Does Aetna Cover Saxenda

Explore Aetna's coverage for Saxenda, reasons for denial, tips to secure approval, costs without insurance, and FAQs in this comprehensive guide.
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Does Aetna Cover Saxenda?

 

  • Saxenda, a medication used for weight management, may be covered by Aetna, depending on your specific health plan.
  •  

  • Coverage typically applies if Saxenda is medically necessary for obesity or weight-related conditions like type 2 diabetes, hypertension, and dyslipidemia.
  •  

  • Prior authorization is often required. Your healthcare provider must supply clinical documentation supporting the necessity of Saxenda therapy.
  •  

  • Criteria for coverage may include a BMI of 30 or higher, or 27 or higher with at least one weight-related condition.
  •  

  • Patients may need to try other weight-loss treatments first, as per step therapy requirements.
  •  

  • Review your specific Aetna plan documents or contact customer service to understand exact coverage guidelines and potential out-of-pocket costs.

 

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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.

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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 Saxenda Coverage with Aetna

 

Verify Saxenda Coverage Under Your Aetna Plan

 

  • Check the Summary of Benefits for your specific Aetna plan to see if Saxenda is listed under prescription coverage. This document is often available in your Aetna member account on their website.
  •  

  • If Saxenda isn't explicitly listed, contact Aetna's customer service to directly inquire about coverage specifics for Saxenda.
  •  

  • Understand that coverage might vary based on your specific health plan, geographic location, and medical necessity.

 

Obtain a Prescription from Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss whether Saxenda is an appropriate treatment for you.
  •  

  • Your healthcare provider should document your health condition and provide a prescription if Saxenda is deemed necessary for you.

 

Provide Necessary Documentation to Aetna

 

  • Aetna may require prior authorization for Saxenda. Ask your healthcare provider to submit any necessary medical documentation to Aetna demonstrating your need for Saxenda.
  •  

  • This documentation typically includes your diagnosis, previous treatments attempted, and how Saxenda will be used in your treatment plan.

 

Complete Aetna’s Prior Authorization Form

 

  • Work with your healthcare provider to complete Aetna's Prior Authorization form, if required. Ensure all sections of the form are filled out correctly and comprehensively.
  •  

  • The completed form should be submitted as directed by Aetna, either online, via fax, or by mail.

 

Follow Up with Aetna for Approval

 

  • After submitting the authorization form, follow up with Aetna to ensure it has been received and is under review.
  •  

  • If there are any additional requirements or information needed, supply this promptly to avoid delays in processing.
  •  

  • Keep a record of all communications and copies of the documents submitted.

 

Check Pharmacy Requirements and Copay

 

  • Once approved, confirm with your pharmacy that they can process and fulfill the Saxenda prescription under your Aetna plan.
  •  

  • Be aware of any copayment or out-of-pocket costs associated with your prescription. Discuss options with your pharmacy if there are any affordability concerns.

 

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FAQs

Does Aetna Cover Saxenda

Explore Aetna's coverage for Saxenda, reasons for denial, tips to secure approval, costs without insurance, and FAQs in this comprehensive guide.
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Is Saxenda Covered by Aetna

 

Does Aetna Cover Saxenda?

 

  • Saxenda, a medication used for weight management, may be covered by Aetna, depending on your specific health plan.
  •  

  • Coverage typically applies if Saxenda is medically necessary for obesity or weight-related conditions like type 2 diabetes, hypertension, and dyslipidemia.
  •  

  • Prior authorization is often required. Your healthcare provider must supply clinical documentation supporting the necessity of Saxenda therapy.
  •  

  • Criteria for coverage may include a BMI of 30 or higher, or 27 or higher with at least one weight-related condition.
  •  

  • Patients may need to try other weight-loss treatments first, as per step therapy requirements.
  •  

  • Review your specific Aetna plan documents or contact customer service to understand exact coverage guidelines and potential out-of-pocket costs.

