Does Affinity Health Plan Cover Semaglutide (Wegovy)

Explore if Affinity Health Plan covers Semaglutide (Wegovy), tips for approval, costs without insurance, and get answers to common questions.
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Affinity Health Plan Coverage Overview

 

  • Affinity Health Plan may cover Semaglutide (Wegovy), primarily when deemed medically necessary for weight management.
  •  
  • Coverage typically requires prior authorization, which involves a healthcare provider's approval demonstrating medical necessity.

 

Situations for Coverage

 

  • Patients with a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² with at least one weight-related comorbidity may qualify.
  •  
  • Weight-related conditions include type 2 diabetes, hypertension, or hyperlipidemia.

 

Basic Rules and Criteria

 

  • Documentation of a trial and failure, intolerance, or contraindication to other weight management medications may be required.
  •  
  • Ongoing documentation of weight loss progress and compliance with prescribed treatment protocols may be necessary for continued coverage.

 

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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 Semaglutide (Wegovy) Coverage with Affinity Health Plan

 

Research Your Coverage Plan

 

  • Start by reviewing your Affinity Health Plan insurance policy documents. Check the formulary, or list of covered medications, to see if Semaglutide (Wegovy) is included.
  •  

  • Visit Affinity Health Plan's official website and navigate to their prescription coverage section. This may offer additional information on covered medications and any specific requirements for high-cost treatments like Semaglutide.

 

Contact Affinity Health Plan

 

  • Reach out to Affinity Health Plan's customer service. Use the contact information on their website or on your insurance card to inquire directly about coverage for Semaglutide (Wegovy).
  •  

  • Ask for any specific procedures or documentation required for obtaining coverage for this medication.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the medical necessity of Semaglutide (Wegovy) for your condition.
  •  

  • Request a letter of medical necessity if required by Affinity Health Plan. This letter should explain why Semaglutide is the appropriate treatment for your health condition.

 

Prepare Necessary Documentation

 

  • Gather all required documentation, including a copy of your insurance card, the letter of medical necessity, and any relevant medical records that support the need for Semaglutide.
  •  

  • Ensure you have the appropriate forms that Affinity Health Plan may require for medication coverage requests or prior authorization.

 

Submit a Coverage Request

 

  • Fill out the necessary forms or prior authorization requests provided by Affinity Health Plan.
  •  

  • Include all gathered documentation and submit the request either online, via fax, or by mail, as instructed by Affinity Health Plan.

 

Follow Up on Your Request

 

  • Monitor the status of your coverage request by checking for updates through the Affinity Health Plan member portal or by contacting their customer service.
  •  

  • If your request is denied, inquire about the appeals process and gather additional information or documentation to support your case for reconsideration.

 

Consider Alternative Options

 

  • If coverage is denied, consult with your healthcare provider about alternative treatments or generic options that may be covered by your plan.
  •  

  • Explore patient assistance programs or discounts directly from the manufacturer of Wegovy, which may offer financial aid for qualifying patients.

 

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FAQs

Does Affinity Health Plan Cover Semaglutide (Wegovy)

Explore if Affinity Health Plan covers Semaglutide (Wegovy), tips for approval, costs without insurance, and get answers to common questions.
Curex allergy drops unboxing

Is Semaglutide (Wegovy) Covered by Affinity Health Plan

 

Affinity Health Plan Coverage Overview

 

  • Affinity Health Plan may cover Semaglutide (Wegovy), primarily when deemed medically necessary for weight management.
  •  
  • Coverage typically requires prior authorization, which involves a healthcare provider's approval demonstrating medical necessity.

 

Situations for Coverage

 

  • Patients with a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² with at least one weight-related comorbidity may qualify.
  •  
  • Weight-related conditions include type 2 diabetes, hypertension, or hyperlipidemia.

 

Basic Rules and Criteria

 

  • Documentation of a trial and failure, intolerance, or contraindication to other weight management medications may be required.
  •  
  • Ongoing documentation of weight loss progress and compliance with prescribed treatment protocols may be necessary for continued coverage.

