Does SummaCare Cover Dulera

Explore why SummaCare might deny Dulera, tips to gain coverage, the out-of-pocket cost, and common FAQs in this comprehensive guide.
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Coverage of Dulera by SummaCare

 

  • SummaCare may cover Dulera for treating asthma as part of its pharmaceutical benefits. Coverage can vary based on individual plans, so confirming specific plan details is essential.
  •  

  • To get Dulera covered, a prescription from a healthcare provider is required, often supported by a diagnosis confirming the need for asthma management.
  •  

  • SummaCare might require prior authorization, where the provider must justify the medication's necessity, especially if alternatives are available.
  •  

  • Formulary categorizations—whether Dulera is preferred or a second-line treatment—can impact cost-sharing responsibilities, such as copayments or deductibles.
  •  

  • Members should verify coverage specifics in their plan documents or contact SummaCare's customer service for personalized assistance regarding Dulera's coverage and authorization criteria.

 

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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 SummaCare

 

Start with SummaCare

 

  • Visit the SummaCare official website to explore their healthcare plans.
  •  

  • Contact their customer service for specific details about prescription drug coverage, including Dulera.

 

Check Your Coverage

 

  • Review the Summary of Benefits and Coverage (SBC) document provided by SummaCare. It clearly outlines the prescription drugs covered under your plan.
  •  

  • Identify if Dulera is listed under preferred drugs or requires prior authorization.

 

Contact Your Healthcare Provider

 

  • Speak with your doctor or healthcare provider about your need for Dulera and discuss adding it to your treatment plan.
  •  

  • Ensure your doctor is aware of any formulary restrictions or required documentation for medications under SummaCare.

 

Obtain Prior Authorization

 

  • If Dulera requires prior authorization, coordinate with your healthcare provider to submit the necessary forms to SummaCare.
  •  

  • Follow up to verify the authorization status and ensure a swift processing of your request.

 

Pharmacy Information

 

  • Confirm with SummaCare that your preferred pharmacy is within their network to avoid non-coverage issues.
  •  

  • Review if there are any copayment or coinsurance responsibilities on your part for Dulera.

 

Utilize SummaCare Resources

 

  • Make use of SummaCare’s online tools or mobile app for managing prescriptions and verifying coverage.
  •  

  • Access support services provided by SummaCare for additional assistance with prescription management and benefit inquiries.

 

Review and Adjust Your Plan Annually

 

  • During open enrollment, review your plan to ensure it continues to meet your prescription needs, including covering Dulera.
  •  

  • Consider switching plans if there are changes in coverage or cost that may affect your access to Dulera.

 

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FAQs

Does SummaCare Cover Dulera

Explore why SummaCare might deny Dulera, tips to gain coverage, the out-of-pocket cost, and common FAQs in this comprehensive guide.
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Is Dulera Covered by SummaCare

 

Coverage of Dulera by SummaCare

 

  • SummaCare may cover Dulera for treating asthma as part of its pharmaceutical benefits. Coverage can vary based on individual plans, so confirming specific plan details is essential.
  •  

  • To get Dulera covered, a prescription from a healthcare provider is required, often supported by a diagnosis confirming the need for asthma management.
  •  

  • SummaCare might require prior authorization, where the provider must justify the medication's necessity, especially if alternatives are available.
  •  

  • Formulary categorizations—whether Dulera is preferred or a second-line treatment—can impact cost-sharing responsibilities, such as copayments or deductibles.
  •  

  • Members should verify coverage specifics in their plan documents or contact SummaCare's customer service for personalized assistance regarding Dulera's coverage and authorization criteria.

 

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SummaCare's Approved Criteria for Dulera Coverage

 

Criteria for Dulera Coverage

 

  • Documented diagnosis of asthma, for which Dulera is being prescribed as a long-term control medication.
  •  

  • Patient must be 12 years of age or older, as Dulera is approved for use only in this age group.
  •  

  • Completion of a trial period with inhaled corticosteroids alone, unless contraindicated or ineffective, to establish the necessity of Dulera for better asthma control.
  •  

  • Evidence of well-documented asthma exacerbations, medical records, or healthcare provider's notes that indicate Dulera as part of a comprehensive asthma management plan.
  •  

  • Prescribed by a licensed healthcare provider with expertise in managing asthma, ensuring that Dulera is used according to guidelines for treating this condition.
  •  

  • A written treatment plan, including expected therapy duration, goals for symptom control, and monitoring schedule to track therapy effectiveness and adherence.
  •  

  • Continued usage contingent on periodic reviews to assess efficacy, adjust dosing if necessary, and confirm persistent necessity for the combination of medications found in Dulera.

 

Why SummaCare Might Deny Dulera Coverage

 

Reasons for Dulera Coverage Denial by SummaCare

 

  • **Non-Formulary Medication:** Dulera may be denied if it is not part of SummaCare's approved drug formulary list.
  •  

  • **Lack of Prior Authorization:** Coverage may be denied if prior authorization was not obtained before the prescription was filled.
  •  

  • **Medical Necessity Not Established:** If there is insufficient evidence or documentation to demonstrate that Dulera is medically necessary, coverage may be denied.
  •  

  • **Quantity Limits:** Requests exceeding the allowable quantity limit set by SummaCare without appropriate justification may be denied.
  •  

  • **Step Therapy Requirements Not Met:** If step therapy protocols (requiring trial of less expensive treatments first) are not followed, coverage may not be provided.
  •  

  • **Out-of-Network Pharmacy:** Using a pharmacy that is not within the SummaCare network without proper veterinary referral can lead to denial of coverage.
  •  

  • **Pre-Existing Condition Exclusion:** If Dulera is prescribed for a condition that is considered pre-existing under the policy terms, it might not be covered.
  •  

  • **Incomplete or Inaccurate Claim Submission:** Claims that are incomplete or contain errors may be rejected and not covered by SummaCare.

 

Together with our partners we have changed the lives of over 300,000 patients.

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 SummaCare

 

Start with SummaCare

 

  • Visit the SummaCare official website to explore their healthcare plans.
  •  

  • Contact their customer service for specific details about prescription drug coverage, including Dulera.

 

Check Your Coverage

 

  • Review the Summary of Benefits and Coverage (SBC) document provided by SummaCare. It clearly outlines the prescription drugs covered under your plan.
  •  

  • Identify if Dulera is listed under preferred drugs or requires prior authorization.

 

Contact Your Healthcare Provider

 

  • Speak with your doctor or healthcare provider about your need for Dulera and discuss adding it to your treatment plan.
  •  

  • Ensure your doctor is aware of any formulary restrictions or required documentation for medications under SummaCare.

 

Obtain Prior Authorization

 

  • If Dulera requires prior authorization, coordinate with your healthcare provider to submit the necessary forms to SummaCare.
  •  

  • Follow up to verify the authorization status and ensure a swift processing of your request.

 

Pharmacy Information

 

  • Confirm with SummaCare that your preferred pharmacy is within their network to avoid non-coverage issues.
  •  

  • Review if there are any copayment or coinsurance responsibilities on your part for Dulera.

 

Utilize SummaCare Resources

 

  • Make use of SummaCare’s online tools or mobile app for managing prescriptions and verifying coverage.
  •  

  • Access support services provided by SummaCare for additional assistance with prescription management and benefit inquiries.

 

Review and Adjust Your Plan Annually

 

  • During open enrollment, review your plan to ensure it continues to meet your prescription needs, including covering Dulera.
  •  

  • Consider switching plans if there are changes in coverage or cost that may affect your access to Dulera.

 

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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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