polyposis.

Coverage often requires prior authorization to ensure the medication is medically necessary.

Patients may need to show results of prior treatments or therapies to qualify for coverage of Dupixent.

Consistent communication with healthcare providers and the insurance company is essential for understanding specific plan requirements and restrictions.

Patients should check their specific Oscar Health plan details to understand the full criteria and process for obtaining coverage for Dupixent.

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Oscar Health's Approved Criteria for Dupixent Coverage

Approved Criteria for Dupixent Coverage by Oscar Health

**Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)**: Dupixent is approved for adult patients diagnosed with CRSwNP who have demonstrated an inadequate response to systemic corticosteroids or require surgeries, despite standard treatments.

**Moderate-to-Severe Asthma**: Coverage is available for patients 12 years and older who have moderate-to-severe asthma. These patients must have had an insufficient response to a medium-to-high dose inhaled corticosteroid and an additional controller such as a long-acting beta agonist.

**Atopic Dermatitis (Eczema)**: Adults and children aged 6 months and older with moderate-to-severe atopic dermatitis may be covered. The condition must not be adequately controlled with topical prescription therapies or when such therapies are not advisable.

**Eosinophilic Esophagitis (EoE)**: Dupixent coverage is approved for patients 12 years and older diagnosed with EoE who have difficulties in swallowing or are not responding to proton pump inhibitors or other therapies.

**Prurigo Nodularis**: Patients 18 years and older diagnosed with prurigo nodularis and experiencing severe itching not relieved by other treatments might receive coverage for Dupixent.

Why Oscar Health Might Deny Dupixent Coverage

Situations & Criteria Where Oscar Health Might Deny Dupixent Coverage

**Non-FDA Approved Indications**: If Dupixent is being prescribed for a condition that is not approved by the FDA, Oscar Health may deny coverage.

**Lack of prior authorization**: Dupixent requires prior authorization to ensure it's medically necessary. Failure to obtain this can result in denial.

**Non-compliance with step therapy**: If alternative treatments that are required as part of a step therapy protocol have not been tried first, Oscar Health may refuse coverage.

**Inadequate documentation**: Insufficient medical records or lack of necessary documentation to prove medical necessity can lead to denial.

**Off-label use**: Prescriptions intended for uses not listed on the approved label may not be covered.

**Plan-specific exclusions**: If the individual's insurance plan has specific exclusions for biological medications or Dupixent itself, coverage may be denied.

**Cost-ineffectiveness**: In cases where Dupixent is not deemed cost-effective compared to other available treatments, coverage may be denied.

**Non-network pharmacy use**: If prescribed through a pharmacy that is not within Oscar Health’s approved network, coverage for Dupixent may be refused.

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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 Oscar Health

Initiate Coverage Inquiry

Contact Oscar Health customer service to inquire about coverage options for Dupixent. You can find contact details on their official website or your insurance card.

Explain your medical needs and why Dupixent is necessary for your treatment. Have your doctor's prescription details ready for reference.

Verify Prescription Drug Plan

Check your current Oscar Health plan details to see if Dupixent is included in the prescription drug formulary.

Utilize the member portal on the Oscar Health website to view and manage your planned benefits, specifically exploring the pharmacy benefits section.

Consult with Your Healthcare Provider

Discuss with your healthcare provider about the medical necessity of Dupixent and obtain any required documentation to support your need for this medication, such as prior authorization forms.

Ask your provider to issue a formal letter explaining the medical necessity of Dupixent, if required by your insurance plan.

Submit Required Documentation

Gather all necessary documentation including the authorized prescription form, the letter of necessity, and any prior authorizations.

Submit these documents to Oscar Health using their specified submission process, which could involve fax, email, or uploading via their member portal.

Follow Up and Confirmation

Regularly follow up with Oscar Health after submission to ensure your documents have been received and are being processed.

Once the review is complete, confirm if Dupixent is covered under your insurance plan and understand any copay or reimbursement details.

Explore Alternative Options if Necessary

If Dupixent is not immediately covered, discuss alternative solutions with your healthcare provider, including applying through patient assistance programs.

Consider appeal options with Oscar Health by understanding and following their processes for coverage denial appeals.

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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 Oscar Health Cover Dupixent

Explore how Oscar Health covers Dupixent, ways to secure coverage, cost breakdown, and answers to FAQs in this insightful guide.

Achieve Your Goals Faster with Curex