Does Scripps Health Cover Dulera

Discover why Scripps Health might deny Dulera, how to gain coverage, understand costs without insurance, and find answers to common Dulera questions.
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Dulera Coverage by Scripps Health

 

  • Dulera, a prescription medication for asthma, may be covered by Scripps Health plans under specific conditions.
  •  

  • Coverage usually depends on the particular health plan and formulary provided by Scripps Health. Verify with the specific plan for details.
  •  

  • Typically, prior authorization is required to confirm medical necessity, meaning your healthcare provider must provide documentation justifying the use of Dulera.
  •  

  • Patients should ensure they meet the criteria, including having a documented diagnosis of asthma and a track record of tried-and-failed treatments with alternative medications.
  •  

  • Coverage may be subject to copayments or deductibles, depending on the individual's plan benefits and pharmacy benefits tier.
  •  

  • For the most accurate information, contact Scripps Health customer service or review the prescription drug benefits outlined in your health plan documents.

 

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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 Dulera Coverage with Scripps Health

 

Check Your Insurance Plan

 

  • Log into your Scripps Health member account or contact the customer service team to confirm if your current insurance plan covers Dulera.
  •  

  • Review your plan’s formulary to ensure that Dulera is listed as a covered medication.

 

Consult with Your Healthcare Provider

 

  • Discuss your respiratory health needs with your Scripps Health primary care physician or specialist.
  •  

  • Have your doctor assess whether Dulera is the appropriate medication for your treatment plan.

 

Request a Prescription

 

  • If Dulera is deemed suitable, ask your doctor to write a prescription for it.
  •  

  • Ensure your doctor includes all necessary details on the prescription to facilitate insurance processing.

 

Verify Pharmacy Participation

 

  • Contact your preferred pharmacy to confirm that they accept Scripps Health insurance and can fill the Dulera prescription.
  •  

  • Check if the pharmacy can assist in confirming Dulera coverage through Scripps Health.

 

Submit Prior Authorization (if required)

 

  • Check with Scripps Health if a prior authorization form is needed for Dulera. Your doctor may need to provide additional justifications for the prescription.
  •  

  • Work with your healthcare provider and Scripps Health to complete and submit any necessary prior authorization documents.

 

Understand Cost and Copay Obligations

 

  • Contact Scripps Health to determine the copay or any other out-of-pocket costs associated with filling the Dulera prescription.
  •  

  • Use Scripps Health’s pharmacy services or customer care to explore options for reducing medication costs if needed.

 

Arrange for Prescription Fulfillment

 

  • Ensure the prescription is sent to the pharmacy either electronically or via paper.
  •  

  • Pick up the medication or arrange for delivery as per your convenience.

 

Review Your Medication Coverage

 

  • Upon receiving Dulera, check your insurance claims to ensure it's covered properly.
  •  

  • Contact Scripps Health for any discrepancies in coverage or billing.

 

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FAQs

Does Scripps Health Cover Dulera

Discover why Scripps Health might deny Dulera, how to gain coverage, understand costs without insurance, and find answers to common Dulera questions.
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Is Dulera Covered by Scripps Health

 

Dulera Coverage by Scripps Health

 

  • Dulera, a prescription medication for asthma, may be covered by Scripps Health plans under specific conditions.
  •  

  • Coverage usually depends on the particular health plan and formulary provided by Scripps Health. Verify with the specific plan for details.
  •  

  • Typically, prior authorization is required to confirm medical necessity, meaning your healthcare provider must provide documentation justifying the use of Dulera.
  •  

  • Patients should ensure they meet the criteria, including having a documented diagnosis of asthma and a track record of tried-and-failed treatments with alternative medications.
  •  

  • Coverage may be subject to copayments or deductibles, depending on the individual's plan benefits and pharmacy benefits tier.
  •  

  • For the most accurate information, contact Scripps Health customer service or review the prescription drug benefits outlined in your health plan documents.

