Does Amerigroup Cover Naltrexone/Bupropion (Contrave)

Explore Amerigroup's coverage of Contrave, potential denial reasons, costs without insurance, and tips to secure coverage. Find answers to all your questions.
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Coverage for Naltrexone/Bupropion (Contrave)

 

  • Amerigroup may cover the prescription medication Naltrexone/Bupropion, commonly known by the brand name Contrave, as part of its pharmacy benefits.
  •  

  • Coverage often depends on whether the medication is listed on Amerigroup's formulary, which can vary by state and the specific plan.

 

Criteria for Coverage

 

  • To have Contrave covered, patients typically need to meet specific criteria, such as being diagnosed with obesity-related conditions or failing other weight loss medications.
  •  

  • Prior authorization from a healthcare provider is usually required, demonstrating medical necessity for using Naltrexone/Bupropion for weight management.

 

Important Considerations

 

  • Patients should check with Amerigroup directly for the most accurate information regarding their coverage and any possible copayments or restrictions.
  •  

  • Review your specific plan details and consult with a healthcare provider to determine the best steps for initiating coverage for Contrave.

 

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Naltrexone/Bupropion (Contrave) Coverage with Amerigroup

 

Check Amerigroup Formulary

 

  • Visit the Amerigroup website to access their formulary, a list of medications that are covered under your plan.
  •  

  • Search for Naltrexone/Bupropion (Contrave) to confirm if it's included in the formulary.
  •  

  • If the medication is listed, note any specific requirements or tier levels that may apply.

 

Consult Your Prescribing Doctor

 

  • Schedule a consultation with your healthcare provider to discuss your need for Naltrexone/Bupropion (Contrave).
  •  

  • Ensure your doctor understands your insurance requirements and can provide necessary documentation or prior authorization.
  •  

  • Your doctor might need to fill out a prior authorization form if the medication isn’t readily covered.

 

Contact Amerigroup Member Services

 

  • Call the member services number found on your Amerigroup insurance card for direct assistance.
  •  

  • Ask about the specific coverage details for Naltrexone/Bupropion (Contrave), including any steps required before coverage is approved.
  •  

  • Inquire if prior authorization or additional paperwork needs to be completed by your healthcare provider.

 

Complete Necessary Paperwork

 

  • Fill out any forms provided by Amerigroup, such as prior authorization or exception request forms.
  •  

  • Coordinate with your doctor’s office to ensure all required information and documentation are correctly submitted.
  •  

  • Monitor the status of your request, and stay in contact with Amerigroup for updates.

 

Verify Authorization and Coverage

 

  • Once Amerigroup has processed your request, verify that Naltrexone/Bupropion (Contrave) is covered under your plan.
  •  

  • Ensure you understand the copayments or additional costs associated with the medication.
  •  

  • If approved, ask for details about the coverage duration and refill requirements.

 

Utilize Covered Pharmacy Services

 

  • Identify a pharmacy within Amerigroup's network for purchasing your medication.
  •  

  • Present your Amerigroup insurance card at the pharmacy when filling your prescription for Naltrexone/Bupropion (Contrave).
  •  

  • Confirm that the pharmacy processes the prescription according to your coverage benefits.

 

Handle Denials or Appeals if Necessary

 

  • If your initial request is denied, review the reasons provided by Amerigroup for the decision.
  •  

  • Work with your doctor to gather additional evidence or documentation that supports your medical need for the medication.
  •  

  • File an appeal with Amerigroup within the specified time frame, if needed, to request a re-evaluation of your coverage.

 

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FAQs

Does Amerigroup Cover Naltrexone/Bupropion (Contrave)

Explore Amerigroup's coverage of Contrave, potential denial reasons, costs without insurance, and tips to secure coverage. Find answers to all your questions.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by Amerigroup

 

Coverage for Naltrexone/Bupropion (Contrave)

 

  • Amerigroup may cover the prescription medication Naltrexone/Bupropion, commonly known by the brand name Contrave, as part of its pharmacy benefits.
  •  

  • Coverage often depends on whether the medication is listed on Amerigroup's formulary, which can vary by state and the specific plan.

 

Criteria for Coverage

 

  • To have Contrave covered, patients typically need to meet specific criteria, such as being diagnosed with obesity-related conditions or failing other weight loss medications.
  •  

  • Prior authorization from a healthcare provider is usually required, demonstrating medical necessity for using Naltrexone/Bupropion for weight management.

 

Important Considerations

 

  • Patients should check with Amerigroup directly for the most accurate information regarding their coverage and any possible copayments or restrictions.
  •  

  • Review your specific plan details and consult with a healthcare provider to determine the best steps for initiating coverage for Contrave.

