Does Aetna Cover Orlistat (Xenical, Alli)

Discover coverage options for Orlistat with Aetna, costs without insurance, and tips to get approved. Plus, find answers to common questions.
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Coverage of Orlistat by Aetna

 

  • Aetna may cover Orlistat (Xenical, Alli) for obesity management if the medication is deemed medically necessary.
  •  

  • Typically, it is covered under prescription drug benefits, subject to the terms and conditions of an individual's health plan.
  •  

  • Prior authorization might be required, meaning your healthcare provider must demonstrate the necessity of the medication for weight management, especially if other weight-loss methods have failed.
  •  

  • Eligibility typically requires a Body Mass Index (BMI) of 30 or higher, or a BMI of 27 or higher with an additional weight-related health condition, such as hypertension or diabetes.
  •  

  • It's advisable to consult with Aetna or your healthcare provider to confirm specific coverage details and any out-of-pocket costs associated with Orlistat.

 

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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 Orlistat (Xenical, Alli) Coverage with Aetna

 

Check Your Aetna Policy

 

  • Review your specific Aetna health insurance policy documents to understand the coverage details and limitations regarding prescription medications.
  •  

  • Focus on the section concerning prescription drugs, which may list Orlistat (Xenical, Alli) or provide guidance on medications for weight loss management.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Orlistat (Xenical, Alli) as part of your weight management plan.
  •  

  • Ensure your healthcare provider is aware of your insurance plan and can provide any necessary documentation or justification required by Aetna for coverage approval.

 

Contact Aetna Customer Service

 

  • Reach out to Aetna's customer service team to inquire about their coverage for Orlistat (Xenical, Alli). Make sure to have your policy number and any relevant medical information on hand.
  •  

  • Ask about any specific requirements or steps needed to secure coverage for Orlistat, such as pre-authorization or specific documentation.

 

Submit a Pre-Authorization Request

 

  • If required, your healthcare provider should help you in submitting a pre-authorization request to Aetna. This process typically involves submitting medical records and a prescription plan.
  •  

  • Ensure that all necessary documentation has been provided, including a strong medical rationale for why Orlistat is needed.

 

Review Any Additional Requirements

 

  • Check if Aetna requires you to try alternative treatments or medications before approving coverage for Orlistat. This is sometimes known as a "step therapy" requirement.
  •  

  • Follow any necessary guidelines or fulfill requirements that Aetna specifies to improve the chances of coverage approval.

 

Appeal if Necessary

 

  • If your request for coverage is denied, review the denial letters to understand the reasons and gather the required information to file an appeal.
  •  

  • Work with your healthcare provider to compile additional supporting documents or explanations to strengthen your appeal.

 

Monitor Your Pharmacy Benefits

 

  • Once approval is obtained, coordinate with your pharmacy to ensure Orlistat is covered under your prescription benefits and verify the copay or out-of-pocket costs.
  •  

  • Continuously monitor your Aetna account and pharmacy benefits to stay updated on any changes in coverage policy or costs.

 

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FAQs

Does Aetna Cover Orlistat (Xenical, Alli)

Discover coverage options for Orlistat with Aetna, costs without insurance, and tips to get approved. Plus, find answers to common questions.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Aetna

 

Coverage of Orlistat by Aetna

 

  • Aetna may cover Orlistat (Xenical, Alli) for obesity management if the medication is deemed medically necessary.
  •  

  • Typically, it is covered under prescription drug benefits, subject to the terms and conditions of an individual's health plan.
  •  

  • Prior authorization might be required, meaning your healthcare provider must demonstrate the necessity of the medication for weight management, especially if other weight-loss methods have failed.
  •  

  • Eligibility typically requires a Body Mass Index (BMI) of 30 or higher, or a BMI of 27 or higher with an additional weight-related health condition, such as hypertension or diabetes.
  •  

  • It's advisable to consult with Aetna or your healthcare provider to confirm specific coverage details and any out-of-pocket costs associated with Orlistat.

