Does Sharp Health Plan Cover Symbicort

Explore Symbicort coverage with Sharp Health Plan, denial reasons, costs without insurance, and FAQs in this comprehensive guide.
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Sharp Health Plan Coverage for Symbicort

 

  • Symbicort is generally covered under Sharp Health Plan's prescription drug benefits. However, coverage may vary based on specific plan details and formulary tiers.
  •  

  • To qualify for coverage, Symbicort may require prior authorization. This process ensures it's medically necessary for the patient.
  •  

  • Step therapy might apply, requiring patients to try less expensive alternatives before coverage is approved for Symbicort.
  •  

  • Check if Symbicort is included in the formulary of your specific plan. This can be done through the Sharp Health Plan website or by contacting customer service.
  •  

  • Cost-sharing aspects, such as copayments or coinsurance, are determined by the plan's tier level for Symbicort.
  •  

  • Doctors must provide a prescription that aligns with FDA-approved indications, such as managing asthma or COPD, to qualify for coverage.
  •  

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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.

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 Sharp Health Plan

 

Contact Sharp Health Plan Support

 

  • Reach out to Sharp Health Plan's customer service to inquire about the coverage details for Symbicort. You can do this by phone or through their online contact form.
  •  

  • Ask about the specific requirements needed to have Symbicort covered under your current health plan.

 

Review Your Plan Documentation

 

  • Check your Sharp Health Plan documents for prescription drug coverage specifics. This will help you understand if Symbicort is included or if it requires prior authorization.
  •  

  • Look for the formulary, which is a list of medications covered by your health plan, to confirm Symbicort's tier level and any alternatives.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Symbicort for your condition.
  •  

  • Request your healthcare provider to write a prescription for Symbicort while indicating any necessary medical reasons why it's needed over other medications.

 

Obtain Prior Authorization

 

  • If required, work with your healthcare provider to submit a prior authorization request to Sharp Health Plan. This often includes justification for why Symbicort is necessary for your treatment.
  •  

  • Ensure all required documentation, such as your prescription and medical history, is provided during the prior authorization process.

 

Verify Coverage Confirmation

 

  • Once the prior authorization is approved, confirm with Sharp Health Plan that Symbicort is now covered under your plan.
  •  

  • Request written confirmation or documentation of the coverage, including any co-pays or cost-sharing details.

 

Fill Your Prescription

 

  • With authorization and coverage confirmed, take your prescription to a participating pharmacy under your Sharp Health Plan.
  •  

  • Ensure you obtain the medication under the terms agreed upon with your health plan and be aware of any out-of-pocket costs.

 

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FAQs

Does Sharp Health Plan Cover Symbicort

Explore Symbicort coverage with Sharp Health Plan, denial reasons, costs without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

Is Symbicort Covered by Sharp Health Plan

 

Sharp Health Plan Coverage for Symbicort

 

  • Symbicort is generally covered under Sharp Health Plan's prescription drug benefits. However, coverage may vary based on specific plan details and formulary tiers.
  •  

  • To qualify for coverage, Symbicort may require prior authorization. This process ensures it's medically necessary for the patient.
  •  

  • Step therapy might apply, requiring patients to try less expensive alternatives before coverage is approved for Symbicort.
  •  

  • Check if Symbicort is included in the formulary of your specific plan. This can be done through the Sharp Health Plan website or by contacting customer service.
  •  

  • Cost-sharing aspects, such as copayments or coinsurance, are determined by the plan's tier level for Symbicort.
  •  

  • Doctors must provide a prescription that aligns with FDA-approved indications, such as managing asthma or COPD, to qualify for coverage.
  •  

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Sharp Health Plan's Approved Criteria for Symbicort Coverage

 

Symbicort Coverage Criteria by Sharp Health Plan

 

  • **Diagnosis**: Symbicort is covered for members diagnosed with asthma or chronic obstructive pulmonary disease (COPD), where it is deemed medically necessary for the management of their condition.
  •  