 

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Amerigroup's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Coverage Criteria for Naltrexone/Bupropion (Contrave)

 

  • The patient must be 18 years of age or older. This medication is approved for adult patients only.
  •  

  • A documented diagnosis of obesity, which means a Body Mass Index (BMI) of 30 kg/m² or higher.
  •  

  • For overweight individuals, a BMI of 27 kg/m² or higher is acceptable if accompanied by at least one weight-related comorbidity such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • The prescriber must provide evidence that the patient has attempted to manage their weight through lifestyle interventions such as diet and exercise, and these have not been sufficient for weight loss.
  •  

  • The medication must be prescribed as part of a comprehensive weight management program that includes lifestyle modifications such as a reduced-calorie diet and increased physical activity.
  •  

  • No history of seizures, as bupropion (a component of Contrave) lowers the seizure threshold.
  •  

  • Patients must not have a history of bulimia or anorexia nervosa, as there is an increased risk of seizures in these populations.
  •  

  • Total treatment duration will be evaluated; treatment is usually considered appropriate if results demonstrate weight loss within 12 weeks of taking the medication, aligning with clinical guidelines.
  •  

  • Continuous use will require periodic assessments of weight loss progress, adherence to lifestyle interventions, and evaluation of potential side effects.
  •  

 

Patient Monitoring Requirements

 

  • The healthcare provider must monitor blood pressure and heart rate, given the potential cardiovascular effects associated with the medication.
  •  

  • Regular follow-up appointments are necessary to evaluate the effectiveness of the treatment and ensure the safety of the patient.
  •  

  • Consideration for ongoing therapy will be given only if the patient has shown satisfactory progress (usually defined as at least 5% weight loss from baseline) without significant adverse effects.
  •  

 

Why Amerigroup Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Reasons for Denial of Naltrexone/Bupropion (Contrave) Coverage by Amerigroup

 

  • **Non-Medically Necessary:** The medication may be deemed non-medically necessary based on the individual's health condition. If the patient does not meet specific medical criteria outlined by Amerigroup, the prescription might not be covered.
  •  

  • **Exclusion from Plan:** Naltrexone/Bupropion (Contrave) might be excluded from certain Amerigroup plans. These exclusions could arise from formulary restrictions or plan-specific guidelines.
  •  

  • **Alternative Treatment Requirements:** If Amerigroup policy requires that other weight-loss treatments or medications be tried and documented as ineffective before approving Naltrexone/Bupropion, coverage could be denied if this step has not been completed.
  •  

  • **Lack of Prior Authorization:** Coverage might be denied if prior authorization has not been obtained. Amerigroup may require prior authorization to confirm medical necessity and compliance with their guidelines.
  •  

  • **Age or Gender Restrictions:** Specific age or gender restrictions may apply, and failure to meet these criteria can lead to coverage denial. Amerigroup may have restrictions based on FDA approvals or their policy assessments.
  •  

 

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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 Amerigroup

 

Check Amerigroup Formulary

 

  • Visit the Amerigroup website to access their formulary, a list of medications that are covered under your plan.
  •  

  • Search for Naltrexone/Bupropion (Contrave) to confirm if it's included in the formulary.
  •  

  • If the medication is listed, note any specific requirements or tier levels that may apply.

 

Consult Your Prescribing Doctor

 

  • Schedule a consultation with your healthcare provider to discuss your need for Naltrexone/Bupropion (Contrave).
  •  

  • Ensure your doctor understands your insurance requirements and can provide necessary documentation or prior authorization.
  •  

  • Your doctor might need to fill out a prior authorization form if the medication isn’t readily covered.

 

Contact Amerigroup Member Services

 

  • Call the member services number found on your Amerigroup insurance card for direct assistance.
  •  

  • Ask about the specific coverage details for Naltrexone/Bupropion (Contrave), including any steps required before coverage is approved.
  •  

  • Inquire if prior authorization or additional paperwork needs to be completed by your healthcare provider.

 

Complete Necessary Paperwork

 

  • Fill out any forms provided by Amerigroup, such as prior authorization or exception request forms.
  •  

  • Coordinate with your doctor’s office to ensure all required information and documentation are correctly submitted.
  •  

  • Monitor the status of your request, and stay in contact with Amerigroup for updates.

 

Verify Authorization and Coverage

 

  • Once Amerigroup has processed your request, verify that Naltrexone/Bupropion (Contrave) is covered under your plan.
  •  

  • Ensure you understand the copayments or additional costs associated with the medication.
  •  

  • If approved, ask for details about the coverage duration and refill requirements.

 

Utilize Covered Pharmacy Services

 

  • Identify a pharmacy within Amerigroup's network for purchasing your medication.
  •  

  • Present your Amerigroup insurance card at the pharmacy when filling your prescription for Naltrexone/Bupropion (Contrave).
  •  

  • Confirm that the pharmacy processes the prescription according to your coverage benefits.

 

Handle Denials or Appeals if Necessary

 

  • If your initial request is denied, review the reasons provided by Amerigroup for the decision.
  •  

  • Work with your doctor to gather additional evidence or documentation that supports your medical need for the medication.
  •  

  • File an appeal with Amerigroup within the specified time frame, if needed, to request a re-evaluation of your coverage.

 

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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.

 

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Titration

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

Additional Treatments

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

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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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