 

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Aetna's Approved Criteria for Orlistat (Xenical, Alli) Coverage

 

Criteria for Orlistat Coverage

 

  • The member must have a documented Body Mass Index (BMI) of at least 30 kg/m². For members with a BMI between 27 and 29.9 kg/m², the presence of additional risk factors such as hypertension, diabetes, or dyslipidemia is required.
  •  

  • There must be documented evidence of previous attempts to lose weight through other means such as diet and exercise, which have not resulted in successful weight management. This can include participation in a physician-supervised weight loss program or a commercial weight loss program.
  •  

  • Xenical is considered medically necessary when there is documentation of dietary history and nutritional counseling provided by a licensed healthcare professional, indicating compliance with a low-calorie diet plan.
  •  

  • Continuation of therapy beyond initial approval requires documentation that the member has achieved at least a 5% reduction in baseline weight within 12 weeks from the start of therapy, unless contraindicated.
  •  

  • Alli is covered when used as an adjunct to reduced-calorie, low-fat diet and physical activity in either adults or adolescents aged 12 to 18 who meet the specified weight criteria.
  •  

  • Documentation supporting the medical necessity for Orlistat must accompany any requests for renewal of therapy to ensure continued clinical benefit for the member.
  •  

 

Consultation and Monitoring

 

  • Regular follow-up and monitoring by the prescribing physician are required for all members on Orlistat to assess its effectiveness and manage any side effects.
  •  

  • Progress notes should reflect ongoing engagement with dietary management and physical activity as part of the treatment plan.
  •  

  • The member should be educated on the possible gastrointestinal side effects associated with Orlistat and be counseled on how to manage these effects.
  •  

 

Why Aetna Might Deny Orlistat (Xenical, Alli) Coverage

 

Situations Where Aetna Might Deny Orlistat (Xenical, Alli) Coverage

 

  • Aetna might deny coverage if Orlistat (Xenical, Alli) is prescribed for weight loss in individuals with a body mass index (BMI) below the threshold defined by the plan's policy.
  •  

  • Coverage may not be provided if there is insufficient documentation indicating that Orlistat is part of a comprehensive weight management program, including diet, physical activity, and behavioral interventions.
  •  

  • Aetna might reject coverage if Orlistat is requested for cosmetic weight loss rather than medically necessary weight management.
  •  

  • Denial could occur if Orlistat is prescribed in combination with other non-covered weight loss medications or therapies not supported by Aetna’s policy guidelines.
  •  

  • The plan may not cover Orlistat if the prescription does not meet predefined clinical criteria for weight loss medications, such as requirements for prior weight loss attempts with lifestyle modifications.
  •  

  • Orlistat might not be covered if there are documented contraindications or safety concerns for the individual based on their current medical conditions or concomitant medications.

 

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How Much Does Orlistat (Xenical, Alli) Cost without Insurance?

 

Cost of Orlistat (Xenical, Alli) Without Insurance

 

  • Xenical: The brand-name Orlistat, Xenical, can be quite expensive without insurance. Typically, the cost is around $800 to $1,000 for a supply of 90 capsules, with each capsule being 120 mg.
  •  

  • Alli: The over-the-counter version, Alli, is generally less expensive than its prescription counterpart. The price for Alli ranges from $50 to $100 for a supply of 120 capsules, with each capsule being 60 mg.
  •  

  • Generic Orlistat: While generic options may be available, they usually do not offer significant savings over the brand-name versions. The prices for generic Orlistat are often comparable to those of Alli, varying from $50 to $100 for a similar quantity.
  •  

  • Shopping Tips: Prices can vary depending on the pharmacy, location, and availability. Consider using pharmacy discount cards, online coupons, or comparing prices at different pharmacies to obtain the best deal.
  •  

  • Considerations: Always consult a healthcare provider before starting Orlistat, and discuss any potential insurance coverage or assistance programs they might recommend.

 

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 Orlistat (Xenical, Alli) Coverage with Aetna

 

Check Your Aetna Policy

 

  • Review your specific Aetna health insurance policy documents to understand the coverage details and limitations regarding prescription medications.
  •  

  • Focus on the section concerning prescription drugs, which may list Orlistat (Xenical, Alli) or provide guidance on medications for weight loss management.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Orlistat (Xenical, Alli) as part of your weight management plan.
  •  

  • Ensure your healthcare provider is aware of your insurance plan and can provide any necessary documentation or justification required by Aetna for coverage approval.

