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Does UPMC Health Plan Cover Symbicort

Explore UPMC Health Plan coverage for Symbicort, learn about potential denials, coverage tips, costs without insurance, and find answers in our FAQ section.
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UPMC Health Plan Coverage for Symbicort

 

  • **Formulary Status:** Symbicort is typically covered under UPMC Health Plan's formulary, which includes preferred brand medications.

    •  

  • **Prior Authorization:** Some plans may require prior authorization to ensure Symbicort is medically necessary for the patient.

    •  

  • **Step Therapy:** Members may need to try other preferred medications first or demonstrate therapeutic failure with them before Symbicort is approved.

    •  

  • **Copayments/Coinsurance:** Coverage may involve copayments or coinsurance, depending on the member's specific plan.

    •  

  • **Specific Plans:** Coverage and requirements may vary across different UPMC Health Plan options and member agreements, so it is advisable to review plan details or consult with customer service.

 

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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

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 UPMC Health Plan

 

Contact UPMC Health Plan Customer Service

 

  • Reach out to UPMC Health Plan's customer service to inquire about prescription drug coverage. You can find the contact number on your insurance card or UPMC Health Plan's website.

    •  

  • Ask specific questions regarding the coverage for Symbicort under your health plan.

 

Consult the Prescription Drug Formulary

 

  • Review UPMC Health Plan's prescription drug formulary to determine if Symbicort is listed and under what tier it falls. This can usually be found on their website or requested via customer service.

    •  

  • Note any requirements, such as prior authorization or step therapy, that might apply to Symbicort.

 

Visit Your Healthcare Provider

 

  • Discuss your need for Symbicort with your healthcare provider. They can confirm the necessity of the medication based on your health condition.

    •  

  • Your provider can also provide the necessary documentation if UPMC Health Plan requires prior authorization or a letter of medical necessity.

 

Submit a Prior Authorization Request

 

  • If your plan requires prior authorization for Symbicort, work with your healthcare provider to submit a request. This typically involves completing a form provided by UPMC Health Plan or through an online portal.

    •  

  • Ensure all fields are correctly filled out and submit any additional documentation your provider recommends.

 

Follow Up on the Prior Authorization Request

 

  • Contact UPMC Health Plan to confirm receipt of your prior authorization request and inquire about the timeline for a decision.

    •  

  • If required, provide any further documentation or information that UPMC Health Plan might request.

 

Review Coverage Decisions

 

  • Once UPMC Health Plan has made a decision, review the approval or denial notice. This will provide an explanation and any next steps.

    •  

  • If your request is denied, you can discuss alternative steps with your healthcare provider or learn about the appeal process.

 

Appeal a Coverage Denial

 

  • If necessary, file an appeal with UPMC Health Plan. Gather additional documentation supporting your need for Symbicort to enhance your appeal.

    •  

  • Follow up regularly on the status of your appeal to ensure it is being reviewed in a timely manner.

 

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Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does UPMC Health Plan Cover Symbicort

Explore UPMC Health Plan coverage for Symbicort, learn about potential denials, coverage tips, costs without insurance, and find answers in our FAQ section.
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Is Symbicort Covered by UPMC Health Plan

 

UPMC Health Plan Coverage for Symbicort

 

  • **Formulary Status:** Symbicort is typically covered under UPMC Health Plan's formulary, which includes preferred brand medications.

    •  

  • **Prior Authorization:** Some plans may require prior authorization to ensure Symbicort is medically necessary for the patient.

    •  

  • **Step Therapy:** Members may need to try other preferred medications first or demonstrate therapeutic failure with them before Symbicort is approved.

    •  

  • **Copayments/Coinsurance:** Coverage may involve copayments or coinsurance, depending on the member's specific plan.

    •  

  • **Specific Plans:** Coverage and requirements may vary across different UPMC Health Plan options and member agreements, so it is advisable to review plan details or consult with customer service.

 

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UPMC Health Plan's Approved Criteria for Symbicort Coverage

 

Eligibility Requirements for Symbicort Coverage

 

  • The patient must have a diagnosis of asthma or chronic obstructive pulmonary disease (COPD) confirmed by medical records from a healthcare provider.

