Does Presbyterian Healthcare Services Cover Dulera

Find out if Presbyterian Healthcare covers Dulera, reasons for denial, ways to secure coverage, costs without insurance, and frequently asked questions.
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Presbyterian Healthcare Services Coverage for Dulera

 

  • Dulera, a combination medication used for asthma, may be covered under certain health plans offered by Presbyterian Healthcare Services. Coverage could depend on the specific health plan you are enrolled in and its formulary list.
  •  

  • Typically, medications like Dulera are covered under a prescription drug plan; however, a prior authorization process may be required. This means your healthcare provider must verify that Dulera is necessary for your treatment.
  •  

  • In general, to get Dulera covered, you'll likely need to ensure it is on the formulary list. Contact your plan directly to confirm if it is covered and what out-of-pocket costs might apply.
  •  

  • Consider consulting your healthcare provider or a Presbyterian patient advocate for assistance in navigating the coverage specifics and understanding any required steps for prior authorization.

 

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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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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 Presbyterian Healthcare Services

 

Verify Your Current Coverage

 

  • Check your current health insurance policy documents or online account to see if Dulera is already covered under your prescription drug benefits.
  •  
  • Contact Presbyterian Healthcare Services directly via their customer service hotline to confirm your existing coverage for Dulera.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Dulera. They can provide documentation and medical necessity justification which may be required by Presbyterian Healthcare Services.
  •  
  • Ensure your healthcare provider is within the Presbyterian Healthcare Network to facilitate smoother claims processing.

 

Review Plan Options

 

  • Visit the Presbyterian Healthcare Services website to explore different health insurance plans they offer. Pay close attention to prescription drug coverages and any relevant formulary lists.
  •  
  • Consider reaching out to a Presbyterian Healthcare Services representative to discuss plans that would best meet your needs, particularly if you need new coverage or a change in current coverage.

 

Submit a Coverage Request

 

  • Once you have verified that Dulera is covered or believe it should be, gather any necessary forms or documents required by Presbyterian Healthcare Services to request drug coverage.
  •  
  • Complete and submit any required documents, including a letter of medical necessity from your healthcare provider, to Presbyterian Healthcare Services for approval.

 

Understand Preauthorization Requirements

 

  • Investigate any preauthorization requirements for Dulera through Presbyterian Healthcare Services. This information can usually be found on their website or by speaking with their pharmacy services department.
  •  
  • Work with your prescribing physician to ensure any required preauthorization is submitted to Presbyterian Healthcare Services.

 

Update or Enroll in a Plan

 

  • If your current plan does not cover Dulera, prepare to update or enroll in a different plan during the next enrollment period that includes Dulera coverage.
  •  
  • Check for specific enrollment periods or any special circumstances that might allow for a mid-year plan change.

 

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FAQs

Does Presbyterian Healthcare Services Cover Dulera

Find out if Presbyterian Healthcare covers Dulera, reasons for denial, ways to secure coverage, costs without insurance, and frequently asked questions.
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Is Dulera Covered by Presbyterian Healthcare Services

 

Presbyterian Healthcare Services Coverage for Dulera

 

  • Dulera, a combination medication used for asthma, may be covered under certain health plans offered by Presbyterian Healthcare Services. Coverage could depend on the specific health plan you are enrolled in and its formulary list.
  •  

  • Typically, medications like Dulera are covered under a prescription drug plan; however, a prior authorization process may be required. This means your healthcare provider must verify that Dulera is necessary for your treatment.
  •  

  • In general, to get Dulera covered, you'll likely need to ensure it is on the formulary list. Contact your plan directly to confirm if it is covered and what out-of-pocket costs might apply.
  •  

  • Consider consulting your healthcare provider or a Presbyterian patient advocate for assistance in navigating the coverage specifics and understanding any required steps for prior authorization.

 

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Presbyterian Healthcare Services's Approved Criteria for Dulera Coverage

 

Eligibility for Coverage

 

  • Dulera is approved for coverage in patients diagnosed with asthma as long as a comprehensive evaluation by a licensed healthcare provider supports its necessity.
  •  

  • The patient must demonstrate an inadequate response to maintenance therapy with either inhaled corticosteroids alone or a combination of inhaled corticosteroids and a long-acting beta-agonist, if previously attempted.

