Does Amerigroup Cover Liraglutide (Saxenda)

Explore Amerigroup's coverage for Liraglutide (Saxenda), reasons for denial, coverage tips, costs without insurance, and FAQs in our comprehensive guide.
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Coverage Criteria for Liraglutide (Saxenda) with Amerigroup

 

  • Amerigroup may cover Liraglutide (Saxenda) for members who meet specific medical criteria. Typically, coverage is considered for patients with a medical diagnosis of obesity or overweight with at least one weight-related condition such as type 2 diabetes, high blood pressure, or elevated cholesterol.
  •  

  • Eligibility generally requires a Body Mass Index (BMI) of 30 or higher, or a BMI of 27 or higher with associated weight-related medical conditions.

 

Steps to Obtain Coverage

 

  • A healthcare provider must verify the patient's eligibility by providing documentation of the medical necessity for Saxenda, including the patient's BMI and any relevant medical conditions.
  •  

  • Prior authorization from Amerigroup might be required. The prescribing physician must submit detailed clinical information supporting the use of Saxenda for weight management in the eligible patient.

 

Important Considerations

 

  • Coverage policies can vary based on the specific Amerigroup health plan and location, so it's crucial to verify the specific terms of coverage directly with Amerigroup or through a healthcare provider.
  •  

  • Patients may also need to demonstrate unsuccessful attempts with other weight management options before Saxenda is approved.

 

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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 Liraglutide (Saxenda) Coverage with Amerigroup

 

Verify Your Amerigroup Plan Coverage

 

  • Contact Amerigroup customer service to verify whether your specific insurance plan covers weight loss medications like Liraglutide (Saxenda).
  •  

  • Check online through the Amerigroup member portal to review your policy's drug formulary list for Saxenda coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss your weight loss goals and treatment options with your healthcare provider. Ensure that they support the use of Saxenda for your condition.
  •  

  • Obtain a prescription for Liraglutide (Saxenda) from your doctor. This will be necessary for processing coverage approval.

 

Obtain Prior Authorization if Required

 

  • Contact Amerigroup or have your healthcare provider's office reach out to find out if prior authorization is required for Saxenda.
  •  

  • Submit any required medical justification or documentation supporting the necessity of Saxenda for your treatment to Amerigroup.

 

Complete and Submit Any Amerigroup Forms

 

  • Amerigroup might have specific forms that need to be completed for specialty drug coverage. Obtain and complete these forms accurately.
  •  

  • Ensure all documentation is attached as needed, including your prescription and prior authorization approval if applicable.

 

Follow Up Promptly

 

  • After submission, follow up with both Amerigroup and your healthcare provider to confirm that all required paperwork has been received and processed.
  •  

  • Keep records of all communications, receipts, and submissions regarding your Saxenda coverage request.

 

Evaluate Alternative Support Programs

 

  • If you encounter difficulties in securing coverage through Amerigroup, inquire about alternative support programs from the manufacturer or other patient assistance services.
  •  

  • Explore any potential copay assistance or discount programs offered by Saxenda’s manufacturer that might lessen out-of-pocket costs.

 

Appeal Denial if Necessary

 

  • If your request for coverage is denied, review the denial reason provided by Amerigroup and gather additional supporting information regarding your medical necessity.
  •  

  • Submit an appeal following Amerigroup's process, including any new or omitted documentation that can support your case for Saxenda.

 

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FAQs

Does Amerigroup Cover Liraglutide (Saxenda)

Explore Amerigroup's coverage for Liraglutide (Saxenda), reasons for denial, coverage tips, costs without insurance, and FAQs in our comprehensive guide.
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Is Liraglutide (Saxenda) Covered by Amerigroup

 

Coverage Criteria for Liraglutide (Saxenda) with Amerigroup

 

  • Amerigroup may cover Liraglutide (Saxenda) for members who meet specific medical criteria. Typically, coverage is considered for patients with a medical diagnosis of obesity or overweight with at least one weight-related condition such as type 2 diabetes, high blood pressure, or elevated cholesterol.
  •  

  • Eligibility generally requires a Body Mass Index (BMI) of 30 or higher, or a BMI of 27 or higher with associated weight-related medical conditions.

