Does Oscar Health Cover Symbicort

Explore Symbicort coverage with Oscar Health, reasons for denial, tips for obtaining coverage, cost without insurance, and FAQs in this comprehensive guide.
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Overview of Oscar Health and Symbicort Coverage

 

  • Oscar Health generally includes coverage for prescription medications, which may include Symbicort, depending on your specific plan and tier formulary.

 

Situations Covered

 

  • Symbicort is typically covered when prescribed for asthma or chronic obstructive pulmonary disease (COPD), considering the patient's therapeutic needs.
  • Coverage may require prior authorization, particularly for long-term use.

 

Basic Rules and Criteria

 

  • Patients usually need a valid prescription and diagnosis aligning with Oscar's plan specifications for Symbicort coverage.
  • Prior authorization may be necessary to confirm the medical need and compliance with insurance policies.
  • Utilizing in-network pharmacies ensures coverage benefits.

 

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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 Oscar Health

 

Check Your Plan Coverage

 

  • Contact Oscar Health directly by calling their customer service number found on your insurance card or their website. Ask them if Symbicort is covered under your current health plan.
  •  

  • Log into your Oscar Health online account to review your benefits manually. Check if Symbicort is listed under covered medications.
  •  

 

Consult with Your Doctor

 

  • Discuss your need for Symbicort with your healthcare provider. Ensure they deem it medically necessary and are willing to provide the appropriate documentation to Oscar Health.
  •  

  • Your doctor can suggest alternatives if Symbicort is not covered, or assist in the appeals process for coverage.

 

Request Prior Authorization

 

  • Work with your healthcare provider to obtain a prior authorization if needed. This is often required when a medication is not initially covered.
  •  

  • Your doctor will submit the necessary forms and documentation to Oscar Health on your behalf.

 

File an Appeal if Necessary

 

  • If your initial request is denied, file an appeal with Oscar Health. Obtain the appeal forms from their website or customer service.
  •  

  • Include supporting documentation from your healthcare provider explaining the necessity of Symbicort for your treatment.
  •  

  • Follow up regularly with Oscar Health to check the status of your appeal.

 

Utilize Pharmacy Benefits

 

  • Check if any participating pharmacies under your Oscar Health plan offer discounts or additional programs for medications like Symbicort.
  •  

  • Some pharmacies have savings programs which might help reduce out-of-pocket costs for drugs not covered by your plan.

 

Explore Additional Resources

 

  • Look into manufacturer coupon programs or direct patient assistance from the Symbicort manufacturer, which may offer discounts or cost-saving plans.
  •  

  • Consider speaking with a healthcare advocate or consultant, who can assist in navigating insurance challenges.

 

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FAQs

Does Oscar Health Cover Symbicort

Explore Symbicort coverage with Oscar Health, reasons for denial, tips for obtaining coverage, cost without insurance, and FAQs in this comprehensive guide.
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Is Symbicort Covered by Oscar Health

 

Overview of Oscar Health and Symbicort Coverage

 

  • Oscar Health generally includes coverage for prescription medications, which may include Symbicort, depending on your specific plan and tier formulary.

 

Situations Covered

 

  • Symbicort is typically covered when prescribed for asthma or chronic obstructive pulmonary disease (COPD), considering the patient's therapeutic needs.
  • Coverage may require prior authorization, particularly for long-term use.

 

Basic Rules and Criteria

 

  • Patients usually need a valid prescription and diagnosis aligning with Oscar's plan specifications for Symbicort coverage.
  • Prior authorization may be necessary to confirm the medical need and compliance with insurance policies.
  • Utilizing in-network pharmacies ensures coverage benefits.

 

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Oscar Health's Approved Criteria for Symbicort Coverage

 

Eligibility Criteria for Symbicort Coverage

 

  • Members must have a documented diagnosis of asthma or Chronic Obstructive Pulmonary Disease (COPD) confirmed by a healthcare provider.
  •  

  • Before approving Symbicort, the patient must have tried and shown an inadequate response or intolerance to at least one other asthma or COPD maintenance therapy, unless contraindicated.
  •  

  • A healthcare provider must submit a detailed rationale explaining why other therapies are not suitable for the patient in question. This may include specific medical notes, test results, or documented adverse reactions.

