Does UPMC Health Plan Cover Dulera

Explore UPMC Health Plan's coverage for Dulera, reasons for denial, cost without insurance, and FAQs in our comprehensive guide.
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UPMC Health Plan Coverage for Dulera

 

  • UPMC Health Plan may cover Dulera if it is deemed medically necessary for the treatment of asthma.
  •  

  • Coverage typically requires a valid prescription from a healthcare provider. Be sure the provider is within the UPMC network to maximize insurance benefits.
  •  

  • It's important to check if Dulera is included in your specific plan's formulary. Coverage may vary depending on the plan type (e.g., HMO, PPO).
  •  

  • Prior authorization might be required to ensure it is the appropriate treatment, especially if alternative medications have not been effective.
  •  

  • Patients may need to meet certain criteria, like documented asthma diagnosis and previous history with other inhalers.
  •  

  • Out-of-pocket costs can differ based on the plan's copayment tier structure. Confirm any copays or coinsurance amounts for Dulera.

 

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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 UPMC Health Plan

 

Check UPMC Health Plan Formulary

 

  • Access the UPMC Health Plan website to find their Prescription Drug Formulary, which is a list of medications covered under your plan.
  •  

  • Search for "Dulera" to verify if it is included in the list of covered medications.

 

Consult Your Healthcare Provider

 

  • Discuss your need for Dulera with your doctor. Ensure that it is the right medication for your condition and that alternative options have been considered if Dulera is not covered.
  •  

  • Your healthcare provider can provide documentation or justification if Dulera is necessary for your treatment, which may be required by the insurance company.

 

Check Your Plan's Tier Level

 

  • Determine the tier level of Dulera in the UPMC Health Plan Formulary. Medications are often categorized into different tiers that determine your out-of-pocket costs.
  •  

  • Understanding the tier level can help you estimate the co-pay or co-insurance required for Dulera.

 

Pre-authorization Requirement

 

  • Check if Dulera requires pre-authorization under your plan. Pre-authorization is a process where your insurance provider approves a medication before it is dispensed.
  •  

  • If pre-authorization is needed, work with your healthcare provider to submit the necessary documents to UPMC Health Plan.

 

Contact UPMC Member Services

 

  • Reach out to UPMC Member Services directly by phone or online for specific questions about your coverage options for Dulera.
  •  

  • Request them to provide detailed information on what steps to follow if Dulera is not initially covered under your plan.

 

Review Prescription Drug Benefits

 

  • Read through the Prescription Drug Benefits section in your UPMC Health Plan member handbook for detailed information on how medications are covered.
  •  

  • Understand the processes involved for claims, appeals, or exceptions if required.

 

Submit a Formal Exception Request

 

  • If Dulera is not covered, you can submit an exception request through UPMC Health Plan's appeals process, providing detailed information from your healthcare provider that supports the necessity of the medication for your treatment.
  •  

  • Follow the procedures outlined by UPMC for submitting an appeal, ensuring all required documentation and information are included for a favorable review.

 

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FAQs

Does UPMC Health Plan Cover Dulera

Explore UPMC Health Plan's coverage for Dulera, reasons for denial, cost without insurance, and FAQs in our comprehensive guide.
Curex allergy drops unboxing

Is Dulera Covered by UPMC Health Plan

 

UPMC Health Plan Coverage for Dulera

 

  • UPMC Health Plan may cover Dulera if it is deemed medically necessary for the treatment of asthma.
  •  

  • Coverage typically requires a valid prescription from a healthcare provider. Be sure the provider is within the UPMC network to maximize insurance benefits.
  •  

  • It's important to check if Dulera is included in your specific plan's formulary. Coverage may vary depending on the plan type (e.g., HMO, PPO).
  •  

  • Prior authorization might be required to ensure it is the appropriate treatment, especially if alternative medications have not been effective.
  •  

  • Patients may need to meet certain criteria, like documented asthma diagnosis and previous history with other inhalers.
  •  

  • Out-of-pocket costs can differ based on the plan's copayment tier structure. Confirm any copays or coinsurance amounts for Dulera.