  • **Prescriber's Role**: Must be prescribed by a licensed healthcare provider specializing in respiratory illnesses, including pulmonologists and primary care doctors with relevant expertise.
  •  

  • **Previous Treatment Requirements**: Members should have tried and not achieved adequate control with inhaled corticosteroids alone, or must have a documented history that necessitates a long-term maintenance treatment combining both an inhaled corticosteroid and a long-acting beta-agonist.
  •  

  • **Age Criteria**: Appropriately covered for pediatric and adult patients as approved by the FDA labeling and/or clinical guidelines.
  •  

  • **Dosing and Quantity Limitations**: Coverage follows FDA guidelines for dosage and might include specific quantity restrictions to ensure safe and effective use.
  •  

  • **Clinical Documentation**: Appropriate evidence or clinical documentation must be provided to verify diagnosis, treatment history, and necessity for combination medication therapy.
  •  

  • **Periodic Review**: Continuation of Symbicort is subject to regular review processes that assess therapeutic effectiveness and adherence to prescribed therapy.
  •  

  • **Benefit Limitations**: Coverage might be subject to co-pays, prior authorization, or tiered formulary restrictions based on the specific health plan benefits.

 

Why Sharp Health Plan Might Deny Symbicort Coverage

 

Situations Where Sharp Health Plan Denies Symbicort Coverage

 

  • Non-Formulary Status: If Symbicort is not included in the formulary list of Sharp Health Plan, coverage may be denied unless an exception is granted.
  •  

  • Generic Alternatives: Coverage may be denied if there are generic equivalents or preferred alternatives available that have not been tried by the patient.
  •  

  • Lack of Prior Authorization: If prior authorization is required and not obtained before purchasing Symbicort, coverage may be denied.
  •  

  • Non-Medical Necessity: If it's determined that Symbicort is not medically necessary for the patient's condition as per the plan's criteria.
  •  

  • Off-Label Use: Prescribing Symbicort for conditions that are not FDA-approved indications may lead to denial of coverage.
  •  

  • Non-Adherence to Step Therapy: If the patient has not followed the required step therapy protocol, which may include trying other treatments first, coverage might be denied.
  •  

  • Benefit Limitations: If the prescribed amount exceeds the plan's limit on quantity or dosage, the additional amount might not be covered.
  •  

  • Eligibility Issues: Coverage may be denied if there are issues with the patient's eligibility, such as invalid enrollment status.

 

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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 Sharp Health Plan

 

Contact Sharp Health Plan Support

 

  • Reach out to Sharp Health Plan's customer service to inquire about the coverage details for Symbicort. You can do this by phone or through their online contact form.
  •  

  • Ask about the specific requirements needed to have Symbicort covered under your current health plan.

 

Review Your Plan Documentation

 

  • Check your Sharp Health Plan documents for prescription drug coverage specifics. This will help you understand if Symbicort is included or if it requires prior authorization.
  •  

  • Look for the formulary, which is a list of medications covered by your health plan, to confirm Symbicort's tier level and any alternatives.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Symbicort for your condition.
  •  

  • Request your healthcare provider to write a prescription for Symbicort while indicating any necessary medical reasons why it's needed over other medications.

 

Obtain Prior Authorization

 

  • If required, work with your healthcare provider to submit a prior authorization request to Sharp Health Plan. This often includes justification for why Symbicort is necessary for your treatment.
  •  

  • Ensure all required documentation, such as your prescription and medical history, is provided during the prior authorization process.

 

Verify Coverage Confirmation

 

  • Once the prior authorization is approved, confirm with Sharp Health Plan that Symbicort is now covered under your plan.
  •  

  • Request written confirmation or documentation of the coverage, including any co-pays or cost-sharing details.

 

Fill Your Prescription

 

  • With authorization and coverage confirmed, take your prescription to a participating pharmacy under your Sharp Health Plan.
  •  

  • Ensure you obtain the medication under the terms agreed upon with your health plan and be aware of any out-of-pocket costs.

 

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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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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 (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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