Does Affinity Health Plan Cover Naltrexone/Bupropion (Contrave)

Explore Affinity Health Plan's coverage for Naltrexone/Bupropion, costs, and tips to secure coverage. Get answers to your FAQs on this weight loss medication.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Naltrexone/Bupropion (Contrave)

 

  • Affinity Health Plan may cover Naltrexone/Bupropion (Contrave) for weight management as part of its prescription drug plan, but this often depends on specific plan details and medical necessity criteria.
  • Coverage is typically provided when the medication is prescribed for obesity treatment or weight-related conditions, subject to the individual meeting specific clinical requirements including a body mass index (BMI) criteria.

 

Obtaining Coverage

 

  • Prior authorization is likely required. Patients should consult with their healthcare provider to ensure proper documentation of medical necessity is submitted.
  • To improve the chances of coverage, physicians may need to provide evidence of unsuccessful weight loss attempts with other methods.
  • Patients should verify with Affinity Health Plan directly or via their healthcare provider to understand the specific formulary and any step therapy requirements that might apply.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

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 Naltrexone/Bupropion (Contrave) Coverage with Affinity Health Plan

 

Check Your Coverage

 

  • Contact Affinity Health Plan customer service to verify if Naltrexone/Bupropion (Contrave) is included in your current plan's formulary. You can find the customer service number on your insurance card or the Affinity Health Plan website.
  •  

  • Review your policy documents or online member portal to understand the specific coverage benefits and any limitations related to prescription medications.

 

Consult Your Physician

 

  • Discuss with your healthcare provider the need for Naltrexone/Bupropion (Contrave), ensuring it is the right medication for your treatment plan.
  •  

  • Ask your physician to provide a detailed prescription and any medical documentation supporting the necessity of the medication, which can be helpful if a prior authorization is required.

 

Submit a Prior Authorization Request

 

  • If Naltrexone/Bupropion (Contrave) requires prior authorization, work with your healthcare provider to complete this process. They will need to submit the necessary forms and supporting documentation to Affinity Health Plan.
  •  

  • Await a decision from Affinity Health Plan regarding the prior authorization request. This process can take a few days, so maintain communication with your physician’s office and the insurance company.

 

Appeal if Necessary

 

  • If your prior authorization request is denied, review the explanation provided by Affinity Health Plan for the denial.
  •  

  • Work with your healthcare provider to gather additional evidence or alternative treatment justifications, and submit an appeal to Affinity Health Plan. Ensure you understand the timeline and requirements for the appeals process.

 

Utilize Pharmacy Assistance Programs

 

  • If coverage is still denied or costs are too high, research assistance programs that might offer medication at reduced prices or provide cost-sharing options.
  •  

  • Discuss with your pharmacist or healthcare provider about these programs, as they might have information on local or national initiatives.

 

Follow Up Regularly

 

  • Regularly check the status of your coverage, appeals, or any assistance you have applied for through the Affinity Health Plan portal or by contacting customer service.
  •  

  • Maintain a record of all communications with Affinity Health Plan, including dates and details of phone conversations, to enhance follow-up efficiency.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

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

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Affinity Health Plan Cover Naltrexone/Bupropion (Contrave)

Explore Affinity Health Plan's coverage for Naltrexone/Bupropion, costs, and tips to secure coverage. Get answers to your FAQs on this weight loss medication.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by Affinity Health Plan

 

Coverage for Naltrexone/Bupropion (Contrave)

 

  • Affinity Health Plan may cover Naltrexone/Bupropion (Contrave) for weight management as part of its prescription drug plan, but this often depends on specific plan details and medical necessity criteria.
  • Coverage is typically provided when the medication is prescribed for obesity treatment or weight-related conditions, subject to the individual meeting specific clinical requirements including a body mass index (BMI) criteria.

 

Obtaining Coverage

 

  • Prior authorization is likely required. Patients should consult with their healthcare provider to ensure proper documentation of medical necessity is submitted.
  • To improve the chances of coverage, physicians may need to provide evidence of unsuccessful weight loss attempts with other methods.
  • Patients should verify with Affinity Health Plan directly or via their healthcare provider to understand the specific formulary and any step therapy requirements that might apply.

