Does Affinity Health Plan Cover Benzphetamine (Didrex)

Explore Affinity Health's Benzphetamine coverage, reasons for denial, cost without insurance, and tips for securing coverage. Get answers to your questions.
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Coverage for Benzphetamine (Didrex)

 

  • Affinity Health Plan may cover Benzphetamine (Didrex) as part of its prescription drug benefits, primarily for weight management in patients who meet specific medical criteria.
  •  

  • Coverage typically applies when Benzphetamine is prescribed for obesity treatment in conjunction with a comprehensive weight reduction program, including exercise, behavior modification, and calorie restriction.
  •  

 

Eligibility and Criteria

 

  • To qualify for coverage, patients may need to demonstrate a Body Mass Index (BMI) above a certain threshold or have comorbid conditions like hypertension or diabetes.
  •  

  • Prior authorization is generally required, where the prescribing doctor must provide information about the patient's medical history and prior weight loss attempts.
  •  

  • Regular evaluation of the patient's progress is generally necessary to continue receiving coverage for this medication.

 

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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 Benzphetamine (Didrex) Coverage with Affinity Health Plan

 

Start by Understanding Affinity Health Plan's Coverage Policies

 

  • Review the Affinity Health Plan's official website or member materials to check if they list Benzphetamine (Didrex) as a covered medication. This information can often be found in their drug formulary or prescription drug coverage section.
  •  

  • Understand any restrictions or criteria needed to qualify for Benzphetamine (Didrex) coverage, such as prior authorization or step therapy requirements.

 

Consult with Your Healthcare Provider

 

  • Contact your physician to discuss your need for Benzphetamine (Didrex). Ensure they are aware of Affinity Health Plan's requirements and can provide the necessary documentation or rationale for prescribing Benzphetamine.
  •  

  • Your healthcare provider can help you understand whether there are preferred alternatives that might be more easily covered under your plan.

 

Contact Affinity Health Plan Member Services

 

  • Reach out to Affinity Health Plan member services via phone or their online portal to confirm coverage details specific to your plan. Inquire about any necessary procedures for obtaining coverage for Benzphetamine (Didrex).
  •  

  • Ask about any specific forms or paperwork required to gain approval for Benzphetamine coverage.

 

Complete and Submit Required Documentation

 

  • If prior authorization is necessary, work with your healthcare provider to fill out the appropriate prior authorization forms required by Affinity Health Plan.
  •  

  • Ensure all documentation is thoroughly completed and promptly submitted, adhering to any guidelines provided by Affinity Health Plan.

 

Follow Up on Your Request

 

  • Monitor the status of your request by staying in contact with Affinity Health Plan. Regularly follow up if you have not received a response within their stated timeframe.
  •  

  • If your request is denied, inquire about the reasons and gather information for submitting an appeal if necessary.

 

Submit an Appeal if Necessary

 

  • In the event of a denial, review the refusal notice to understand their reasoning. You can often find appeal procedures in your plan documentation, or by contacting member services.
  •  

  • Prepare an appeal with additional supporting documents from your healthcare provider that justify the necessity for Benzphetamine (Didrex) treatment.
  •  

  • Submit the appeal according to Affinity Health Plan’s guidelines, and follow up to track its progress.

 

Consider Additional Support Program Options

 

  • Explore patient assistance programs or manufacturer discounts for Benzphetamine (Didrex) if coverage issues persist, potentially helping mitigate out-of-pocket costs.
  •  

  • Reach out to support groups or patient advocacy organizations that may offer guidance or resources for obtaining medication coverage.

 

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FAQs

Does Affinity Health Plan Cover Benzphetamine (Didrex)

Explore Affinity Health's Benzphetamine coverage, reasons for denial, cost without insurance, and tips for securing coverage. Get answers to your questions.
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Is Benzphetamine (Didrex) Covered by Affinity Health Plan

 

Coverage for Benzphetamine (Didrex)

 

  • Affinity Health Plan may cover Benzphetamine (Didrex) as part of its prescription drug benefits, primarily for weight management in patients who meet specific medical criteria.
  •  

  • Coverage typically applies when Benzphetamine is prescribed for obesity treatment in conjunction with a comprehensive weight reduction program, including exercise, behavior modification, and calorie restriction.
  •  

 

Eligibility and Criteria

 

  • To qualify for coverage, patients may need to demonstrate a Body Mass Index (BMI) above a certain threshold or have comorbid conditions like hypertension or diabetes.
  •  

  • Prior authorization is generally required, where the prescribing doctor must provide information about the patient's medical history and prior weight loss attempts.
  •  

  • Regular evaluation of the patient's progress is generally necessary to continue receiving coverage for this medication.

