Does Affinity Health Plan Cover Diethylpropion (Tenuate)

Explore Diethylpropion coverage with Affinity Health Plan, costs without insurance, reasons for denial, and how to secure coverage.
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Coverage for Diethylpropion

 

  • Affinity Health Plan may cover Diethylpropion (Tenuate) under specific situations such as if it's prescribed for managing obesity alongside diet and exercise.
  •  

  • Prior authorization might be required to ensure the medication is used appropriately within the plan's guidelines.

 

Criteria for Coverage

 

  • Prescription by a licensed healthcare provider is essential.
  •  

  • Documentation proving obesity and failed attempts with non-pharmacological options may be necessary.
  •  

  • The healthcare provider might need to justify the medical necessity of Diethylpropion.

 

Basic Rules

 

  • Review the specific policy details of your plan, as coverage can vary.
  •  

  • Stay informed about any updates to coverage policies from Affinity Health Plan.
  •  

  • Coordinate with your healthcare provider to ensure all necessary information is submitted accurately.

 

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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.

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 Diethylpropion (Tenuate) Coverage with Affinity Health Plan

 

Understanding Affinity Health Plan Requirements

 

  • Before seeking coverage for Diethylpropion (Tenuate), review Affinity Health Plan's formulary to ensure the medication is listed and understand any specific requirements or restrictions.
  •  

  • Check for any necessary pre-authorization requirements for the medication. This may include prior approval before the drug is covered.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about prescribing Diethylpropion (Tenuate) and express your intention to get it covered through Affinity Health Plan.
  •  

  • Your provider might need to provide documentation supporting the medical necessity for choosing Diethylpropion over other treatments.

 

Contact Affinity Health Plan Member Services

 

  • Get in touch with Affinity Health Plan's member services. You can find the contact information on your insurance card or the plan's official website.
  •  

  • Request detailed information about the coverage process for Diethylpropion (Tenuate). Ask about the required documentation and steps for getting the medication approved.

 

Submit a Pre-authorization Request

 

  • If required, work with your healthcare provider to submit a pre-authorization request for Diethylpropion (Tenuate) to Affinity Health Plan.
  •  

  • Ensure all necessary information is included, such as the prescribing physician’s details, dosage, and any supporting documentation on medical necessity.

 

Follow Up on Your Request

 

  • Monitor the status of your pre-authorization request by maintaining contact with both your healthcare provider and Affinity Health Plan.
  •  

  • If your request is approved, proceed with obtaining the medication as per your plan’s guidelines. If denied, inquire about the appeals process.

 

File an Appeal if Necessary

 

  • If Affinity Health Plan denies coverage, gather documentation supporting the necessity of Diethylpropion and file an appeal.
  •  

  • Provide any additional information requested and clearly state why the medication is medically necessary for your condition.

 

Review Your Coverage Plan

 

  • Verify if Diethylpropion (Tenuate) has any specific tier levels that may affect the cost sharing or copayment responses within your plan.
  •  

  • Understand other potential coverage options or requirements such as step therapy, which may require trying less expensive drugs first.

 

Consult a Pharmacist or Case Manager

 

  • If there are ongoing difficulties, consider consulting a pharmacist or a case manager for additional support and advocacy within the healthcare plan.
  •  

  • They may provide insights or suggestions on facilitating the process for covering Diethylpropion (Tenuate).

 

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FAQs

Does Affinity Health Plan Cover Diethylpropion (Tenuate)

Explore Diethylpropion coverage with Affinity Health Plan, costs without insurance, reasons for denial, and how to secure coverage.
Curex allergy drops unboxing

Is Diethylpropion (Tenuate) Covered by Affinity Health Plan

 

Coverage for Diethylpropion

 

  • Affinity Health Plan may cover Diethylpropion (Tenuate) under specific situations such as if it's prescribed for managing obesity alongside diet and exercise.
  •  

  • Prior authorization might be required to ensure the medication is used appropriately within the plan's guidelines.

 

Criteria for Coverage

 

  • Prescription by a licensed healthcare provider is essential.
  •  

  • Documentation proving obesity and failed attempts with non-pharmacological options may be necessary.
  •  

  • The healthcare provider might need to justify the medical necessity of Diethylpropion.

 

Basic Rules

 

  • Review the specific policy details of your plan, as coverage can vary.
  •  

  • Stay informed about any updates to coverage policies from Affinity Health Plan.
  •  

  • Coordinate with your healthcare provider to ensure all necessary information is submitted accurately.