 

A weight management program tailored to you

Start with Curex

Affinity Health Plan's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Eligibility Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

  • Applicants must be enrolled in the Affinity Health Plan and have valid coverage at the time of the request for Naltrexone/Bupropion.
  •  

  • The medication is prescribed by a licensed healthcare provider specializing in weight management or treating obesity-related conditions.

 

Clinical Criteria

 

  • Patients must have a Body Mass Index (BMI) of 30 kg/m2 or higher, OR a BMI of 27 kg/m2 or higher with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • There must be a documented history of unsuccessful weight loss endeavors through diet and exercise alone, generally spanning over at least 6 months.

 

Treatment Plan Requirements

 

  • The healthcare provider must present a comprehensive treatment plan that includes lifestyle interventions like dietary changes and increased physical activity, in addition to pharmacotherapy.
  •  

  • Regular follow-ups with the prescribing physician must be scheduled to monitor progress and any potential side effects.

 

Prior Authorization Process

 

  • A prior authorization request is required, which should include detailed clinical documentation justifying the need for Naltrexone/Bupropion treatment based on the criteria outlined.
  •  

  • The patient's medical history, current treatment plan, and supporting evidence for the medical necessity of Contrave should be submitted as part of the prior authorization process.

 

Continuation of Therapy

 

  • Continuation of therapy is contingent upon demonstrating significant weight loss progress, typically defined as at least 5% reduction of baseline body weight over the initial 12-week therapy period.
  •  

  • Documentation showing that the patient is tolerating the medication well with no significant adverse effects is necessary to justify ongoing treatment coverage.

 

Why Affinity Health Plan Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Reasons for Non-Coverage of Naltrexone/Bupropion (Contrave) by Affinity Health Plan

 

  • **Off-label Use**: Affinity Health Plan may deny coverage if Naltrexone/Bupropion is prescribed for uses not approved by the FDA.
  •  

  • **Non-compliance with Medical Criteria**: If the patient does not meet required body mass index (BMI) criteria or exhibit related co-morbid conditions as per plan specifications, coverage may be refused.
  •  

  • **Prior Authorization Not Obtained**: If necessary prior authorization procedures are not followed, the plan might deny coverage.
  •  

  • **Lack of Clinical Justification**: Coverage might be denied if there is insufficient clinical justification in the patient’s records supporting the necessity of the medication.
  •  

  • **Exclusion from Policy Terms**: If the medication is explicitly excluded in the patient’s health plan policy, it will not be covered.
  •  

  • **Alternative Therapy Requirement**: If the plan requires trying alternative therapies before allowing coverage of Naltrexone/Bupropion and these steps are not completed, coverage can be denied.
  •  

  • **Prescription from Out-of-Network Provider**: If the medication is prescribed by a provider not within the Affinity Health Plan network, coverage might be denied unless otherwise specified in the plan.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Naltrexone/Bupropion (Contrave) Cost without Insurance?

 

Cost of Naltrexone/Bupropion (Contrave) Without Insurance

 

  • The cost of Naltrexone/Bupropion (Contrave) without insurance can vary significantly depending on the pharmacy you visit. On average, you might expect to pay around $100 to $300 for a 30-day supply.
  •  

  • The price can differ between pharmacies, so it may be beneficial to shop around or use a pharmacy discount card to potentially reduce the cost.
  •  

  • Coupons or discount programs offered by manufacturers or online platforms might further lower the expense, sometimes making it more affordable than the average cash price.
  •  

  • Factors such as generic availability or quantity prescribed also influence the price, with larger prescriptions potentially offering a lower cost per unit.

 

Ways to Lower Your Cost

 

  • Check online resources or discount programs that provide coupons applicable at various pharmacies to potentially save money.
  •  

  • Discuss with your healthcare provider about any potential lower-cost alternatives or generics, if available, which could lower your expenses.
  •  

  • Consider pharmacy loyalty programs or memberships, which often provide discounts on prescriptions.
  •  

  • Consult with your pharmacy about any special savings programs or payment plans they might offer, which can reduce financial burden.

 

Conclusion

 

  • Naltrexone/Bupropion (Contrave) is a medication whose price can vary widely without insurance, typically costing around $100 to $300 per month.
  •  

  • Utilize discounts, coupons, and comparison shopping to find the most cost-effective option.
  •  

  • Consult with healthcare professionals for advice on managing these costs and addressing any financial concerns related to prescriptions.