 

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UPMC Health Plan's Approved Criteria for Dulera Coverage

 

Approved Criteria for Dulera Coverage

 

  • Dulera is covered for patients who have a documented diagnosis of asthma and are aged 12 years or older.
  •  

  • The patient must have experienced suboptimal control of asthma symptoms with an inhaled corticosteroid alone for at least three months.
  •  

  • Dulera may be approved if the patient has used and failed, or has a contraindication to, another combination product, such as fluticasone/salmeterol or budesonide/formoterol.
  •  

  • For continued coverage, periodic review and reassessment of therapy effectiveness and patient adherence to treatment is required.
  •  

  • Patients must demonstrate documented improvement with Dulera use, shown through reduced frequency of asthma exacerbations or improved lung function tests.

 

Why UPMC Health Plan Might Deny Dulera Coverage

 

Situations Where UPMC Health Plan Might Deny Dulera Coverage

 

  • Dulera prescriptions that exceed the recommended dosage limits set by the manufacturer or medical guidelines might be denied.
  •  

  • Requests for Dulera for indications not approved by relevant regulatory authorities, such as the FDA, can be refused.
  •  

  • Coverage might be denied if Dulera is prescribed without a documented failure or intolerance to alternative, preferred medications on the formulary.
  •  

  • Renewal requests may be declined if there is insufficient documentation of the medication's effectiveness or necessity for continued use, based on the patient's treatment plan.
  •  

  • The plan may deny Dulera if it is prescribed for off-label use that is not documented as medically necessary.
  •  

  • Claims lacking necessary pre-authorization or completed prior-approval forms based on UPMC policies can result in denial of coverage.
  •  

  • Dulera usage that does not align with UPMC Health Plan’s step therapy protocols, which require trying alternate treatments first, may be denied.
  •  

  • Prescription for Dulera may be denied if it is determined that the patient does not meet age or other demographic criteria outlined by the plan.

 

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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 UPMC Health Plan

 

Check UPMC Health Plan Formulary

 

  • Access the UPMC Health Plan website to find their Prescription Drug Formulary, which is a list of medications covered under your plan.
  •  

  • Search for "Dulera" to verify if it is included in the list of covered medications.

 

Consult Your Healthcare Provider

 

  • Discuss your need for Dulera with your doctor. Ensure that it is the right medication for your condition and that alternative options have been considered if Dulera is not covered.
  •  

  • Your healthcare provider can provide documentation or justification if Dulera is necessary for your treatment, which may be required by the insurance company.

 

Check Your Plan's Tier Level

 

  • Determine the tier level of Dulera in the UPMC Health Plan Formulary. Medications are often categorized into different tiers that determine your out-of-pocket costs.
  •  

  • Understanding the tier level can help you estimate the co-pay or co-insurance required for Dulera.

 

Pre-authorization Requirement

 

  • Check if Dulera requires pre-authorization under your plan. Pre-authorization is a process where your insurance provider approves a medication before it is dispensed.
  •  

  • If pre-authorization is needed, work with your healthcare provider to submit the necessary documents to UPMC Health Plan.

 

Contact UPMC Member Services

 

  • Reach out to UPMC Member Services directly by phone or online for specific questions about your coverage options for Dulera.
  •  

  • Request them to provide detailed information on what steps to follow if Dulera is not initially covered under your plan.

 

Review Prescription Drug Benefits

 

  • Read through the Prescription Drug Benefits section in your UPMC Health Plan member handbook for detailed information on how medications are covered.
  •  

  • Understand the processes involved for claims, appeals, or exceptions if required.

 

Submit a Formal Exception Request

 

  • If Dulera is not covered, you can submit an exception request through UPMC Health Plan's appeals process, providing detailed information from your healthcare provider that supports the necessity of the medication for your treatment.
  •  

  • Follow the procedures outlined by UPMC for submitting an appeal, ensuring all required documentation and information are included for a favorable review.

 

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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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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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