 

Age Requirements

 

  • Coverage is available for individuals aged 12 years and older, as established clinical guidelines and safety profiles support use within this age group.
  •  

  • For patients younger than 12 years, additional medical evaluation and documentation of specific necessity and safety considerations are required.

 

Documentation and Prescription Requirements

 

  • A valid prescription from a qualified healthcare provider must be submitted alongside a comprehensive medical history illustrating previous treatments and the need for Dulera.
  •  

  • Healthcare providers should include information on dosage, frequency, and expected duration of Dulera use, following Presbyterian Healthcare Services' guidelines and requirements.

 

Special Circumstances

 

  • For patients with concomitant respiratory conditions, such as chronic obstructive pulmonary disease (COPD), specific case-by-case approval may be sought after additional medical information is reviewed and confirmed.
  •  

  • Patients with documented cases of allergic reactions to alternative treatments may be eligible for coverage, pending a detailed review of medical records and substantiation of Dulera as a safer option.

 

Continuous Evaluation and Reauthorization

 

  • Regular follow-up consultations as directed by Presbyterian Healthcare Services are required to evaluate treatment efficacy and ensure continued necessity of Dulera.
  •  

  • Reauthorization for continued coverage requires satisfactory documentation of therapeutic benefits observed and minimal adverse reactions reported during consistent usage.

 

Why Presbyterian Healthcare Services Might Deny Dulera Coverage

 

Non-Formulary Status

 

  • The medication is not listed on the company's formulary. Dulera may not be covered if it is not included in the list of preferred medications.
  •  

  • Alternative medications are available on the formulary that are considered as effective and more cost-efficient.

 

Prior Authorization Not Obtained

 

  • Coverage for Dulera might be denied if the necessary prior authorization has not been received from Presbyterian Healthcare Services.
  •  

  • The prescription does not meet certain predefined medical criteria needed for authorization.

 

Off-Label Use

 

  • If Dulera is prescribed for a condition not approved by the FDA or not specified by Presbyterian Healthcare Services' guidelines, coverage may be denied.
  •  

  • Usage that does not align with the documented age or dosage specifications can also be a cause for denial.

 

Lack of Medical Necessity

 

  • The healthcare provider might deny coverage if Dulera is not deemed medically necessary compared to other available treatments.
  •  

  • A prescription lacking sufficient clinical documentation proving the necessity as reviewed by the insurer may not be approved.

 

Quantity Limits Exceeded

 

  • The prescription surpasses quantity limits set by the healthcare provider without an approved exception request.
  •  

  • Attempts to refill the prescription too early may result in denial due to quantity restrictions.

 

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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 Presbyterian Healthcare Services

 

Verify Your Current Coverage

 

  • Check your current health insurance policy documents or online account to see if Dulera is already covered under your prescription drug benefits.
  •  
  • Contact Presbyterian Healthcare Services directly via their customer service hotline to confirm your existing coverage for Dulera.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Dulera. They can provide documentation and medical necessity justification which may be required by Presbyterian Healthcare Services.
  •  
  • Ensure your healthcare provider is within the Presbyterian Healthcare Network to facilitate smoother claims processing.

 

Review Plan Options

 

  • Visit the Presbyterian Healthcare Services website to explore different health insurance plans they offer. Pay close attention to prescription drug coverages and any relevant formulary lists.
  •  
  • Consider reaching out to a Presbyterian Healthcare Services representative to discuss plans that would best meet your needs, particularly if you need new coverage or a change in current coverage.

 

Submit a Coverage Request

 

  • Once you have verified that Dulera is covered or believe it should be, gather any necessary forms or documents required by Presbyterian Healthcare Services to request drug coverage.
  •  
  • Complete and submit any required documents, including a letter of medical necessity from your healthcare provider, to Presbyterian Healthcare Services for approval.

 

Understand Preauthorization Requirements

 

  • Investigate any preauthorization requirements for Dulera through Presbyterian Healthcare Services. This information can usually be found on their website or by speaking with their pharmacy services department.
  •  
  • Work with your prescribing physician to ensure any required preauthorization is submitted to Presbyterian Healthcare Services.

 

Update or Enroll in a Plan

 

  • If your current plan does not cover Dulera, prepare to update or enroll in a different plan during the next enrollment period that includes Dulera coverage.
  •  
  • Check for specific enrollment periods or any special circumstances that might allow for a mid-year plan change.

 

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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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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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