Does Presbyterian Healthcare Services Cover Symbicort

Explore if Presbyterian Healthcare covers Symbicort, reasons for denial, tips to secure coverage, cost without insurance, and Symbicort FAQs.
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Coverage of Symbicort by Presbyterian Healthcare Services

 

  • Symbicort, a medication used for asthma and COPD management, may be covered by Presbyterian Healthcare Services, depending on plan specifics.
  •  

  • Coverage often requires prior authorization; this means your healthcare provider needs to demonstrate medical necessity.
  •  

  • The formulary status of Symbicort in Presbyterian's pharmacy benefits will influence coverage. Check your plan’s formulary for its tier status.

 

Steps to Ensure Coverage

 

  • Consult with your healthcare provider to discuss the need for Symbicort and explore alternative options if necessary.
  •  

  • Ensure your provider completes any required prior authorization forms promptly.
  •  

  • Contact Presbyterian's member services to confirm specific coverage details and any associated costs under your plan.

 

Basic Rules & Criteria

 

  • Coverage for Symbicort typically applies to those with a documented diagnosis of asthma or COPD as per your plan’s medical guidelines.
  •  

  • Members may need to try other medications first, depending on tiered formulary requirements.

 

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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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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 Presbyterian Healthcare Services

 

Contact Presbyterian Healthcare Services

 

  • Reach out to Presbyterian Healthcare Services by visiting their official website or calling their customer service number to inquire about coverage options for Symbicort.
  •  

  • Ensure you have your insurance policy details on hand to provide necessary information for specific coverage queries.

 

Review Your Prescription Benefits

 

  • Log into your online health insurance account or review your benefits package to understand the specifics of your prescription coverage.
  •  

  • Look for any specific mention of Symbicort or similar inhalers in the formulary provided by Presbyterian Healthcare Services.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with the healthcare provider who prescribed Symbicort to discuss your coverage and any potential alternatives if required.
  •  

  • Request documentation or a letter of medical necessity if required by Presbyterian Healthcare Services for prior authorization.

 

Request Prior Authorization

 

  • Contact Presbyterian Healthcare Services to determine if prior authorization is needed for Symbicort and obtain the necessary forms.
  •  

  • Work with your healthcare provider to complete and submit the prior authorization documentation, including any supporting medical records.

 

Follow Up on Your Request

 

  • After submitting your prior authorization, follow up with Presbyterian Healthcare Services to verify receipt and ask about the timeline for processing.
  •  

  • Keep track of any communications or documentation related to your authorization request for future reference.

 

Explore Prescription Assistance Programs

 

  • If coverage through Presbyterian Healthcare Services is denied, investigate if AstraZeneca, the manufacturer of Symbicort, offers any patient assistance programs.
  •  

  • Consider alternative medication options that are covered by your insurance plan while working with your healthcare provider.

 

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FAQs

Does Presbyterian Healthcare Services Cover Symbicort

Explore if Presbyterian Healthcare covers Symbicort, reasons for denial, tips to secure coverage, cost without insurance, and Symbicort FAQs.
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Is Symbicort Covered by Presbyterian Healthcare Services

 

Coverage of Symbicort by Presbyterian Healthcare Services

 

  • Symbicort, a medication used for asthma and COPD management, may be covered by Presbyterian Healthcare Services, depending on plan specifics.
  •  

  • Coverage often requires prior authorization; this means your healthcare provider needs to demonstrate medical necessity.
  •  

  • The formulary status of Symbicort in Presbyterian's pharmacy benefits will influence coverage. Check your plan’s formulary for its tier status.

 

Steps to Ensure Coverage

 

  • Consult with your healthcare provider to discuss the need for Symbicort and explore alternative options if necessary.
  •  

  • Ensure your provider completes any required prior authorization forms promptly.
  •  

  • Contact Presbyterian's member services to confirm specific coverage details and any associated costs under your plan.

 

Basic Rules & Criteria

 

  • Coverage for Symbicort typically applies to those with a documented diagnosis of asthma or COPD as per your plan’s medical guidelines.
  •  

  • Members may need to try other medications first, depending on tiered formulary requirements.

