Does Affinity Health Plan Cover Orlistat (Xenical, Alli)

Discover if Affinity Health Plan covers Orlistat, explore reasons for possible denial, learn coverage steps, costs without insurance, and more in our detailed guide.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Orlistat (Xenical, Alli)

 

  • Affinity Health Plan typically covers Orlistat if it is deemed medically necessary for weight loss management alongside a reduced-calorie diet.
  • Coverage may vary, so it is advisable to verify specifics through the plan documentation or communicate directly with Affinity Health Plan.

 

Criteria for Coverage

 

  • Orlistat might be covered for individuals who meet specific health-related criteria, such as a body mass index (BMI) requirement or obesity-associated conditions (e.g., hypertension, diabetes).
  • A prior authorization from a healthcare provider may be necessary, outlining the need for Orlistat based on the patient’s health status and previous weight loss attempts.
  • Applicants might need to show documented evidence of previous weight loss strategies that did not work as anticipated.

 

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 Orlistat (Xenical, Alli) Coverage with Affinity Health Plan

 

Start by Reviewing Your Benefits

 

  • Log in to your Affinity Health Plan member portal to review your policy. Look for any specific coverage information related to prescription drugs.
  •  

  • Check the formulary list provided by Affinity Health Plan to see if Orlistat (Xenical or Alli) is included. This list will determine if the medication is typically covered.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Orlistat.
  •  

  • Request that your healthcare provider provide a detailed prescription and, if necessary, a letter of medical necessity to support your coverage request.

 

Contact Affinity Health Plan's Customer Service

 

  • Call the number on the back of your insurance card to reach customer service.
  •  

  • Ask specifically if Orlistat (Xenical or Alli) is covered under your plan based on your policy details.
  •  

  • Request information about any required steps, such as prior authorization or step therapy, that you must complete to get coverage for Orlistat.

 

Submit a Prior Authorization Request

 

  • If required, have your healthcare provider submit a prior authorization request. This will involve providing medical documentation justifying the need for Orlistat.
  •  

  • Ensure that all forms and documentation are completed correctly and submitted promptly to avoid delays in processing.

 

Follow Up on the Authorization Process

 

  • Check the status of your prior authorization request through the Affinity Health Plan member portal or by calling customer service.
  •  

  • If the request is denied, inquire about the reasons and ask for guidance on how to appeal the decision.

 

Explore Additional Options If Necessary

 

  • If coverage is denied, discuss with your healthcare provider alternative medications or therapies that might be covered by your insurance plan.
  •  

  • Consider reaching out to the pharmaceutical company for patient assistance programs that could offer discounts or financial aid for Orlistat.
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 Orlistat (Xenical, Alli)

Discover if Affinity Health Plan covers Orlistat, explore reasons for possible denial, learn coverage steps, costs without insurance, and more in our detailed guide.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Affinity Health Plan

 

Coverage for Orlistat (Xenical, Alli)

 

  • Affinity Health Plan typically covers Orlistat if it is deemed medically necessary for weight loss management alongside a reduced-calorie diet.
  • Coverage may vary, so it is advisable to verify specifics through the plan documentation or communicate directly with Affinity Health Plan.

 

Criteria for Coverage

 

  • Orlistat might be covered for individuals who meet specific health-related criteria, such as a body mass index (BMI) requirement or obesity-associated conditions (e.g., hypertension, diabetes).
  • A prior authorization from a healthcare provider may be necessary, outlining the need for Orlistat based on the patient’s health status and previous weight loss attempts.
  • Applicants might need to show documented evidence of previous weight loss strategies that did not work as anticipated.

 

A weight management program tailored to you

Start with Curex

Affinity Health Plan's Approved Criteria for Orlistat (Xenical, Alli) Coverage

 

Eligibility Criteria for Orlistat Coverage

 

  • Member must have a documented diagnosis of obesity with a Body Mass Index (BMI) of 30 kg/m² or greater.
  •  

  • For members with a BMI between 27 kg/m² and 29.9 kg/m², there must be at least one weight-related comorbidity such as type 2 diabetes, hypertension, or hyperlipidemia.
  •  

  • Member should have demonstrated unsuccessful weight loss with previous dietary and lifestyle interventions over a period of at least six months, as documented by a healthcare provider.
  •  

  • There must be a current, comprehensive weight management plan that includes a reduced-calorie diet and an exercise regime, supervised by a licensed healthcare professional.
  •  

  • Regular follow-ups with the healthcare provider must be scheduled to monitor weight management progress, adherence to Orlistat therapy, and assessment of any side effects or adverse reactions.
  •  

  • Member should have no contraindications to Orlistat therapy, as determined by the prescribing physician based on their health status and concurrent medications.

