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Does Presbyterian Healthcare Services Cover Dupixent

Discover if Presbyterian Healthcare covers Dupixent, reasons for denial, ways to secure coverage, costs without insurance, and answers to common questions.

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Dupixent Coverage with Presbyterian Healthcare Services

Presbyterian Healthcare Services typically covers Dupixent, subject to specific criteria. Coverage often depends on whether Dupixent is FDA-approved for the patient's specific condition.

Common conditions covered include moderate-to-severe atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis. Patients must meet established severity and treatment-refractory criteria, often requiring documentation of previous therapies.

Preauthorization is necessary. This involves a detailed review of the patient's medical history, confirming the diagnosis, and substantiating the need for Dupixent based on medical necessity.

Patients are advised to consult their healthcare provider and Presbyterian Healthcare Services to understand the specific requirements and documentation needed to initiate coverage approval.

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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.

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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 Dupixent Coverage with Presbyterian Healthcare Services

Initial Steps with Presbyterian Healthcare Services

Contact Presbyterian Healthcare Services customer support to confirm whether Dupixent is covered under your specific plan.

Gather your health insurance policy documents to understand the specifics of your coverage. Look for sections related to prescription drugs and specialty medications.

Consult Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Dupixent. Obtain a written prescription if deemed necessary by your healthcare professional.

Request that your healthcare provider provides medical records or documentation that support the medical necessity of Dupixent for your condition.

Prescription Coverage Verification

Ask your healthcare provider's office to contact Presbyterian Healthcare Services to verify Dupixent coverage and check if any prior authorizations are required.

Ensure your healthcare provider submits all necessary forms and documentation to expedite the insurance approval process.

Prior Authorization Process

Work with your healthcare provider to initiate a prior authorization request if needed. This request typically includes information on why Dupixent is medically necessary for your treatment plan.

Follow up with Presbyterian Healthcare Services to track the status of your prior authorization.

Appeals Process (if initially denied)

If the coverage is denied, review the denial letter from Presbyterian Healthcare Services for the reason(s) given.

Work with your healthcare provider to provide additional documentation or justification to support the necessity of Dupixent and submit an appeal.

Contact Presbyterian Healthcare Services to understand their appeals process, timelines, and any additional information required.

Receive Approval and Obtain Medication

Once approved, coordinate with your pharmacy to fill the Dupixent prescription.

If using a specialty pharmacy, ensure they process any required co-pay assistance if applicable.

Monitor your prescription's fulfillment and keep communication open with both the pharmacy and your insurance provider to smooth out any possible issues.

Regularly Update Your Information

Maintain regular communication with Presbyterian Healthcare Services about any changes in your condition or treatment plan that might affect your coverage.

Re-evaluate your insurance coverage annually or upon any changes to ensure continued coverage of Dupixent.

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Does Presbyterian Healthcare Services Cover Dupixent

Discover if Presbyterian Healthcare covers Dupixent, reasons for denial, ways to secure coverage, costs without insurance, and answers to common questions.

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Is Dupixent Covered by Presbyterian Healthcare Services

Dupixent Coverage with Presbyterian Healthcare Services

Presbyterian Healthcare Services typically covers Dupixent, subject to specific criteria. Coverage often depends on whether Dupixent is FDA-approved for the patient's specific condition.

Common conditions covered include moderate-to-severe atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis. Patients must meet established severity and treatment-refractory criteria, often requiring documentation of previous therapies.

Preauthorization is necessary. This involves a detailed review of the patient's medical history, confirming the diagnosis, and substantiating the need for Dupixent based on medical necessity.

Patients are advised to consult their healthcare provider and Presbyterian Healthcare Services to understand the specific requirements and documentation needed to initiate coverage approval.

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Presbyterian Healthcare Services's Approved Criteria for Dupixent Coverage

Presbyterian Healthcare Services Coverage Criteria for Dupixent

Prescribed by a board-certified dermatologist, immunologist, pulmonologist, or allergist with relevant experience in treating the indicated condition.

The patient has a confirmed diagnosis for one of the following: moderate-to-severe atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), or eosinophilic esophagitis.

For atopic dermatitis, the affected individual should be at least 6 years old and weigh at least 15 kg, with documentation of inadequate response to topical prescription therapies or when such treatments are not advisable.