 

Steps to Obtain Coverage

 

  • A healthcare provider must verify the patient's eligibility by providing documentation of the medical necessity for Saxenda, including the patient's BMI and any relevant medical conditions.
  •  

  • Prior authorization from Amerigroup might be required. The prescribing physician must submit detailed clinical information supporting the use of Saxenda for weight management in the eligible patient.

 

Important Considerations

 

  • Coverage policies can vary based on the specific Amerigroup health plan and location, so it's crucial to verify the specific terms of coverage directly with Amerigroup or through a healthcare provider.
  •  

  • Patients may also need to demonstrate unsuccessful attempts with other weight management options before Saxenda is approved.

 

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Amerigroup's Approved Criteria for Liraglutide (Saxenda) Coverage

 

Eligibility Criteria for Liraglutide (Saxenda) Coverage

 

  • Individuals must provide documented evidence of a Body Mass Index (BMI) greater than or equal to 30 kg/m2. Alternatively, a BMI of 27 kg/m2 or greater must be accompanied by at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia).

 

Previous Weight Loss Efforts

 

  • Documentation showing unsuccessful weight loss attempts through lifestyle interventions (diet and exercise) must be provided. These interventions should have been tried for a minimum duration of 6 months.

 

Age Requirement

 

  • Patients must be 18 years of age or older to qualify for coverage.

 

Clinical Evaluation and Monitoring

 

  • A healthcare provider must conduct a comprehensive clinical evaluation. This assessment ensures that the patient is an appropriate candidate for Liraglutide (Saxenda) treatment.

 

Adherence to Treatment Plan

 

  • Patients must have an established plan for maintaining compliance with Liraglutide (Saxenda) treatment, including regular follow-ups with healthcare professionals to monitor treatment efficacy and side effects.

 

Absence of Contraindications

 

  • Individuals must not have a history of medullary thyroid carcinoma (MTC) or a personal/family history of Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

 

Insurance Approval Process

 

  • The prescribing physician must submit all necessary documentation to Amerigroup for authorization. This includes clinical notes, history of weight management attempts, and other relevant medical records.

 

Why Amerigroup Might Deny Liraglutide (Saxenda) Coverage

 

Situations Where Amerigroup Might Deny Coverage for Liraglutide (Saxenda)

 

  • **Non-Medically Necessary Use:** Amerigroup may not cover Liraglutide if it is deemed not medically necessary for the patient's condition. Such assessments are based on their guidelines and medical policies.
  •  

  • **Off-Label Use:** Coverage for off-label uses of Liraglutide, not specifically approved by the FDA, might be denied due to lack of supporting clinical evidence as per Amerigroup's policy.
  •  

  • **Lack of Prior Authorization:** If prior authorization requirements are not met, Amerigroup may deny coverage. This typically involves submitting clinical information to justify the need for the medication.
  •  

  • **Dosing Criteria Not Met:** If the dosing of Liraglutide exceeds limits specified in Amerigroup's coverage criteria, it may result in denial of coverage.
  •  

  • **Non-Compliance with Weight Management Program:** If the patient does not comply with an approved weight management program, which might be a condition for continuation of therapy, Amerigroup might deny coverage.
  •  

  • **Age Restrictions:** Liraglutide use might be denied if the patient falls outside the age range covered under Amerigroup's policy for this medication.
  •  

  • **Negative Clinical Outcomes:** If there is documented evidence of adverse clinical outcomes or lack of efficacy from prior use, coverage might be denied.

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How Much Does Liraglutide (Saxenda) Cost without Insurance?

 

Liraglutide (Saxenda) Cost without Insurance

 

  • The cost of Liraglutide, commonly marketed under the brand name Saxenda, can vary based on location and pharmacy, but it typically ranges between $1,300 and $1,500 for a 30-day supply, which includes five injectable pens.
  •  

  • Prices can fluctuate due to factors like pharmacy pricing policies, manufacturer offers, and location. It is advisable to compare prices from various pharmacies or online sources.
  •  

  • Pharmacies may offer discount programs or coupons that could reduce the out-of-pocket cost. It's a good idea to inquire about available savings options.
  •  

  • Some online pharmacy platforms may provide competitive pricing and discounts, so checking these can be beneficial for finding better deals.
  •  

  • Prescription assistance programs, sometimes offered by the manufacturer, can provide help for individuals who meet certain income or insurance criteria. Exploring these options might also lead to cost savings.