 

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Affinity Health Plan's Approved Criteria for Benzphetamine (Didrex) Coverage

 

Eligibility Requirements for Benzphetamine (Didrex) Coverage

 

  • Applicant must be an active member of the Affinity Health Plan.
  •  

  • Benzphetamine (Didrex) must be prescribed by a licensed healthcare provider.
  •  

  • The patient must be diagnosed with obesity, with a Body Mass Index (BMI) of 30 kg/m2 or greater, or with a BMI of 27 kg/m2 or greater in the presence of co-morbidities such as hypertension, hyperlipidemia, or type 2 diabetes.

 

Documentation and Prescription Requirements

 

  • A signed and dated prescription from a licensed healthcare provider must be submitted.
  •  

  • Documentation must include a detailed medical history supporting the diagnosis of obesity or associated comorbid conditions.
  •  

  • Evidence must be provided showing a structured weight-loss program is being followed, which includes a reduced calorie diet and increased physical activity.

 

Previously Attempted Therapies

 

  • The patient should have previously attempted weight loss strategies, including dietary, exercise, and behavioral interventions, and have not achieved significant weight loss or maintenance.
  •  

  • Documentation must demonstrate unsuccessful outcomes from the aforementioned strategies prior to the prescription of Benzphetamine (Didrex).

 

Monitoring and Follow-up

 

  • Regular follow-up appointments must be scheduled with the prescribing healthcare provider to monitor the patient's progress and to evaluate the continuation of therapy.
  •  

  • Documentation from follow-up visits should include the patient's adherence to the weight-loss program and any side effects experienced.

 

Age Criteria

 

  • Benzphetamine (Didrex) is typically covered for individuals aged 16 years and older unless specified otherwise by the healthcare provider based on individual health assessments.

 

Duration of Therapy

 

  • Initial approval for Benzphetamine (Didrex) will be for a period of three months, with potential for extension based on documented improvement in weight and/or comorbid conditions.

 

Renewal Criteria

 

  • The patient must demonstrate clinically significant reduction in body weight and improvement in obesity-related conditions for renewal of the therapy.
  •  

  • Renewal requests must be supported by updated medical documentation and progress reports from healthcare provider follow-up visits.

 

Exclusions

 

  • Coverage is limited to members who align with medical necessity criteria as outlined and may not apply to certain plan types.

 

Why Affinity Health Plan Might Deny Benzphetamine (Didrex) Coverage

 

Situations When Affinity Health Plan Does Not Cover Benzphetamine (Didrex)

 

  • No Medical Necessity: The medication may be denied if it is deemed not medically necessary according to Affinity Health Plan's criteria.
  •  

  • Lack of Proper Documentation: Coverage might be denied if there is insufficient documentation supporting the need for Benzphetamine.
  •  

  • Non-Compliance with Prior Authorization: If prior authorization requirements are not met, the plan may deny coverage for the medication.
  •  

  • Health Plan Exclusions: Benzphetamine may be specifically excluded from the beneficiary's plan coverage, which would result in denial.
  •  

  • Off-Label Use: Usage of Benzphetamine for conditions not approved by the FDA may lead to denial of coverage.
  •  

  • Failure to Explore Alternative Therapies: If less costly or alternative therapies have not been tried first, coverage may be denied.
  •  

  • Plan Guidelines and Restrictions: Coverage might be denied if the prescribed use doesn't adhere to plan-specific guidelines or restrictions.
  •  

 

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How Much Does Benzphetamine (Didrex) Cost without Insurance?

 

Understanding Benzphetamine (Didrex) Cost

 

  • Benzphetamine, commonly known by the brand name Didrex, is a prescription medication used as a short-term adjunct in weight reduction therapy.
  •  

  • The cost of Benzphetamine without insurance can vary significantly depending on the pharmacy and the dosage prescribed.
  •  

  • On average, the cost for a 30-day supply of Benzphetamine (50 mg tablets) can range from $40 to $70.
  •  

  • Prices may be higher or lower, depending on location, pharmacy pricing policies, and available discounts or coupons.
  •  

  • Pharmacy discount programs and generic versions of the drug may offer cost savings.