For asthma, the individual should be at least 6 years old with an eosinophilic phenotype or oral corticosteroid-dependent asthma, documented by a previous trial of high-dose inhaled corticosteroids and additional controller medications that did not yield adequate asthma control.

For CRSwNP, Dupixent is covered for adults with inadequate response to systemic corticosteroids and/or surgery, used as an add-on therapy to nasal corticosteroids.

For eosinophilic esophagitis, the individual must be at least 12 years old, weighing at least 40 kg, with documented symptoms inadequately controlled by proton pump inhibitors and elimination diets, or if such treatments are not recommended by a healthcare provider.

Prior authorization is generally required, with documentation from the corresponding specialist outlining the medical necessity based on the patient's symptoms, previous failed therapies, or contraindications.

Renewal of coverage may require evidence of significant symptom improvement or quality of life enhancement as documented by the treating physician.

Why Presbyterian Healthcare Services Might Deny Dupixent Coverage

Non-FDA Approved Uses

Presbyterian Healthcare Services may deny coverage for Dupixent if it is prescribed for conditions that are not approved by the FDA.

Lack of Medical Necessity

Coverage may be denied if it is determined that Dupixent is not medically necessary for the patient's condition as per their guidelines.

Failure to Meet Prior Authorization Requirements

If prior authorization requirements are not met or documentation does not support the need for Dupixent, coverage might be denied.

Use in Non-Specified Patient Population

Dupixent may be denied if prescribed to patients outside of the population specified in the plan's coverage criteria, such as age or specific medical history restrictions.

Non-Adherence to Step Therapy Protocols

Insurance coverage might be denied if patients have not followed prescribed step therapy protocols, which may include using other medications first.

Exceeding Prescribed Dosage

Claims might be denied if the prescribed dosage of Dupixent exceeds the maximum allowed dosage outlined in the insurance plan.

Plan Exclusions

If Dupixent is explicitly excluded in the patient's specific health insurance plan, coverage will be denied regardless of the condition.

Expired Coverage

Coverage may not be provided if the patient's policy is no longer active or in good standing.

Lack of Required Documentation

Failure to provide necessary documentation or medical records that support the use of Dupixent for the patient’s condition can lead to denial of coverage.

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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 Presbyterian Healthcare Services

Initial Steps with Presbyterian Healthcare Services

Contact Presbyterian Healthcare Services customer support to confirm whether Dupixent is covered under your specific plan.

Gather your health insurance policy documents to understand the specifics of your coverage. Look for sections related to prescription drugs and specialty medications.

Consult Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Dupixent. Obtain a written prescription if deemed necessary by your healthcare professional.

Request that your healthcare provider provides medical records or documentation that support the medical necessity of Dupixent for your condition.

Prescription Coverage Verification

Ask your healthcare provider's office to contact Presbyterian Healthcare Services to verify Dupixent coverage and check if any prior authorizations are required.

Ensure your healthcare provider submits all necessary forms and documentation to expedite the insurance approval process.

Prior Authorization Process

Work with your healthcare provider to initiate a prior authorization request if needed. This request typically includes information on why Dupixent is medically necessary for your treatment plan.

Follow up with Presbyterian Healthcare Services to track the status of your prior authorization.

Appeals Process (if initially denied)

If the coverage is denied, review the denial letter from Presbyterian Healthcare Services for the reason(s) given.

Work with your healthcare provider to provide additional documentation or justification to support the necessity of Dupixent and submit an appeal.

Contact Presbyterian Healthcare Services to understand their appeals process, timelines, and any additional information required.

Receive Approval and Obtain Medication

Once approved, coordinate with your pharmacy to fill the Dupixent prescription.

If using a specialty pharmacy, ensure they process any required co-pay assistance if applicable.

Monitor your prescription's fulfillment and keep communication open with both the pharmacy and your insurance provider to smooth out any possible issues.

Regularly Update Your Information

Maintain regular communication with Presbyterian Healthcare Services about any changes in your condition or treatment plan that might affect your coverage.

Re-evaluate your insurance coverage annually or upon any changes to ensure continued coverage of Dupixent.

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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 Presbyterian Healthcare Services Cover Dupixent

Discover if Presbyterian Healthcare covers Dupixent, reasons for denial, ways to secure coverage, costs without insurance, and answers to common questions.

Achieve Your Goals Faster with Curex