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Does UnitedHealthcare Cover Dupixent

Learn about Dupixent coverage under UnitedHealthcare, reasons for denial, steps to get approval, costs without insurance, and FAQs in this comprehensive guide.

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Does UnitedHealthcare Cover Dupixent?

Dupixent may be covered for patients with specific conditions such as moderate to severe atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyps, depending on the patient's specific UnitedHealthcare plan.

Coverage typically requires prior authorization, where the prescribing physician must demonstrate the medical necessity of Dupixent.

Documentation of previous treatments and their outcomes might be required, as UnitedHealthcare often needs proof that traditional therapies were ineffective or not suitable.

Patients must follow specific criteria outlined in their policy documentation, which might include age restrictions, condition severity, and frequency or dosage limitations.

It's crucial for policyholders to review their specific plan details or contact UnitedHealthcare directly to understand precise coverage rules and any co-payment or deductible requirements.

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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.

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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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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 UnitedHealthcare

Verify Dupixent Requirement

Determine with your healthcare provider if Dupixent is the appropriate medication for your condition.

Ensure that your diagnosis and treatment plan are accurately documented by your healthcare provider.

Review UnitedHealthcare's Drug Coverage Policy

Visit the UnitedHealthcare website to access the online formulary (drug list) to check if Dupixent is included.

Look for any special restrictions or requirements such as prior authorization or step therapy.

Check Your Specific Plan Benefits

Login to your UnitedHealthcare online account or review your plan documents to check your specific drug coverage benefits.

Contact UnitedHealthcare customer service if you need clarity on coverage details for Dupixent.

Obtain a Prescription

Schedule a visit with your healthcare provider to discuss obtaining a prescription for Dupixent.

Ensure your healthcare provider is aware of any UnitedHealthcare requirements for Dupixent coverage.

Initiate a Prior Authorization Request

Your healthcare provider may need to submit a prior authorization request to UnitedHealthcare to get Dupixent approved. This often involves submitting medical records and documentation of medical necessity.

Follow up with your healthcare provider to ensure the authorization request is submitted promptly.

Follow Up on Prior Authorization Status

Contact UnitedHealthcare to check the status of the prior authorization request. This can often be done online or by calling customer service.

In case of denial, work with your healthcare provider to furnish any additional information or appeal the decision.

Fill Your Prescription

Once approved, you can fill your Dupixent prescription at a pharmacy within UnitedHealthcare’s network.

Verify any copays or coinsurance responsibilities before completing your order.

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FAQs

Does UnitedHealthcare Cover Dupixent

Learn about Dupixent coverage under UnitedHealthcare, reasons for denial, steps to get approval, costs without insurance, and FAQs in this comprehensive guide.

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Is Dupixent Covered by UnitedHealthcare

Does UnitedHealthcare Cover Dupixent?

Dupixent may be covered for patients with specific conditions such as moderate to severe atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyps, depending on the patient's specific UnitedHealthcare plan.

Coverage typically requires prior authorization, where the prescribing physician must demonstrate the medical necessity of Dupixent.

Documentation of previous treatments and their outcomes might be required, as UnitedHealthcare often needs proof that traditional therapies were ineffective or not suitable.

Patients must follow specific criteria outlined in their policy documentation, which might include age restrictions, condition severity, and frequency or dosage limitations.

It's crucial for policyholders to review their specific plan details or contact UnitedHealthcare directly to understand precise coverage rules and any co-payment or deductible requirements.

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UnitedHealthcare's Approved Criteria for Dupixent Coverage

Criteria for Dupixent Coverage

**Diagnosis Confirmation:** The patient must have a documented diagnosis that Dupixent is approved to treat, such as moderate-to-severe atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis.

**Specialist Consultation:** A referral or confirmation of diagnosis from a specialist such as a dermatologist, allergist, or pulmonologist who is managing the patient's condition.

**Previous Treatment Attempt:** Documentation of previous treatments tried and failed, or contraindications to those treatments. For instance, prior use of topical corticosteroids or systemic immunosuppressants with atopic dermatitis.

**Age Requirements:** The patient must meet specific age requirements for Dupixent use based on FDA approval for the given condition.

**Treatment Plan:** There must be a clear and detailed treatment plan outlining the intended use of Dupixent and tracking its effectiveness over time.

**Regular Follow-up:** Commitment to regular follow-ups as part of ongoing care to monitor the patient's condition and response to Dupixent therapy.

**Insurance Pre-Approval:** Completion of any necessary forms and submission of medical records required for pre-approval by UnitedHealthcare.

Why UnitedHealthcare Might Deny Dupixent Coverage

Reasons for Dupixent Coverage Denial by UnitedHealthcare

Dupixent is not covered if prescribed for conditions not approved by the U.S. Food and Drug Administration (FDA). This includes off-label uses that are not explicitly supported by clinical guidelines.

The treatment may be denied if the patient's medical records do not demonstrate that they have tested and failed other preferred therapies or medications before considering Dupixent.

If the prescription does not meet the specific diagnostic criteria outlined by UnitedHealthcare for approved conditions, coverage may be denied.

Lack of sufficient medical documentation or failure to submit required prior authorization paperwork can result in denial of coverage for Dupixent.

Dupixent may be denied if the patient is not adherent to the guidelines, such as age restrictions or confirmation that adult patients are within certain chronic conditions.

UnitedHealthcare may deny coverage if Dupixent is deemed not medically necessary based on their evaluation criteria, which look at the patient's condition and treatment history.

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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 UnitedHealthcare

Verify Dupixent Requirement

Determine with your healthcare provider if Dupixent is the appropriate medication for your condition.

Ensure that your diagnosis and treatment plan are accurately documented by your healthcare provider.

Review UnitedHealthcare's Drug Coverage Policy

Visit the UnitedHealthcare website to access the online formulary (drug list) to check if Dupixent is included.

Look for any special restrictions or requirements such as prior authorization or step therapy.

Check Your Specific Plan Benefits

Login to your UnitedHealthcare online account or review your plan documents to check your specific drug coverage benefits.

Contact UnitedHealthcare customer service if you need clarity on coverage details for Dupixent.

Obtain a Prescription

Schedule a visit with your healthcare provider to discuss obtaining a prescription for Dupixent.

Ensure your healthcare provider is aware of any UnitedHealthcare requirements for Dupixent coverage.

Initiate a Prior Authorization Request

Your healthcare provider may need to submit a prior authorization request to UnitedHealthcare to get Dupixent approved. This often involves submitting medical records and documentation of medical necessity.

Follow up with your healthcare provider to ensure the authorization request is submitted promptly.

Follow Up on Prior Authorization Status

Contact UnitedHealthcare to check the status of the prior authorization request. This can often be done online or by calling customer service.

In case of denial, work with your healthcare provider to furnish any additional information or appeal the decision.

Fill Your Prescription

Once approved, you can fill your Dupixent prescription at a pharmacy within UnitedHealthcare’s network.

Verify any copays or coinsurance responsibilities before completing your order.

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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 UnitedHealthcare Cover Dupixent

Learn about Dupixent coverage under UnitedHealthcare, reasons for denial, steps to get approval, costs without insurance, and FAQs in this comprehensive guide.

Achieve Your Goals Faster with Curex