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Does Scripps Health Cover Dupixent

Explore Dupixent coverage through Scripps Health with insights on potential denials, obtaining coverage, costs without insurance, and FAQs.

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Does Scripps Health Cover Dupixent

Scripps Health may cover Dupixent under certain plans. Coverage often extends to conditions like atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis.

Patients typically need to meet specific criteria, such as severity of condition and failure to respond to other treatments, to get Dupixent authorized.

Pre-authorization is usually required. This means your healthcare provider must submit documentation to demonstrate medical necessity before approval.

Plan members are advised to check with Scripps Health regarding detailed coverage options, as criteria and policies can vary. Contact a representative for personalized confirmation and guidance.

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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.

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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 Dupixent Coverage with Scripps Health

Consult with Your Healthcare Provider

Discuss with your primary healthcare provider or specialist about the need for Dupixent, ensuring it's an appropriate treatment for your condition.

Obtain a formal prescription or recommendation from your doctor for Dupixent.

Check Scripps Health Insurance Network

Visit the Scripps Health website and review their insurance plans to confirm that your plan covers Dupixent.

If necessary, contact your insurance provider via phone or email to verify Dupixent coverage and any potential copays or prerequisites.

Gather Required Documentation

Ensure you have your insurance information ready, including your policy number, group ID, and any relevant personal identifiers.

Collect any medical documentation that supports the need for Dupixent treatment, such as diagnosis reports or history of treatment attempts.

Contact Scripps Health

Call or visit a Scripps Health facility to speak with a billing specialist or patient liaison about Dupixent coverage.

Inquire about any required prior authorizations or paperwork that needs completion before obtaining coverage for Dupixent.

Submit Prior Authorization Request

Work with your healthcare provider to complete a prior authorization request form, if required by your insurance plan.

Submit the form with all necessary documentation to Scripps Health or your insurance provider, as instructed.

Follow Up on Authorization Status

Regularly check the status of your prior authorization by contacting Scripps Health or your insurance company.

Be prepared to provide any additional information requested to expedite the approval process for Dupixent.

Obtain and Begin Treatment

Once approved, coordinate with Scripps Health to fill your Dupixent prescription through their pharmacy services.

Discuss with your healthcare provider any additional guidelines or monitoring required during your treatment with Dupixent.

Review Copayment and Benefits

Understand any copay amounts or patient responsibility after your insurance has been applied to the Dupixent treatment cost.

Consider financial assistance programs offered by the manufacturer or Scripps Health if necessary to manage out-of-pocket expenses.

Maintain Regular Check-ins

Schedule follow-up appointments with your healthcare provider to monitor the efficacy of Dupixent treatment and make any necessary adjustments.

Stay informed about your insurance coverage, as policies may change annually or with different plan subscriptions.

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FAQs

Does Scripps Health Cover Dupixent

Explore Dupixent coverage through Scripps Health with insights on potential denials, obtaining coverage, costs without insurance, and FAQs.

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Is Dupixent Covered by Scripps Health

Does Scripps Health Cover Dupixent

Scripps Health may cover Dupixent under certain plans. Coverage often extends to conditions like atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis.

Patients typically need to meet specific criteria, such as severity of condition and failure to respond to other treatments, to get Dupixent authorized.

Pre-authorization is usually required. This means your healthcare provider must submit documentation to demonstrate medical necessity before approval.

Plan members are advised to check with Scripps Health regarding detailed coverage options, as criteria and policies can vary. Contact a representative for personalized confirmation and guidance.

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Scripps Health's Approved Criteria for Dupixent Coverage

Criteria for Dupixent Coverage under Scripps Health

Patient must be diagnosed with moderate-to-severe atopic dermatitis as confirmed by medical records.

Documentation showing that traditional systemic therapies have been ineffective, contraindicated, or are not tolerated by the patient.

Evidence of significant impact on quality of life or daily functioning due to the severity of atopic dermatitis is required.

Dupixent may be considered for patients aged 6 years and older, consistent with the approved labeling by the FDA.