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 Benzphetamine (Didrex) Coverage with Affinity Health Plan

 

Start by Understanding Affinity Health Plan's Coverage Policies

 

  • Review the Affinity Health Plan's official website or member materials to check if they list Benzphetamine (Didrex) as a covered medication. This information can often be found in their drug formulary or prescription drug coverage section.
  •  

  • Understand any restrictions or criteria needed to qualify for Benzphetamine (Didrex) coverage, such as prior authorization or step therapy requirements.

 

Consult with Your Healthcare Provider

 

  • Contact your physician to discuss your need for Benzphetamine (Didrex). Ensure they are aware of Affinity Health Plan's requirements and can provide the necessary documentation or rationale for prescribing Benzphetamine.
  •  

  • Your healthcare provider can help you understand whether there are preferred alternatives that might be more easily covered under your plan.

 

Contact Affinity Health Plan Member Services

 

  • Reach out to Affinity Health Plan member services via phone or their online portal to confirm coverage details specific to your plan. Inquire about any necessary procedures for obtaining coverage for Benzphetamine (Didrex).
  •  

  • Ask about any specific forms or paperwork required to gain approval for Benzphetamine coverage.

 

Complete and Submit Required Documentation

 

  • If prior authorization is necessary, work with your healthcare provider to fill out the appropriate prior authorization forms required by Affinity Health Plan.
  •  

  • Ensure all documentation is thoroughly completed and promptly submitted, adhering to any guidelines provided by Affinity Health Plan.

 

Follow Up on Your Request

 

  • Monitor the status of your request by staying in contact with Affinity Health Plan. Regularly follow up if you have not received a response within their stated timeframe.
  •  

  • If your request is denied, inquire about the reasons and gather information for submitting an appeal if necessary.

 

Submit an Appeal if Necessary

 

  • In the event of a denial, review the refusal notice to understand their reasoning. You can often find appeal procedures in your plan documentation, or by contacting member services.
  •  

  • Prepare an appeal with additional supporting documents from your healthcare provider that justify the necessity for Benzphetamine (Didrex) treatment.
  •  

  • Submit the appeal according to Affinity Health Plan’s guidelines, and follow up to track its progress.

 

Consider Additional Support Program Options

 

  • Explore patient assistance programs or manufacturer discounts for Benzphetamine (Didrex) if coverage issues persist, potentially helping mitigate out-of-pocket costs.
  •  

  • Reach out to support groups or patient advocacy organizations that may offer guidance or resources for obtaining medication coverage.

 

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Benzphetamine (Didrex) FAQ

What are the side effects of Benzphetamine (Didrex)?

 

Common Side Effects

 

  • Insomnia
  • Nervousness
  • Dizziness
  • Dry Mouth
  • Headache
  • Constipation

 

Severe Side Effects

 

  • Increased Blood Pressure
  • Heart Palpitations
  • Seizures
  • Severe Mood Changes
  • Chest Pain
  • Breathing Difficulties

 

Important Considerations

 

  • If you experience severe side effects, seek medical attention immediately.
  • Use cautiously if you have a history of cardiovascular conditions.
  • Avoid usage in individuals with a history of drug abuse.
  • Always follow the prescribed dosage to minimize risks.
  • Inform your doctor of any existing health conditions or medications.

 

How does Benzphetamine help with weight loss?

 

Mechanism of Action

 

  • Benzphetamine is an appetite suppressant. It stimulates the central nervous system, which increases heart rate and blood pressure.
  •  
  • This leads to a reduced appetite and a feeling of fullness, helping individuals to control their caloric intake.

 

Usage Guidelines

 

  • It should be used as part of a comprehensive weight loss plan, including diet, exercise, and behavioral modification.
  •  
  • Typically prescribed for short-term use to jump-start weight loss efforts.

 

Precautions

 

  • Not suitable for individuals with a history of cardiovascular diseases, hyperthyroidism, or glaucoma.
  •  
  • It may cause side effects such as insomnia, dizziness, and dry mouth.

Is Benzphetamine similar to Phentermine?

 

Similarity between Benzphetamine and Phentermine

 

  • Benzphetamine (Didrex) and Phentermine are both stimulant medications primarily used to treat obesity.
  •  

  • They function as appetite suppressants by affecting the central nervous system.
  •  

  • Both are chemically related to amphetamines but are not classified as amphetamines themselves.

 

Differences

 

  • Benzphetamine is a prodrug and metabolizes into amphetamine and methamphetamine, while Phentermine does not convert into amphetamine derivatives.
  •  

  • Phentermine is generally preferred due to a more established safety profile and fewer side effects compared to Benzphetamine.
  •  

  • Phentermine is typically dosed once daily, whereas Benzphetamine might require multiple doses.

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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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