 

Required Documentation for Coverage Approval

 

  • Documented weight management history, including all previous interventions and their outcomes.
  •  

  • Detailed documentation of current weight-related comorbidities, if applicable.
  •  

  • A comprehensive weight loss plan signed by both the member and a healthcare provider.
  •  

  • Evidence of follow-up appointments to assess treatment adherence and effectiveness.
  •  

  • Healthcare provider’s attestation of no contraindications for Orlistat use.

 

Review and Renewal Process

 

  • Continued coverage is contingent upon regular documentation of weight loss progress and adherence to the weight management plan.
  •  

  • Renewal requests should include updated physician assessments and any adjustments to the weight management plan.
  •  

  • Evidence of positive outcomes, such as weight reduction or improved health parameters related to comorbidities, must be included in renewal submissions.

 

Why Affinity Health Plan Might Deny Orlistat (Xenical, Alli) Coverage

 

Exclusions of Orlistat Coverage

 

  • Affinity Health Plan may not cover Orlistat (Xenical, Alli) if it is considered a non-essential form of treatment. This means that if the prescribed use of the medication is not deemed medically necessary, the plan could exclude it from coverage.
  •  

  • The coverage might be denied if Orlistat is used for cosmetic weight loss purposes rather than for treatment of a medical condition related to obesity.
  •  

  • If there are cheaper, generic alternatives available that are approved by the healthcare provider, Affinity Health Plan might not cover the more expensive brand-name medication.
  •  

  • Orlistat may not be covered if it is not prescribed by a healthcare provider within the network affiliated with Affinity Health Plan. Using out-of-network providers can result in denial of coverage for the medication.
  •  

  • If Orlistat is prescribed without prior authorization from the plan, it may lead to denial of coverage. Prior authorization ensures the necessity and appropriateness of the medication before it's approved.
  •  

  • In cases where the insured does not meet specific weight-related criteria defined by Affinity Health Plan for Orlistat treatment, coverage may be denied. This typically involves ensuring a certain Body Mass Index (BMI) threshold is met.
  •  

  • Eligibility for coverage may require documented trials of other weight-loss interventions before Orlistat is approved. If such documentation is missing, coverage can be denied.

 

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

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

 

Cost of Orlistat (Xenical, Alli) Without Insurance

 

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

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

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

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

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

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Orlistat (Xenical, Alli) Coverage with Affinity Health Plan

 

Start by Reviewing Your Benefits

 

  • Log in to your Affinity Health Plan member portal to review your policy. Look for any specific coverage information related to prescription drugs.
  •  

  • Check the formulary list provided by Affinity Health Plan to see if Orlistat (Xenical or Alli) is included. This list will determine if the medication is typically covered.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Orlistat.
  •  

  • Request that your healthcare provider provide a detailed prescription and, if necessary, a letter of medical necessity to support your coverage request.

 

Contact Affinity Health Plan's Customer Service

 

  • Call the number on the back of your insurance card to reach customer service.
  •  

  • Ask specifically if Orlistat (Xenical or Alli) is covered under your plan based on your policy details.
  •  

  • Request information about any required steps, such as prior authorization or step therapy, that you must complete to get coverage for Orlistat.

 

Submit a Prior Authorization Request

 

  • If required, have your healthcare provider submit a prior authorization request. This will involve providing medical documentation justifying the need for Orlistat.
  •  

  • Ensure that all forms and documentation are completed correctly and submitted promptly to avoid delays in processing.

 

Follow Up on the Authorization Process

 

  • Check the status of your prior authorization request through the Affinity Health Plan member portal or by calling customer service.
  •  

  • If the request is denied, inquire about the reasons and ask for guidance on how to appeal the decision.

 

Explore Additional Options If Necessary

 

  • If coverage is denied, discuss with your healthcare provider alternative medications or therapies that might be covered by your insurance plan.
  •  

  • Consider reaching out to the pharmaceutical company for patient assistance programs that could offer discounts or financial aid for Orlistat.

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.

Orlistat (Xenical, Alli) FAQ

1. What are the side effects of taking Orlistat?

 

Possible Side Effects of Orlistat

 

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

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

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

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

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

 

2. How effective is Orlistat for weight loss?

 

Effectiveness of Orlistat

 

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

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

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

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

 

3. Can I buy Orlistat over the counter?

 

Can I Buy Orlistat Over the Counter?

 

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

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

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

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

 

Considerations Before Using Orlistat

 

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

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

 

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