 

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Aetna's Approved Criteria for Saxenda Coverage

 

Eligibility Criteria for Saxenda Coverage

 

  • Members must have a documented diagnosis of chronic weight management.
  •  

  • Eligibility requires that the member has a Body Mass Index (BMI) of at least 30 kg/m2 or greater.
  •  

  • Coverage may be provided if the member has a BMI of 27 kg/m2 or greater with one weight-related comorbidity, such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • The member should have attempted weight management strategies, such as diet, exercise, and behavioral modifications, without achieving adequate weight loss.
  •  

  • A healthcare provider must document the need for medical intervention as part of a comprehensive weight management program.

 

Trial Period and Monitoring

 

  • There must be documentation of a trial period with Saxenda and evidence of clinical benefits such as weight loss.
  •  

  • The member’s response to Saxenda should be assessed within 16 weeks of initiation, and a weight loss of at least 4% should be documented for continued coverage.
  •  

  • Ongoing Saxenda therapy requires regular monitoring by the healthcare provider to ensure continued efficacy and safety.

 

Physician's Role in Coverage Approval

 

  • The request for Saxenda coverage should come through a licensed healthcare provider specializing in weight management or a related field.
  •  

  • A comprehensive treatment plan must outline the role of Saxenda in conjunction with lifestyle modification.
  •  

  • The healthcare provider must regularly evaluate the member’s progress, adhere to Aetna's guidelines for drug efficacy and safety, and provide documentation of these evaluations.

 

Why Aetna Might Deny Saxenda Coverage

 

Possible Reasons Aetna Might Deny Saxenda Coverage

 

  • Aetna considers Saxenda not medically necessary for weight management in the absence of a chronic weight-related condition.
  •  

  • The patient does not meet the body mass index (BMI) criteria required by Aetna's policy for Saxenda coverage.
  •  

  • Medical documentation does not sufficiently support the diagnosis, treatment necessity, or compliance with Aetna's specific criteria for Saxenda.
  •  

  • Aetna does not cover Saxenda for cosmetic weight loss or general weight loss without a supporting medical condition that meets their standards.
  •  

  • Previous weight management attempts in the patient's medical history are not documented, as Aetna may require evidence of prior attempts before approving coverage for Saxenda.
  •  

  • The prescribed usage falls outside Aetna’s approved indications and dosage recommendations for Saxenda, such as its use with other weight loss products.
  •  

  • Patient lacks the necessary pre-authorization or approval from Aetna when required before beginning treatment with Saxenda.

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket costs.

 

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 Saxenda Coverage with Aetna

 

Verify Saxenda Coverage Under Your Aetna Plan

 

  • Check the Summary of Benefits for your specific Aetna plan to see if Saxenda is listed under prescription coverage. This document is often available in your Aetna member account on their website.
  •  

  • If Saxenda isn't explicitly listed, contact Aetna's customer service to directly inquire about coverage specifics for Saxenda.
  •  

  • Understand that coverage might vary based on your specific health plan, geographic location, and medical necessity.

 

Obtain a Prescription from Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss whether Saxenda is an appropriate treatment for you.
  •  

  • Your healthcare provider should document your health condition and provide a prescription if Saxenda is deemed necessary for you.

 

Provide Necessary Documentation to Aetna

 

  • Aetna may require prior authorization for Saxenda. Ask your healthcare provider to submit any necessary medical documentation to Aetna demonstrating your need for Saxenda.
  •  

  • This documentation typically includes your diagnosis, previous treatments attempted, and how Saxenda will be used in your treatment plan.

 

Complete Aetna’s Prior Authorization Form

 

  • Work with your healthcare provider to complete Aetna's Prior Authorization form, if required. Ensure all sections of the form are filled out correctly and comprehensively.
  •  

  • The completed form should be submitted as directed by Aetna, either online, via fax, or by mail.

 

Follow Up with Aetna for Approval

 

  • After submitting the authorization form, follow up with Aetna to ensure it has been received and is under review.
  •  

  • If there are any additional requirements or information needed, supply this promptly to avoid delays in processing.
  •  

  • Keep a record of all communications and copies of the documents submitted.

 

Check Pharmacy Requirements and Copay

 

  • Once approved, confirm with your pharmacy that they can process and fulfill the Saxenda prescription under your Aetna plan.
  •  

  • Be aware of any copayment or out-of-pocket costs associated with your prescription. Discuss options with your pharmacy if there are any affordability concerns.

 

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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.

Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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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