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Does Sharp Health Plan Cover Dupixent

Learn about Sharp Health Plan's Dupixent coverage, potential denial reasons, costs without insurance, and FAQs. Tips to secure your Dupixent coverage.

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Dupixent Coverage by Sharp Health Plan

Sharp Health Plan may cover Dupixent for FDA-approved indications such as moderate-to-severe eczema, asthma, or chronic sinusitis with nasal polyposis.

Coverage criteria usually include documented medical necessity determined by a healthcare provider, failure of alternative treatments, and prior authorization.

The patient's prescription must align with Sharp Health Plan's formulary, and the prescriber may need to submit clinical documentation supporting the necessity for Dupixent.

It is essential to verify specific coverage details and any copayments or deductibles by contacting Sharp Health Plan directly.

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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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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 Sharp Health Plan

Check Your Coverage

Contact Sharp Health Plan member services to confirm if Dupixent is included in your current coverage.

Review your Sharp Health Plan documentations, such as the Summary of Benefits, to understand your specific prescription drug coverage related to Dupixent.

Obtain Prescription from Your Doctor

Schedule an appointment with your healthcare provider to discuss your medical condition and the necessity of Dupixent treatment.

Your doctor will provide a prescription if Dupixent is deemed appropriate for your treatment plan.

Check for Prior Authorization

Determine if Dupixent requires prior authorization through Sharp Health Plan. This step is essential as some medications need approval before coverage.

Your healthcare provider can assist in submitting a prior authorization request, if necessary.

Visit an In-network Pharmacy

Locate an in-network pharmacy within the Sharp Health Plan network to fill your Dupixent prescription.

Provide your Sharp Health Plan member ID when picking up your prescription to ensure coverage processing.

Appeal if Necessary

If coverage is initially denied, review the denial notice for the reason and consider filing an appeal with Sharp Health Plan.

Gather supportive documents from your healthcare provider to strengthen your appeal case.

Stay Informed About Your Plan

Regularly check for updates regarding medication coverage as plans may change annually.

Consider reaching out to Sharp Health Plan customer service for any questions or clarification needed about Dupixent coverage in the future.

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FAQs

Does Sharp Health Plan Cover Dupixent

Learn about Sharp Health Plan's Dupixent coverage, potential denial reasons, costs without insurance, and FAQs. Tips to secure your Dupixent coverage.

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Is Dupixent Covered by Sharp Health Plan

Dupixent Coverage by Sharp Health Plan

Sharp Health Plan may cover Dupixent for FDA-approved indications such as moderate-to-severe eczema, asthma, or chronic sinusitis with nasal polyposis.

Coverage criteria usually include documented medical necessity determined by a healthcare provider, failure of alternative treatments, and prior authorization.

The patient's prescription must align with Sharp Health Plan's formulary, and the prescriber may need to submit clinical documentation supporting the necessity for Dupixent.

It is essential to verify specific coverage details and any copayments or deductibles by contacting Sharp Health Plan directly.

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Sharp Health Plan's Approved Criteria for Dupixent Coverage

Criteria for Dupixent Coverage

Member must have a confirmed diagnosis of atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), or eosinophilic esophagitis, as per the latest medical guidelines.

Treatment must be prescribed by a healthcare provider specializing in dermatology, allergy/immunology, pulmonology, or otolaryngology, consistent with the member's diagnosis.

For members diagnosed with atopic dermatitis, the condition should be moderate to severe, with documented previous treatment failure or intolerance to topical prescription therapies.

In cases of asthma, the member needs to exhibit moderate-to-severe eosinophilic phenotype or oral corticosteroid dependent asthma, confirmed by medical evaluation.

Members with CRSwNP should have evidence of disease that is inadequately controlled with standard therapies such as nasal corticosteroids.

For eosinophilic esophagitis, member’s condition must be inadequately controlled despite standard treatment approaches, or if standard treatments are inappropriate for the patient.

An initial authorization for Dupixent is typically approved for a period which allows assessment of treatment efficacy, often not exceeding six months. Continued authorization will require documentation of clinical improvement.

Why Sharp Health Plan Might Deny Dupixent Coverage

Situations Where Sharp Health Plan Might Deny Dupixent Coverage

Dupixent is prescribed for non-FDA approved indications. The treatment must be for an approved condition as determined by the FDA.

The patient has not shown evidence of inadequate response, contraindication, or intolerance to conventional therapies prior to Dupixent. Step therapy protocols must be satisfied.

Dupixent is requested for use as a first-line treatment contrary to established guidelines recommending alternative therapies as the initial approach.

There is a lack of appropriate clinical documentation or diagnostic procedures validating the necessity of Dupixent for the specified condition as per plan requirements.

The request for Dupixent exceeds the dosing limits or duration approved by the plan, lacking medical justification for the higher dosing regimen.

Dupixent is intended for use in combination with treatments that are contraindicated or not supported by scientific evidence and guidelines for such concurrent use.

There are discrepancies or inaccuracies in the submitted prior authorization forms or supporting documentation provided for Dupixent coverage consideration.

The patient has a history of non-compliance with treatment protocols which could affect the expected outcome of using Dupixent.

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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 Sharp Health Plan

Check Your Coverage

Contact Sharp Health Plan member services to confirm if Dupixent is included in your current coverage.

Review your Sharp Health Plan documentations, such as the Summary of Benefits, to understand your specific prescription drug coverage related to Dupixent.

Obtain Prescription from Your Doctor

Schedule an appointment with your healthcare provider to discuss your medical condition and the necessity of Dupixent treatment.

Your doctor will provide a prescription if Dupixent is deemed appropriate for your treatment plan.

Check for Prior Authorization

Determine if Dupixent requires prior authorization through Sharp Health Plan. This step is essential as some medications need approval before coverage.

Your healthcare provider can assist in submitting a prior authorization request, if necessary.

Visit an In-network Pharmacy

Locate an in-network pharmacy within the Sharp Health Plan network to fill your Dupixent prescription.

Provide your Sharp Health Plan member ID when picking up your prescription to ensure coverage processing.

Appeal if Necessary

If coverage is initially denied, review the denial notice for the reason and consider filing an appeal with Sharp Health Plan.

Gather supportive documents from your healthcare provider to strengthen your appeal case.

Stay Informed About Your Plan

Regularly check for updates regarding medication coverage as plans may change annually.

Consider reaching out to Sharp Health Plan customer service for any questions or clarification needed about Dupixent coverage in the future.

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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 Sharp Health Plan Cover Dupixent

Learn about Sharp Health Plan's Dupixent coverage, potential denial reasons, costs without insurance, and FAQs. Tips to secure your Dupixent coverage.

Achieve Your Goals Faster with Curex