Does Amerigroup Cover Orlistat (Xenical, Alli)

Explore Amerigroup's coverage for Orlistat, understand possible denials, find ways to secure coverage, and learn the cost without insurance in this informative guide.
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Amerigroup Coverage for Orlistat (Xenical, Alli)

 

  • Amerigroup may cover Orlistat if it meets certain medical necessity criteria. Coverage often requires a prescription and justification of need as part of a weight management program.
  •  

  • The medication is typically covered for individuals with a body mass index (BMI) of 30 or higher, or 27 with additional risk factors such as hypertension or diabetes.
  •  

  • Pre-authorization from Amerigroup may be necessary before the medication is approved. The prescribing doctor usually needs to submit a request explaining why Orlistat is medically necessary.
  •  

  • Patients might also be required to prove that diet and exercise alone did not result in significant weight loss before Orlistat coverage is approved.
  •  

  • Individuals should check their specific Amerigroup plan as coverage and rules can vary based on state and policy.

 

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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.

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 Amerigroup

 

Research Amerigroup's Drug Coverage Policies

 

  • Visit the Amerigroup website to access their formulary or drug coverage list.
  •  

  • Look for Orlistat under brand names like Xenical or Alli, noting any coverage restrictions or requirements.
  •  

  • Contact Amerigroup customer support for specific questions about Orlistat coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss the medical necessity of Orlistat with your healthcare provider.
  •  

  • Obtain a prescription and discuss potential alternatives if Orlistat is not covered.
  •  

  • Ensure your provider is aware of any prior authorization or step therapy requirements from Amerigroup.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to gather necessary documentation to support a prior authorization request.
  •  

  • Submit the prior authorization request to Amerigroup as specified in their guidelines.
  •  

  • Be prepared to provide evidence of medical necessity and any previous unsuccessful treatments.

 

Consider Alternative Appeal Processes

 

  • If the prior authorization is denied, work with your healthcare provider to understand the reasons for denial.
  •  

  • Check Amerigroup's appeal process on their website or by contacting their support team.
  •  

  • Submit an appeal with any additional supporting documentation required.

 

Explore Savings and Assistance Programs

 

  • Research any available manufacturer's savings cards or patient assistance programs for Orlistat.
  •  

  • Check whether generic versions or alternative medications are covered by Amerigroup at a lower cost.
  •  

  • Consult with your provider about non-prescription weight management strategies as an interim solution.

 

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Does Amerigroup Cover Orlistat (Xenical, Alli)

Explore Amerigroup's coverage for Orlistat, understand possible denials, find ways to secure coverage, and learn the cost without insurance in this informative guide.
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Is Orlistat (Xenical, Alli) Covered by Amerigroup

 

Amerigroup Coverage for Orlistat (Xenical, Alli)

 

  • Amerigroup may cover Orlistat if it meets certain medical necessity criteria. Coverage often requires a prescription and justification of need as part of a weight management program.
  •  

  • The medication is typically covered for individuals with a body mass index (BMI) of 30 or higher, or 27 with additional risk factors such as hypertension or diabetes.
  •  

  • Pre-authorization from Amerigroup may be necessary before the medication is approved. The prescribing doctor usually needs to submit a request explaining why Orlistat is medically necessary.
  •  

  • Patients might also be required to prove that diet and exercise alone did not result in significant weight loss before Orlistat coverage is approved.
  •  

  • Individuals should check their specific Amerigroup plan as coverage and rules can vary based on state and policy.

 

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Amerigroup's Approved Criteria for Orlistat (Xenical, Alli) Coverage

 

Eligibility Criteria for Orlistat Coverage

 

  • Individual must be an enrolled member of Amerigroup insurance plan.
  •  

  • Insurance coverage for Orlistat is available for both approved brand names, Xenical and Alli.
  •  

  • Member must have a Body Mass Index (BMI) of 30 kg/m² or greater, which qualifies as obese, or a BMI of 27 kg/m² or greater if accompanied by comorbidities such as hypertension, diabetes, or dyslipidemia.

 

Previous Treatment Requirements

 

  • Documentation must show that the individual has attempted to lose weight through lifestyle changes, including diet and exercise, for at least 6 months with minimal success.
  •  

  • Must have a documented prescription or recommendation from a healthcare provider emphasizing the necessity of Orlistat as part of a comprehensive weight management program.

 

Duration and Follow-up Protocols

 

  • Initial coverage approval may be granted for a 6-month period, allowing for an assessment of weight loss progress and adherence to a weight management program.
  •  

  • Continued coverage beyond the initial period requires evidence of weight loss or improvement in obesity-related conditions after starting Orlistat, as determined by an evaluation from the prescribing healthcare professional.

 

Coordination with Healthcare Providers

 

  • Amerigroup requires coordination with the member's primary care physician or a specialist involved in the weight management process.
  •  

  • Routine follow-up visits should be documented, addressing ongoing weight loss progress, dietary adherence, and any potential side effects or health improvements while on Orlistat.

 

Why Amerigroup Might Deny Orlistat (Xenical, Alli) Coverage

 

Reasons for Orlistat Denial by Amerigroup

 

  • Orlistat (Xenical, Alli) is not covered by Amerigroup if it is requested solely for the purpose of cosmetic weight loss without associated health risks.
  •  

  • Coverage is denied if the patient's medical records do not indicate a body mass index (BMI) that meets Amerigroup's defined criteria for obesity treatment.
  •  

  • If Orlistat is prescribed without prior authorization, Amerigroup may not cover it.
  •  

  • Amerigroup may deny coverage if there is insufficient documentation of attempted weight loss through diet and exercise prior to the request for Orlistat.
  •  

  • The medication is not covered if it is not considered medically necessary according to Amerigroup’s guidelines.
  •  

  • If the prescription does not comply with Amerigroup’s formulary restrictions or there is a lack of exception request documentation, coverage may be denied.

 

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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 Amerigroup

 

Research Amerigroup's Drug Coverage Policies

 

  • Visit the Amerigroup website to access their formulary or drug coverage list.
  •  

  • Look for Orlistat under brand names like Xenical or Alli, noting any coverage restrictions or requirements.
  •  

  • Contact Amerigroup customer support for specific questions about Orlistat coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss the medical necessity of Orlistat with your healthcare provider.
  •  

  • Obtain a prescription and discuss potential alternatives if Orlistat is not covered.
  •  

  • Ensure your provider is aware of any prior authorization or step therapy requirements from Amerigroup.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to gather necessary documentation to support a prior authorization request.
  •  

  • Submit the prior authorization request to Amerigroup as specified in their guidelines.
  •  

  • Be prepared to provide evidence of medical necessity and any previous unsuccessful treatments.

 

Consider Alternative Appeal Processes

 

  • If the prior authorization is denied, work with your healthcare provider to understand the reasons for denial.
  •  

  • Check Amerigroup's appeal process on their website or by contacting their support team.
  •  

  • Submit an appeal with any additional supporting documentation required.

 

Explore Savings and Assistance Programs

 

  • Research any available manufacturer's savings cards or patient assistance programs for Orlistat.
  •  

  • Check whether generic versions or alternative medications are covered by Amerigroup at a lower cost.
  •  

  • Consult with your provider about non-prescription weight management strategies as an interim solution.

 

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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.

 

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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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