 

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Scripps Health's Approved Criteria for Dulera Coverage

 

Scripps Health’s Approved Criteria for Dulera Coverage

 

  • **Documentation of Diagnosis**   - Provide medical records supporting a diagnosis of asthma, indicating the need for long-term maintenance treatment.   - Document the patient’s history of asthma exacerbations or need for constant asthma control.  
  • **Prescriber Requirements**   - The coverage request must come from a licensed healthcare provider with expertise in managing asthma patients, such as a primary care physician, allergist, or pulmonologist.   - Include a detailed plan of treatment involving Dulera.  
  • **Age Criteria**   - Coverage is available for individuals aged 12 years and older due to supporting evidence of efficacy and safety in this age group.  
  • **Prior Medication Trials**   - Medical records must show that previous trials with standard asthma medications, such as inhaled corticosteroids, have been ineffective or poorly tolerated.   - Evidence that the patient requires combination therapy to maintain asthma control.  
  • **Dose Limits and Duration**   - Prescriptions must adhere to FDA-approved dosing guidelines for Dulera to prevent issues of safety and compliance.   - Demonstration of continuous medical necessity through ongoing asthma control assessments and follow-up documentation.  
  • **Monitoring and Follow-Up**   - Regular monitoring of asthma symptoms with documented periodic evaluations by the healthcare provider.   - Provide updates on therapeutic response and any modifications to the asthma management plan.  

 

Why Scripps Health Might Deny Dulera Coverage

 

Reasons for Denial of Dulera Coverage by Scripps Health

 

  • Dulera prescription is not supported by proper medical documentation or diagnosis that justifies its necessity over alternative medications.
  •  

  • Use of Dulera is not aligned with FDA-approved indications or is for an unapproved off-label use that lacks sufficient evidence or physician endorsement.
  •  

  • The patient has not completed or shown evidence of adherence to first-line inhaler therapies or alternative treatments, which are usually required before escalating to Dulera.
  •  

  • Absence of prior authorization approval where such authorization is a mandatory requirement for Dulera coverage.
  •  

  • Provision of Dulera is excluded as per the terms of the patient's specific health plan or policy with Scripps Health.
  •  

  • There exists a generic or more cost-effective version of the medication that has not been attempted or considered by the prescribing physician.
  •  

  • The prescription does not meet the age or dosage criteria set by Scripps Health for coverage, possibly due to standard guidelines or patient safety concerns.

 

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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 Scripps Health

 

Check Your Insurance Plan

 

  • Log into your Scripps Health member account or contact the customer service team to confirm if your current insurance plan covers Dulera.
  •  

  • Review your plan’s formulary to ensure that Dulera is listed as a covered medication.

 

Consult with Your Healthcare Provider

 

  • Discuss your respiratory health needs with your Scripps Health primary care physician or specialist.
  •  

  • Have your doctor assess whether Dulera is the appropriate medication for your treatment plan.

 

Request a Prescription

 

  • If Dulera is deemed suitable, ask your doctor to write a prescription for it.
  •  

  • Ensure your doctor includes all necessary details on the prescription to facilitate insurance processing.

 

Verify Pharmacy Participation

 

  • Contact your preferred pharmacy to confirm that they accept Scripps Health insurance and can fill the Dulera prescription.
  •  

  • Check if the pharmacy can assist in confirming Dulera coverage through Scripps Health.

 

Submit Prior Authorization (if required)

 

  • Check with Scripps Health if a prior authorization form is needed for Dulera. Your doctor may need to provide additional justifications for the prescription.
  •  

  • Work with your healthcare provider and Scripps Health to complete and submit any necessary prior authorization documents.

 

Understand Cost and Copay Obligations

 

  • Contact Scripps Health to determine the copay or any other out-of-pocket costs associated with filling the Dulera prescription.
  •  

  • Use Scripps Health’s pharmacy services or customer care to explore options for reducing medication costs if needed.

 

Arrange for Prescription Fulfillment

 

  • Ensure the prescription is sent to the pharmacy either electronically or via paper.
  •  

  • Pick up the medication or arrange for delivery as per your convenience.

 

Review Your Medication Coverage

 

  • Upon receiving Dulera, check your insurance claims to ensure it's covered properly.
  •  

  • Contact Scripps Health for any discrepancies in coverage or billing.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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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