 

Prescription Dosage Requirements

 

  • The prescribed dosage must adhere to FDA-approved guidelines for the treatment of asthma or COPD, as appropriate for the patient's age and condition.
  •  

  • Coverage is available for the strength and formulation prescribed, provided it matches standard treatment protocols for the patient's condition.

 

Continuity of Coverage

 

  • For continued coverage, the prescribing healthcare provider must periodically reassess the patient’s condition and provide documentation verifying the ongoing necessity and effectiveness of Symbicort therapy.
  •  

  • Continuation of coverage depends on adherence to the prescribed treatment regimen and regular follow-up appointments as advised by the healthcare provider.

 

Prior Authorization Process

 

  • A prior authorization request must be submitted by the prescribing physician, including all necessary clinical documentation, medical history, and rationale for using Symbicort over alternative therapies.
  •  

  • Requests are evaluated based on medical necessity, and approval is contingent upon meeting all aforementioned criteria.

 

Why Oscar Health Might Deny Symbicort Coverage

 

Reasons Oscar Health Might Deny Symbicort Coverage

 

  • **Non-Formulary Medication:** Symbicort may not be included in Oscar Health's formulary list, which contains approved medications that are covered.
  •  

  • **Lack of Prior Authorization:** If prior authorization is required and not obtained, coverage for Symbicort might be denied.
  •  

  • **Step Therapy Requirements:** Patients may be required to try other medications first. If these are not followed, coverage might be denied for Symbicort.
  •  

  • **Off-Label Use:** Symbicort prescribed for an unapproved condition or dosage that is off-label might not be covered.
  •  

  • **Non-Network Provider:** If the prescription is written by a provider not in Oscar Health's network, coverage might not be valid.
  •  

  • **Plan Exclusions:** Certain plans may have specific exclusions for certain medications, including Symbicort.
  •  

  • **Expired Prescription:** If the prescription is outdated, Oscar Health might deny coverage for Symbicort.
  •  

  • **Policy Lapses:** If there is any lapse in the insurance policy or the premium is not paid, Symbicort coverage might be denied.
  •  

 

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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 Oscar Health

 

Check Your Plan Coverage

 

  • Contact Oscar Health directly by calling their customer service number found on your insurance card or their website. Ask them if Symbicort is covered under your current health plan.
  •  

  • Log into your Oscar Health online account to review your benefits manually. Check if Symbicort is listed under covered medications.
  •  

 

Consult with Your Doctor

 

  • Discuss your need for Symbicort with your healthcare provider. Ensure they deem it medically necessary and are willing to provide the appropriate documentation to Oscar Health.
  •  

  • Your doctor can suggest alternatives if Symbicort is not covered, or assist in the appeals process for coverage.

 

Request Prior Authorization

 

  • Work with your healthcare provider to obtain a prior authorization if needed. This is often required when a medication is not initially covered.
  •  

  • Your doctor will submit the necessary forms and documentation to Oscar Health on your behalf.

 

File an Appeal if Necessary

 

  • If your initial request is denied, file an appeal with Oscar Health. Obtain the appeal forms from their website or customer service.
  •  

  • Include supporting documentation from your healthcare provider explaining the necessity of Symbicort for your treatment.
  •  

  • Follow up regularly with Oscar Health to check the status of your appeal.

 

Utilize Pharmacy Benefits

 

  • Check if any participating pharmacies under your Oscar Health plan offer discounts or additional programs for medications like Symbicort.
  •  

  • Some pharmacies have savings programs which might help reduce out-of-pocket costs for drugs not covered by your plan.

 

Explore Additional Resources

 

  • Look into manufacturer coupon programs or direct patient assistance from the Symbicort manufacturer, which may offer discounts or cost-saving plans.
  •  

  • Consider speaking with a healthcare advocate or consultant, who can assist in navigating insurance challenges.

 

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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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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 (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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