 

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Affinity Health Plan's Approved Criteria for Semaglutide (Wegovy) Coverage

 

Eligibility for Semaglutide (Wegovy) Coverage

 

  • The patient must be 18 years of age or older.
  •  

  • The patient has a Body Mass Index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with at least one weight-related comorbidity such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • Previous weight loss efforts through diet and exercise have been unsuccessful, as documented by a healthcare provider.

 

Prescriber Requirements

 

  • The prescription must be written by an endocrinologist or a healthcare provider specializing in obesity or weight management.
  •  

  • The healthcare provider must include documentation confirming that the patient meets the BMI criteria and has tried other weight loss methods unsuccessfully.

 

Initial Coverage Duration

 

  • Coverage may be approved for an initial period of three months.
  •  

  • Continued coverage will be contingent upon documented weight reduction as evidenced by medical records provided by the prescriber.

 

Continuation Criteria

 

  • Documented evidence of at least a 5% weight loss from baseline within the initial three-month period is required for continued coverage.
  •  

  • Regular follow-up visits with the healthcare provider for monitoring progress and any potential side effects are necessary for continuation of therapy.

 

Dosage Requirements

 

  • Wegovy must be prescribed in accordance with FDA-approved dosing recommendations.
  •  

  • The prescribed dose should not exceed the maximum approved dose.

 

Why Affinity Health Plan Might Deny Semaglutide (Wegovy) Coverage

 

Criteria and Situations Where Affinity Health Plan Does Not Cover Semaglutide (Wegovy)

 

  • **Non-FDA Approved Uses**: Affinity Health Plan may deny coverage for Semaglutide (Wegovy) if it is prescribed for uses that have not been approved by the FDA.
  •  

  • **Absence of Medical Necessity**: If the prescription of Semaglutide (Wegovy) is not deemed medically necessary based on the patient's health condition or medical history, it might not be covered.
  •  

  • **Lack of Prior Authorization**: Coverage might be denied if proper prior authorization procedures are not followed or the required approvals are not obtained in advance.
  •  

  • **Non-Compliance with Policy Guidelines**: If the request for Semaglutide (Wegovy) does not align with Affinity Health Plan's specific clinical guidelines, it might be rejected.
  •  

  • **Exceeding Dosage Limits**: Requests exceeding the recommended dosage limitations may not be covered by Affinity Health Plan.
  •  

  • **Use in Excluded Conditions**: The medication may not be covered when prescribed for conditions specifically excluded from coverage under the health plan.
  •  

  • **Pre-existing Condition Clauses**: If a pre-existing condition clause applicable to Semaglutide (Wegovy) usage under the plan exists, this might lead to denial of coverage.
  •  

  • **Out of Network Providers**: Semaglutide (Wegovy) prescribed by providers outside the network may not be covered unless specified otherwise in the health plan.

 

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How Much Does Semaglutide (Wegovy) Cost without Insurance?

 

Approximate Cost of Semaglutide (Wegovy) Without Insurance

 

  • The price of Semaglutide, commonly known as Wegovy, without insurance can be substantial, typically ranging between $1,200 and $1,400 for a supply that lasts approximately one month.
  •  

  • This medication is designed for long-term weight management, thus planning financially for sustained use is important if paying out of pocket.
  •  

  • It's important to note that prices can vary based on the pharmacy, geographic location, and available discounts or pharmacy loyalty programs.
  •  

  • Patients are encouraged to seek patient assistance programs or discounts to help mitigate costs. Some pharmaceutical manufacturers offer discount cards or assistance programs to help with the cost of prescription medications like Wegovy.

 

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 Semaglutide (Wegovy) Coverage with Affinity Health Plan

 

Research Your Coverage Plan

 

  • Start by reviewing your Affinity Health Plan insurance policy documents. Check the formulary, or list of covered medications, to see if Semaglutide (Wegovy) is included.
  •  

  • Visit Affinity Health Plan's official website and navigate to their prescription coverage section. This may offer additional information on covered medications and any specific requirements for high-cost treatments like Semaglutide.