 

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 Naltrexone/Bupropion (Contrave) Coverage with Affinity Health Plan

 

Check Your Coverage

 

  • Contact Affinity Health Plan customer service to verify if Naltrexone/Bupropion (Contrave) is included in your current plan's formulary. You can find the customer service number on your insurance card or the Affinity Health Plan website.
  •  

  • Review your policy documents or online member portal to understand the specific coverage benefits and any limitations related to prescription medications.

 

Consult Your Physician

 

  • Discuss with your healthcare provider the need for Naltrexone/Bupropion (Contrave), ensuring it is the right medication for your treatment plan.
  •  

  • Ask your physician to provide a detailed prescription and any medical documentation supporting the necessity of the medication, which can be helpful if a prior authorization is required.

 

Submit a Prior Authorization Request

 

  • If Naltrexone/Bupropion (Contrave) requires prior authorization, work with your healthcare provider to complete this process. They will need to submit the necessary forms and supporting documentation to Affinity Health Plan.
  •  

  • Await a decision from Affinity Health Plan regarding the prior authorization request. This process can take a few days, so maintain communication with your physician’s office and the insurance company.

 

Appeal if Necessary

 

  • If your prior authorization request is denied, review the explanation provided by Affinity Health Plan for the denial.
  •  

  • Work with your healthcare provider to gather additional evidence or alternative treatment justifications, and submit an appeal to Affinity Health Plan. Ensure you understand the timeline and requirements for the appeals process.

 

Utilize Pharmacy Assistance Programs

 

  • If coverage is still denied or costs are too high, research assistance programs that might offer medication at reduced prices or provide cost-sharing options.
  •  

  • Discuss with your pharmacist or healthcare provider about these programs, as they might have information on local or national initiatives.

 

Follow Up Regularly

 

  • Regularly check the status of your coverage, appeals, or any assistance you have applied for through the Affinity Health Plan portal or by contacting customer service.
  •  

  • Maintain a record of all communications with Affinity Health Plan, including dates and details of phone conversations, to enhance follow-up efficiency.

 

Premium Medication you can trust

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.

Naltrexone/Bupropion (Contrave) FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting can occur, often diminishing over time.
  • Headaches or dizziness are also common, especially early in treatment.
  • Constipation or diarrhea may affect some users.
  • Insomnia and a higher heart rate can occur with usage.

 

Serious Side Effects

 

  • Risk of seizures, especially if there's a history of seizures.
  • Suicidal thoughts or behaviors can increase in some individuals.
  • Increased blood pressure; monitoring is advised.
  • Allergic reactions are possible, presenting as rash, itching, or swelling.

 

Precautions

 

  • Ensure no history of seizure disorders before starting.
  • Disclose any mental health history to your healthcare provider.
  • Assess any medications for potential interactions.
  • Regularly monitor blood pressure when on this medication.

 

How fast can you lose weight with Contrave?

 

What is Contrave?

 

  • Contrave is a combination of naltrexone and bupropion, approved for chronic weight management in adults.

 

How Fast Can You Lose Weight?

 

  • Clinical studies show patients can lose 5-10% of their body weight over 12-24 weeks.
  • Weight loss varies due to individual factors like diet, exercise, and adherence.
  • Initial results might be seen in 4 weeks, with more significant loss over months.

 

Important Considerations

 

  • Must be combined with a reduced-calorie diet and increased physical activity.
  • Not suitable for everyone; consult your healthcare provider before starting.
  • Monitoring for side effects like nausea or dizziness is crucial.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Drinking alcohol while taking Contrave is generally not recommended. Contrave contains naltrexone and bupropion, which may interact negatively with alcohol.
  •  

  • Naltrexone may increase the risk of liver damage when combined with alcohol, and bupropion may heighten seizure risk, both exacerbated by alcohol consumption.
  •  

  • Alcohol can counteract Contrave's effects on weight management and addiction control, undermining its efficacy.
  •  

  • Consult your healthcare provider for personalized advice, as they can determine safe alcohol usage considering your specific health conditions and medication dosage.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Made in Webflow