Does SummaCare Cover Symbicort

Explore SummaCare's Symbicort coverage, reasons for denial, ways to secure it, costs without insurance, and FAQs in this comprehensive article.
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SummaCare Coverage for Symbicort

 

  • **Prescription Drug Coverage:** Symbicort is typically included in the prescription drug formulary of SummaCare plans, subject to certain conditions and tier levels.
  •  

  • **Formulary Tier:** Coverage may vary depending on whether Symbicort is categorized as a preferred or non-preferred brand drug, impacting copay amounts.
  •  

  • **Prior Authorization:** Some SummaCare plans may require prior authorization for Symbicort, ensuring medical necessity before approval for coverage.
  •  

  • **Step Therapy:** Patients may be required to try and fail other medications before Symbicort is approved as part of step therapy protocols.
  •  

  • **Quantity Limits:** Coverage may impose limits on the quantity of Symbicort you can receive within a certain timeframe.
  •  

  • **Eligibility and Enrollment:** Coverage criteria, such as being enrolled in a specific plan or meeting deductible and out-of-pocket maximums, must be met.

 

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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 SummaCare

 

Verify Your Coverage with SummaCare

 

  • Log in to your SummaCare member account online to review your current benefit details and see if Symbicort is included in your formulary.
  •  

  • Contact SummaCare customer service directly to confirm coverage specifics concerning your prescription plan and any possible updates on medication coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about the need for Symbicort, ensuring they understand your insurance situation and can provide a detailed prior authorization if required.
  •  

  • Request that your healthcare provider includes a justification letter if needed, explaining the medical necessity of the medication to increase the chance of approval.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization to SummaCare, outlining the necessity for Symbicort and including supporting medical documentation.
  •  

  • Ensure all forms are complete and submitted by the healthcare provider to facilitate a smoother approval process.

 

Understand Your Plan Benefits

 

  • Review your SummaCare plan documents or speak with a representative to understand your deductible, co-payments, and any out-of-pocket costs related to medications.
  •  

  • Ask specifically if there are any more affordable alternatives or generic options available, in case Symbicort is not covered.

 

Follow Up with SummaCare

 

  • After submission, regularly follow up with SummaCare to check the status of your prior authorization request.
  •  

  • If there are any denials, inquire about the reason and the possibility of an appeal. Gather additional supporting documentation if necessary.

 

Explore Financial Assistance Programs

 

  • Look into manufacturer assistance programs or patient advocacy groups that might offer financial support or discounts for Symbicort.
  •  

  • Consider discussing any financial constraints with your doctor to explore other viable options or additional resources.

 

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FAQs

Does SummaCare Cover Symbicort

Explore SummaCare's Symbicort coverage, reasons for denial, ways to secure it, costs without insurance, and FAQs in this comprehensive article.
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Is Symbicort Covered by SummaCare

 

SummaCare Coverage for Symbicort

 

  • **Prescription Drug Coverage:** Symbicort is typically included in the prescription drug formulary of SummaCare plans, subject to certain conditions and tier levels.
  •  

  • **Formulary Tier:** Coverage may vary depending on whether Symbicort is categorized as a preferred or non-preferred brand drug, impacting copay amounts.
  •  

  • **Prior Authorization:** Some SummaCare plans may require prior authorization for Symbicort, ensuring medical necessity before approval for coverage.
  •  

  • **Step Therapy:** Patients may be required to try and fail other medications before Symbicort is approved as part of step therapy protocols.
  •  

  • **Quantity Limits:** Coverage may impose limits on the quantity of Symbicort you can receive within a certain timeframe.
  •  

  • **Eligibility and Enrollment:** Coverage criteria, such as being enrolled in a specific plan or meeting deductible and out-of-pocket maximums, must be met.

 

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SummaCare's Approved Criteria for Symbicort Coverage

 

General Coverage Criteria for Symbicort

 

  • Treatment must be for patients diagnosed with asthma or Chronic Obstructive Pulmonary Disease (COPD).
  •  

  • The patient must have documentation indicating inadequacy of control with other asthma or COPD therapies or has experienced adverse effects with alternative treatments.
  •  

  • Documentation must detail the patient's current treatment plan, including medications, dosages, and therapeutic outcomes.

 

Documentation Requirements

 

  • Physician documentation must provide a detailed diagnosis, including spirometry results for asthma or COPD, if applicable.
  •  

  • Patient's medical history should reflect previous treatments tried and discussed, including the duration and outcomes of such treatments.
  •  

  • Prescribers must provide a plan for Symbicort use, including dosage and treatment goals.

 

Age and Dosage Criteria

 

  • Symbicort is typically approved for adults and children over the age of 6, based on FDA guidelines and clinical assessments.
  •  

  • The prescribed dosage should align with the FDA-approved dosing instructions for Symbicort, adjusted for patient-specific requirements.

 

Renewal Criteria

 

  • Renewal of Symbicort coverage requires evidence of clinical benefit, such as improved lung function, reduced asthma or COPD exacerbations, or enhanced quality of life measures.
  •  

  • Documentation must show regular follow-up visits with the prescriber to assess the effectiveness and safety of Symbicort use.

 

Why SummaCare Might Deny Symbicort Coverage

 

Symbicort Denial Criteria

 

  • SummaCare may deny coverage for Symbicort if the prescribed use does not align with FDA-approved indications. Off-label use might not be covered.
  •  

  • Prescription requests that lack sufficient documentation to justify medical necessity or do not meet the required clinical criteria may be denied.
  •  

  • Coverage may be refused if the patient's health plan includes a step therapy requirement, and alternative medications have not been tried first.
  •  

  • Requests may be denied if the patient has not gone through the required prior authorization process, or if the request does not obtain approval.
  •  

  • SummaCare might deny coverage if the patient exceeds age or dosage limits defined in the plan's formulary guidelines.
  •  

  • If Symbicort is not listed under the patient's specific SummaCare plan formulary, it might not be covered.
  •  

  • Denial may occur if the patient uses an out-of-network pharmacy to fill the Symbicort prescription, and their plan requires prescriptions to be filled at an in-network pharmacy for coverage.

 

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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 SummaCare

 

Verify Your Coverage with SummaCare

 

  • Log in to your SummaCare member account online to review your current benefit details and see if Symbicort is included in your formulary.
  •  

  • Contact SummaCare customer service directly to confirm coverage specifics concerning your prescription plan and any possible updates on medication coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about the need for Symbicort, ensuring they understand your insurance situation and can provide a detailed prior authorization if required.
  •  

  • Request that your healthcare provider includes a justification letter if needed, explaining the medical necessity of the medication to increase the chance of approval.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization to SummaCare, outlining the necessity for Symbicort and including supporting medical documentation.
  •  

  • Ensure all forms are complete and submitted by the healthcare provider to facilitate a smoother approval process.

 

Understand Your Plan Benefits

 

  • Review your SummaCare plan documents or speak with a representative to understand your deductible, co-payments, and any out-of-pocket costs related to medications.
  •  

  • Ask specifically if there are any more affordable alternatives or generic options available, in case Symbicort is not covered.

 

Follow Up with SummaCare

 

  • After submission, regularly follow up with SummaCare to check the status of your prior authorization request.
  •  

  • If there are any denials, inquire about the reason and the possibility of an appeal. Gather additional supporting documentation if necessary.

 

Explore Financial Assistance Programs

 

  • Look into manufacturer assistance programs or patient advocacy groups that might offer financial support or discounts for Symbicort.
  •  

  • Consider discussing any financial constraints with your doctor to explore other viable options or additional resources.

 

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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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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 (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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