 

Contact Aetna Customer Service

 

  • Reach out to Aetna's customer service team to inquire about their coverage for Orlistat (Xenical, Alli). Make sure to have your policy number and any relevant medical information on hand.
  •  

  • Ask about any specific requirements or steps needed to secure coverage for Orlistat, such as pre-authorization or specific documentation.

 

Submit a Pre-Authorization Request

 

  • If required, your healthcare provider should help you in submitting a pre-authorization request to Aetna. This process typically involves submitting medical records and a prescription plan.
  •  

  • Ensure that all necessary documentation has been provided, including a strong medical rationale for why Orlistat is needed.

 

Review Any Additional Requirements

 

  • Check if Aetna requires you to try alternative treatments or medications before approving coverage for Orlistat. This is sometimes known as a "step therapy" requirement.
  •  

  • Follow any necessary guidelines or fulfill requirements that Aetna specifies to improve the chances of coverage approval.

 

Appeal if Necessary

 

  • If your request for coverage is denied, review the denial letters to understand the reasons and gather the required information to file an appeal.
  •  

  • Work with your healthcare provider to compile additional supporting documents or explanations to strengthen your appeal.

 

Monitor Your Pharmacy Benefits

 

  • Once approval is obtained, coordinate with your pharmacy to ensure Orlistat is covered under your prescription benefits and verify the copay or out-of-pocket costs.
  •  

  • Continuously monitor your Aetna account and pharmacy benefits to stay updated on any changes in coverage policy or costs.

 

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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.

Orlistat (Xenical, Alli) FAQ

1. What are the side effects of taking Orlistat?

 

Possible Side Effects of Orlistat

 

  • Gastrointestinal issues: Common effects include oily or fatty stools, increased defecation, and the urgent or difficult need to control bowel movements.
  •  

  • Abdominal discomfort: Some users experience pain or discomfort in the abdomen region.
  •  

  • Reduced absorption of fat-soluble vitamins: Orlistat can interfere with the absorption of vitamins A, D, E, and K. A multivitamin supplement is often recommended.
  •  

  • Allergic reactions: Though rare, symptoms may include itching, rash, or swelling, especially of the face, tongue, or throat.
  •  

  • Others: Some users report headaches, back pain, or flu-like symptoms.

 

2. How effective is Orlistat for weight loss?

 

Effectiveness of Orlistat

 

  • Orlistat aids weight loss by blocking the absorption of fats from the diet, reducing caloric intake. It can block approximately 25-30% of dietary fat.
  •  

  • Clinical studies suggest that Orlistat use for one year can result in an average weight loss of about 5-10% of initial body weight, when combined with a calorie-reduced diet.
  •  

  • It promotes modest weight loss over time and helps maintain weight loss. The effectiveness can improve with lifestyle changes such as increased physical activity and diet modifications.
  •  

  • Orlistat also has beneficial effects on cholesterol levels and may help reduce blood pressure.

 

3. Can I buy Orlistat over the counter?

 

Can I Buy Orlistat Over the Counter?

 

  • Orlistat is available in two forms: prescription strength (Xenical) and over-the-counter (Alli).
  •  

  • **Xenical**: This is the 120 mg version and requires a doctor's prescription. It's typically used for patients with a higher body mass index (BMI) or more specific medical conditions.
  •  

  • **Alli**: The 60 mg variant can be purchased over the counter in many countries, including the United States and the UK.
  •  

  • Even though Alli is accessible without a prescription, it is advised to consult with a healthcare professional before starting, to discuss its suitability and ensure proper usage.
  •  

 

Considerations Before Using Orlistat

 

  • Proper dietary changes are necessary when taking Orlistat to maximize effectiveness and reduce side effects.
  •  

  • Discuss your complete medical history and any other medications you are taking with your healthcare provider.

 

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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.

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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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