 

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Presbyterian Healthcare Services's Approved Criteria for Symbicort Coverage

 

Eligibility Criteria for Symbicort Coverage

 

  • Member must have a documented diagnosis of asthma or chronic obstructive pulmonary disorder (COPD) requiring regular treatment.
  •  

  • Member should have a medical history of inadequate control of symptoms with inhaled corticosteroids alone.
  •  

  • Extensive documentation of prior treatments and responses, which must include both short-acting and long-acting bronchodilators, as well as inhaled corticosteroids.
  •  

 

Prescribed Dosage Criteria

 

  • Symbicort must be prescribed by a licensed healthcare practitioner who manages respiratory conditions.
  •  

  • The prescribed dosage for asthma or COPD must align with the FDA-approved label for Symbicort.
  •  

  • Members must receive education on the proper use of Symbicort, including dosage and inhalation technique.
  •  

 

Monitoring and Follow-up Requirements

 

  • Regular follow-up appointments with a healthcare provider are required to assess the efficacy and safety of the treatment.
  •  

  • Documentation of improvement in asthma or COPD symptoms, as well as lung function tests (such as FEV1 results), must be submitted periodically.
  •  

 

Continued Coverage Criteria

 

  • Members must demonstrate adherence to prescribed treatment plans and inhalation regimens.
  •  

  • Documentation of continued need, including ongoing symptom control challenges and therapy benefits, should be presented regularly.
  •  

  • Periodic review by the healthcare provider to evaluate any side effects or the need for adjustment in therapy.
  •  

 

Why Presbyterian Healthcare Services Might Deny Symbicort Coverage

 

Reasons for Denial of Symbicort Coverage

 

  • **Non-Formulary Drug:** Symbicort may not be included on Presbyterian Healthcare Services' drug formulary, which lists preferred medications that are covered. If it's not on the list, coverage might be denied unless an exception is granted.
  •  

  • **Lack of Prior Authorization:** If prior authorization is required and not obtained, coverage for Symbicort can be denied. Prior authorization is necessary to confirm that the medication is appropriate and medically necessary.
  •  

  • **Step Therapy Requirements:** Coverage can be withheld if a patient has not tried and failed treatment with less expensive alternative medications before using Symbicort, as it may be a part of a step therapy protocol.
  •  

  • **Coverage Limits or Restrictions:** There might be certain quantity or dosage limitations placed on Symbicort, and exceeding these limits without approval can lead to denial.
  •  

  • **Off-Label Use:** If Symbicort is prescribed for a use not approved by the FDA or not supported by clinical evidence, Presbyterian Healthcare Services may deny coverage.
  •  

  • **Plan Exclusions:** Specific health plans might exclude certain drugs or drug categories, which could include Symbicort, leading to a denial based on plan-specific exclusions.

 

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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 Presbyterian Healthcare Services

 

Contact Presbyterian Healthcare Services

 

  • Reach out to Presbyterian Healthcare Services by visiting their official website or calling their customer service number to inquire about coverage options for Symbicort.
  •  

  • Ensure you have your insurance policy details on hand to provide necessary information for specific coverage queries.

 

Review Your Prescription Benefits

 

  • Log into your online health insurance account or review your benefits package to understand the specifics of your prescription coverage.
  •  

  • Look for any specific mention of Symbicort or similar inhalers in the formulary provided by Presbyterian Healthcare Services.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with the healthcare provider who prescribed Symbicort to discuss your coverage and any potential alternatives if required.
  •  

  • Request documentation or a letter of medical necessity if required by Presbyterian Healthcare Services for prior authorization.

 

Request Prior Authorization

 

  • Contact Presbyterian Healthcare Services to determine if prior authorization is needed for Symbicort and obtain the necessary forms.
  •  

  • Work with your healthcare provider to complete and submit the prior authorization documentation, including any supporting medical records.

 

Follow Up on Your Request

 

  • After submitting your prior authorization, follow up with Presbyterian Healthcare Services to verify receipt and ask about the timeline for processing.
  •  

  • Keep track of any communications or documentation related to your authorization request for future reference.

 

Explore Prescription Assistance Programs

 

  • If coverage through Presbyterian Healthcare Services is denied, investigate if AstraZeneca, the manufacturer of Symbicort, offers any patient assistance programs.
  •  

  • Consider alternative medication options that are covered by your insurance plan while working with your healthcare provider.

 

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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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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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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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