 

Contact Affinity Health Plan

 

  • Reach out to Affinity Health Plan's customer service. Use the contact information on their website or on your insurance card to inquire directly about coverage for Semaglutide (Wegovy).
  •  

  • Ask for any specific procedures or documentation required for obtaining coverage for this medication.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the medical necessity of Semaglutide (Wegovy) for your condition.
  •  

  • Request a letter of medical necessity if required by Affinity Health Plan. This letter should explain why Semaglutide is the appropriate treatment for your health condition.

 

Prepare Necessary Documentation

 

  • Gather all required documentation, including a copy of your insurance card, the letter of medical necessity, and any relevant medical records that support the need for Semaglutide.
  •  

  • Ensure you have the appropriate forms that Affinity Health Plan may require for medication coverage requests or prior authorization.

 

Submit a Coverage Request

 

  • Fill out the necessary forms or prior authorization requests provided by Affinity Health Plan.
  •  

  • Include all gathered documentation and submit the request either online, via fax, or by mail, as instructed by Affinity Health Plan.

 

Follow Up on Your Request

 

  • Monitor the status of your coverage request by checking for updates through the Affinity Health Plan member portal or by contacting their customer service.
  •  

  • If your request is denied, inquire about the appeals process and gather additional information or documentation to support your case for reconsideration.

 

Consider Alternative Options

 

  • If coverage is denied, consult with your healthcare provider about alternative treatments or generic options that may be covered by your plan.
  •  

  • Explore patient assistance programs or discounts directly from the manufacturer of Wegovy, which may offer financial aid for qualifying patients.

 

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.

Semaglutide (Wegovy) FAQ

1. What are the common side effects of Semaglutide (Wegovy)?

 

Common Side Effects of Semaglutide (Wegovy)

 

  • Nausea  — Often occurs at the start of treatment and may decrease over time.
  •  

  • Vomiting  — Related to gastrointestinal upset; usually temporary.
  •  

  • Diarrhea  — Common and may vary in intensity.
  •  

  • Constipation  — It can occur alongside other digestive issues.
  •  

  • Abdominal Pain  — Includes discomfort or cramping sensation.
  •  

  • Headache  — Typically mild but can be persistent.
  •  

  • Dizziness  — May affect balance or result in vertigo-like symptoms.
  •  

  • Fatigue  — Some patients report general tiredness or lack of energy.

 

2. How much weight can I lose with Semaglutide (Wegovy)?

 

Potential Weight Loss with Semaglutide (Wegovy)

 

  • Clinical trials demonstrate that Semaglutide (Wegovy) helps individuals lose a significant amount of weight. On average, participants experienced a weight loss of about 15% of their initial body weight over 68 weeks.
  •  

  • Results vary, with some losing more and others less. Factors include adherence to medication, lifestyle changes, and individual metabolic responses.
  •  

  • Semaglutide should be part of a comprehensive weight management program, including a reduced-calorie diet and increased physical activity.
  •  

  • Consult with a healthcare professional for personalized advice and to discuss possible side effects like nausea or gastrointestinal issues.

 

3. Is Wegovy the same as Ozempic?

 

Differences Between Wegovy and Ozempic

 

  • Formulation: Both contain semaglutide, a GLP-1 receptor agonist, but are formulated for different purposes.
  •  

  • Indication: Wegovy is primarily for weight management in adults with obesity. Ozempic is prescribed for type 2 diabetes management.
  •  

  • Dosage: While both are weekly injections, Wegovy generally has higher dosing than Ozempic (up to 2.4mg vs. 1mg for Ozempic).
  •  

  • Side Effects: Common side effects overlap, including nausea, but may vary in intensity due to different dosages.

 

Conclusion

 

  • Though similar, they serve distinct medical purposes. Always consult your healthcare provider for personalized advice.

 

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Everything you need is included:

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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.

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