    •  

  • For asthma, the patient should have required two or more occasions of oral corticosteroids in the past year or had uncontrolled symptoms despite compliance with inhaled corticosteroids and long-acting beta-agonist therapy.

    •  

  • For COPD, the patient should demonstrate inadequately controlled symptoms despite the use of a combination of inhaled corticosteroids and long-acting beta-agonists or have a history of frequent exacerbations.

 

Medication Trial Requirements

 

  • Evidence of trial and inadequate response, contraindication, or intolerance to preferred formulary alternatives should be provided.

    •  

  • Documentation must include prior treatments and reasons for switching to Symbicort.

 

Age Limitations

 

  • Symbicort may be approved for patients aged 12 years and older for treatment of asthma.

    •  

  • For COPD, coverage is generally available for patients 18 years and older.

 

Prescriber Requirements

 

  • The prescriber should be a specialist in pulmonary medicine, allergy, immunology, or another relevant field, or the patient must have been evaluated by such a specialist.

    •  

  • Prescriber should provide the necessary documentation and care plan indicating the medical necessity of Symbicort use.

 

Why UPMC Health Plan Might Deny Symbicort Coverage

 

Possible Reasons for Denial of Symbicort Coverage by UPMC Health Plan

 

  • The medication does not meet the predetermined criteria for medical necessity as outlined by UPMC Health Plan's clinical guidelines.

    •  

  • Symbicort is not on the UPMC Health Plan's formulary or preferred drug list, indicating that there are recommended alternative medications.

    •  

  • An alternative generic option is available and deemed equally effective, and thus preferred over the brand medication.

    •  

  • The patient has not met any prerequisite requirements or failed to try other medications first, as mandated by a step therapy protocol.

    •  

  • Lack of prior authorization, if required by the insurance for Symbicort coverage, has not been obtained by the prescribing physician.

    •  

  • The prescribed dosage or administration does not fall within UPMC Health Plan's approved dosing guidelines or restrictions.

    •  

  • The use of Symbicort is for a non-FDA approved indication, which may not be covered under the insurance policy.

    •  

  • The patient is already receiving another medication that duplicates therapy and is thus considered unnecessary by the health plan.

 

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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.

 

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

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 UPMC Health Plan

 

Contact UPMC Health Plan Customer Service

 

  • Reach out to UPMC Health Plan's customer service to inquire about prescription drug coverage. You can find the contact number on your insurance card or UPMC Health Plan's website.

    •  

  • Ask specific questions regarding the coverage for Symbicort under your health plan.

 

Consult the Prescription Drug Formulary

 

  • Review UPMC Health Plan's prescription drug formulary to determine if Symbicort is listed and under what tier it falls. This can usually be found on their website or requested via customer service.

    •  

  • Note any requirements, such as prior authorization or step therapy, that might apply to Symbicort.

 

Visit Your Healthcare Provider

 

  • Discuss your need for Symbicort with your healthcare provider. They can confirm the necessity of the medication based on your health condition.

    •  

  • Your provider can also provide the necessary documentation if UPMC Health Plan requires prior authorization or a letter of medical necessity.

 

Submit a Prior Authorization Request

 

  • If your plan requires prior authorization for Symbicort, work with your healthcare provider to submit a request. This typically involves completing a form provided by UPMC Health Plan or through an online portal.

    •  

  • Ensure all fields are correctly filled out and submit any additional documentation your provider recommends.

 

Follow Up on the Prior Authorization Request

 

  • Contact UPMC Health Plan to confirm receipt of your prior authorization request and inquire about the timeline for a decision.

    •  

  • If required, provide any further documentation or information that UPMC Health Plan might request.

 

Review Coverage Decisions

 

  • Once UPMC Health Plan has made a decision, review the approval or denial notice. This will provide an explanation and any next steps.

    •  

  • If your request is denied, you can discuss alternative steps with your healthcare provider or learn about the appeal process.

 

Appeal a Coverage Denial

 

  • If necessary, file an appeal with UPMC Health Plan. Gather additional documentation supporting your need for Symbicort to enhance your appeal.

    •  

  • Follow up regularly on the status of your appeal to ensure it is being reviewed in a timely manner.

 

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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.

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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.

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.

 

Have questions left?

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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A weight management program tailored to you

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 (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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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