 

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Affinity Health Plan's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Eligibility Criteria for Diethylpropion (Tenuate) Coverage

 

  • The patient must be an adult aged 18 years or older and diagnosed with obesity, defined as a body mass index (BMI) of 30 kg/m² or greater.
  •  

  • Alternatively, the patient may have a BMI of 27 kg/m² or greater if accompanied by at least one weight-related comorbidity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • Diethylpropion should be considered as part of a comprehensive weight management plan, which includes lifestyle modifications such as a reduced-calorie diet and physical activity.
  •  

  • The prescribing physician must document that the patient has previously attempted to lose weight through non-pharmacological means and has been unsuccessful in achieving or maintaining significant weight loss.
  •  

  • The use of diethylpropion must be evaluated as medically necessary, and the potential benefits outweigh the possible risks for the individual patient.
  •  

  • Prior authorization is required, and the healthcare provider must submit relevant medical information to support the request for coverage.
  •  

  • Regular follow-up visits should be scheduled to evaluate the efficacy and safety of continuing diethylpropion therapy. Coverage is contingent on demonstrating significant health improvement or weight loss.
  •  

 

Renewal Criteria for Continued Coverage

 

  • Evidence of a significant weight reduction is required, typically at least 5% of baseline weight within three months of therapy initiation.
  •  

  • The patient must not have experienced significant adverse effects that contraindicate continued use of the medication.
  •  

  • A documentation of continued adherence to a structured weight loss program, including dietary and physical activity modifications, must be maintained.
  •  

  • A reassessment of medical necessity is required for renewal, emphasizing the sustained benefits of the treatment compared to potential risks.
  •  

 

Why Affinity Health Plan Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons for Denial of Diethylpropion (Tenuate) Coverage by Affinity Health Plan

 

  • Affinity Health Plan does not cover Diethylpropion if the prescription is not deemed medically necessary as per their criteria and guidelines.
  •  

  • Coverage may be denied if the individual has a body mass index (BMI) that is below the threshold required by Affinity Health Plan's policy for obesity treatments.
  •  

  • The medication will not be covered if there is no documented evidence of a comprehensive weight management program in conjunction with the use of Diethylpropion.
  •  

  • Affinity Health Plan may deny coverage if the prescription exceeds the recommended dosage or duration, as prescribed by standard medical recommendations.
  •  

  • If the patient has contraindications listed by Affinity Health Plan, such as certain pre-existing medical conditions that make the use of Diethylpropion unsafe, it will not be covered.
  •  

  • Situations where an appropriate comparable drug covered under the plan's formulary can be used instead may lead to non-coverage of Diethylpropion.
  •  

  • The use of Diethylpropion for non-FDA approved indications will not be covered by Affinity Health Plan.
  •  

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with Affinity Health Plan

 

Understanding Affinity Health Plan Requirements

 

  • Before seeking coverage for Diethylpropion (Tenuate), review Affinity Health Plan's formulary to ensure the medication is listed and understand any specific requirements or restrictions.
  •  

  • Check for any necessary pre-authorization requirements for the medication. This may include prior approval before the drug is covered.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about prescribing Diethylpropion (Tenuate) and express your intention to get it covered through Affinity Health Plan.
  •  

  • Your provider might need to provide documentation supporting the medical necessity for choosing Diethylpropion over other treatments.

 

Contact Affinity Health Plan Member Services

 

  • Get in touch with Affinity Health Plan's member services. You can find the contact information on your insurance card or the plan's official website.
  •  

  • Request detailed information about the coverage process for Diethylpropion (Tenuate). Ask about the required documentation and steps for getting the medication approved.

 

Submit a Pre-authorization Request

 

  • If required, work with your healthcare provider to submit a pre-authorization request for Diethylpropion (Tenuate) to Affinity Health Plan.
  •  

  • Ensure all necessary information is included, such as the prescribing physician’s details, dosage, and any supporting documentation on medical necessity.

 

Follow Up on Your Request

 

  • Monitor the status of your pre-authorization request by maintaining contact with both your healthcare provider and Affinity Health Plan.
  •  

  • If your request is approved, proceed with obtaining the medication as per your plan’s guidelines. If denied, inquire about the appeals process.

 

File an Appeal if Necessary

 

  • If Affinity Health Plan denies coverage, gather documentation supporting the necessity of Diethylpropion and file an appeal.
  •  

  • Provide any additional information requested and clearly state why the medication is medically necessary for your condition.

 

Review Your Coverage Plan

 

  • Verify if Diethylpropion (Tenuate) has any specific tier levels that may affect the cost sharing or copayment responses within your plan.
  •  

  • Understand other potential coverage options or requirements such as step therapy, which may require trying less expensive drugs first.

 

Consult a Pharmacist or Case Manager

 

  • If there are ongoing difficulties, consider consulting a pharmacist or a case manager for additional support and advocacy within the healthcare plan.
  •  

  • They may provide insights or suggestions on facilitating the process for covering Diethylpropion (Tenuate).

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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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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