 

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Liraglutide (Saxenda) Coverage with Amerigroup

 

Verify Your Amerigroup Plan Coverage

 

  • Contact Amerigroup customer service to verify whether your specific insurance plan covers weight loss medications like Liraglutide (Saxenda).
  •  

  • Check online through the Amerigroup member portal to review your policy's drug formulary list for Saxenda coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss your weight loss goals and treatment options with your healthcare provider. Ensure that they support the use of Saxenda for your condition.
  •  

  • Obtain a prescription for Liraglutide (Saxenda) from your doctor. This will be necessary for processing coverage approval.

 

Obtain Prior Authorization if Required

 

  • Contact Amerigroup or have your healthcare provider's office reach out to find out if prior authorization is required for Saxenda.
  •  

  • Submit any required medical justification or documentation supporting the necessity of Saxenda for your treatment to Amerigroup.

 

Complete and Submit Any Amerigroup Forms

 

  • Amerigroup might have specific forms that need to be completed for specialty drug coverage. Obtain and complete these forms accurately.
  •  

  • Ensure all documentation is attached as needed, including your prescription and prior authorization approval if applicable.

 

Follow Up Promptly

 

  • After submission, follow up with both Amerigroup and your healthcare provider to confirm that all required paperwork has been received and processed.
  •  

  • Keep records of all communications, receipts, and submissions regarding your Saxenda coverage request.

 

Evaluate Alternative Support Programs

 

  • If you encounter difficulties in securing coverage through Amerigroup, inquire about alternative support programs from the manufacturer or other patient assistance services.
  •  

  • Explore any potential copay assistance or discount programs offered by Saxenda’s manufacturer that might lessen out-of-pocket costs.

 

Appeal Denial if Necessary

 

  • If your request for coverage is denied, review the denial reason provided by Amerigroup and gather additional supporting information regarding your medical necessity.
  •  

  • Submit an appeal following Amerigroup's process, including any new or omitted documentation that can support your case for Saxenda.

 

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Liraglutide (Saxenda) FAQ

How much weight can you lose with Saxenda?

 

Weight Loss with Saxenda

 

  • Clinical trials show Saxenda users can lose an average of 5-10% of their initial body weight over 56 weeks.
  •  

  • Weight loss can vary depending on factors such as initial weight, diet, and physical activity.
  •  

  • Combining Saxenda with a reduced-calorie diet and increased physical activity enhances results.
  •  

  • It's important to monitor progress and consult with a healthcare provider to tailor the plan to individual needs.
  •  

  • Results are not guaranteed, and lifestyle changes significantly influence effectiveness.

What are the side effects of Liraglutide?

 

Common Side Effects

 

  • Nausea, particularly when starting treatment.
  • Vomiting or diarrhea, which can lead to dehydration.
  • Reduced appetite, a desired effect for weight management.
  • Headaches and dizziness, usually mild to moderate.

 

Serious Side Effects

 

  • Severe abdominal pain, signaling possible pancreatitis.
  • Symptoms of thyroid tumors, such as neck swelling or difficulty swallowing.
  • Serious allergic reactions, including hives or breath difficulty.
  • Elevated heart rate or palpitations.

 

Recommendations

 

  • Alert healthcare providers about any side effects.
  • Hydrate well to minimize dehydration from gastrointestinal effects.
  • Monitor blood sugar if diabetic, as levels may change.

 

How does Saxenda work for weight loss?

 

Mechanism of Action

 

  • Saxenda (liraglutide) is a GLP-1 receptor agonist. It mimics the action of the glucagon-like peptide-1, a hormone involved in appetite regulation.
  •  

  • It enhances insulin secretion and delays gastric emptying, promoting a feeling of fullness.

 

Appetite Suppression

 

  • Saxenda targets areas of the brain that control hunger, reducing appetite and calorie intake.
  •  

  • This helps in forming healthier eating habits and better portion control.

 

Additional Benefits

 

  • Besides weight loss, it assists in improving glycemic control for type 2 diabetes patients.
  •  

  • May lead to reductions in waist circumference and improvements in cardiovascular measures.

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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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