Coverage is subject to the patient having committed to a treatment plan that includes regular follow-up appointments to assess the effectiveness and any potential side effects of Dupixent.

Patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) must provide a diagnosis confirmed by an ENT specialist and documented failure of nasal corticosteroids.

For patients with asthma, a documented diagnosis of moderate-to-severe asthma is necessary, including lung function tests and evidence of high frequency of exacerbations despite standard care.

Continued coverage for Dupixent will require periodic evidence of clinical benefit, as determined by a healthcare provider at scheduled intervals.

Why Scripps Health Might Deny Dupixent Coverage

Reasons for Denial of Dupixent Coverage

Non-Formulary Drug: Dupixent may be denied if it is not listed in Scripps Health's formulary, which is a list of medications that are covered under their plans.

Lack of Prior Authorization: Coverage may be denied if there is no prior authorization, meaning Scripps Health does not have approval from a healthcare provider that Dupixent is medically necessary.

Non-FDA Approved Uses: If Dupixent is prescribed for uses that are not approved by the FDA, such as for unlisted conditions or experimental treatments, it may not be covered.

Failure to Meet Medical Criteria: Scripps Health may deny coverage if the patient does not meet certain medical criteria or guidelines that justify the necessity of Dupixent for their specific condition.

Exclusion in the Policy: A patient’s specific health insurance policy may exclude coverage for certain injectables, like Dupixent, if listed under exclusions or limitations of the plan.

Lack of Step Therapy Failure: If the patient has not tried and failed other preferred or less expensive medications before Dupixent, coverage might be denied due to step therapy requirements.

Absence of Documented Clinical Benefits: If there is insufficient documentation demonstrating clinical benefits or improvement in the patient's condition with Dupixent, coverage may be denied.

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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 Scripps Health

Consult with Your Healthcare Provider

Discuss with your primary healthcare provider or specialist about the need for Dupixent, ensuring it's an appropriate treatment for your condition.

Obtain a formal prescription or recommendation from your doctor for Dupixent.

Check Scripps Health Insurance Network

Visit the Scripps Health website and review their insurance plans to confirm that your plan covers Dupixent.

If necessary, contact your insurance provider via phone or email to verify Dupixent coverage and any potential copays or prerequisites.

Gather Required Documentation

Ensure you have your insurance information ready, including your policy number, group ID, and any relevant personal identifiers.

Collect any medical documentation that supports the need for Dupixent treatment, such as diagnosis reports or history of treatment attempts.

Contact Scripps Health

Call or visit a Scripps Health facility to speak with a billing specialist or patient liaison about Dupixent coverage.

Inquire about any required prior authorizations or paperwork that needs completion before obtaining coverage for Dupixent.

Submit Prior Authorization Request

Work with your healthcare provider to complete a prior authorization request form, if required by your insurance plan.

Submit the form with all necessary documentation to Scripps Health or your insurance provider, as instructed.

Follow Up on Authorization Status

Regularly check the status of your prior authorization by contacting Scripps Health or your insurance company.

Be prepared to provide any additional information requested to expedite the approval process for Dupixent.

Obtain and Begin Treatment

Once approved, coordinate with Scripps Health to fill your Dupixent prescription through their pharmacy services.

Discuss with your healthcare provider any additional guidelines or monitoring required during your treatment with Dupixent.

Review Copayment and Benefits

Understand any copay amounts or patient responsibility after your insurance has been applied to the Dupixent treatment cost.

Consider financial assistance programs offered by the manufacturer or Scripps Health if necessary to manage out-of-pocket expenses.

Maintain Regular Check-ins

Schedule follow-up appointments with your healthcare provider to monitor the efficacy of Dupixent treatment and make any necessary adjustments.

Stay informed about your insurance coverage, as policies may change annually or with different plan subscriptions.

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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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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.

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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. 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 Scripps Health Cover Dupixent

Explore Dupixent coverage through Scripps Health with insights on potential denials, obtaining coverage, costs without insurance, and FAQs.

Achieve Your Goals Faster with Curex