Does Amerigroup Cover Phentermine (Adipex-P, Lomaira)

Discover why Amerigroup might deny Phentermine coverage, how to secure it, pricing without insurance, and answers to FAQs in this informative guide.
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Coverage Criteria for Phentermine

 

  • Amerigroup may cover Phentermine (Adipex-P, Lomaira) as part of its prescription drug benefits, but specific coverage depends on individual plans and state regulations.
  •  

  • Typically, coverage is for patients who have failed to lose weight with diet and exercise alone and have a BMI ≥ 30, or ≥ 27 with weight-related conditions.

 

Approval and Prior Authorization

 

  • Members usually need prior authorization for Phentermine. Physicians must provide documentation showing that the patient meets the criteria for medical necessity.
  •  

  • Phentermine is often approved for short-term use when integrated with a comprehensive weight management program.

 

Consult with Healthcare Providers

 

  • Verify coverage specifics directly with Amerigroup or through plan documents.
  •  

  • Healthcare providers can help submit the necessary paperwork for authorization.

 

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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 Phentermine (Adipex-P, Lomaira) Coverage with Amerigroup

 

Verify Your Coverage

 

  • Contact Amerigroup directly through their customer service hotline or use their online portal to understand if Phentermine is covered under your current plan.
  •  

  • Review your specific policy documents for any mentions of weight loss medication coverage or exclusions.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Phentermine (Adipex-P, Lomaira) and obtain a prescription if deemed appropriate.
  •  

  • Ask your healthcare provider to document the medical necessity for Phentermine in your health records, as this may help with authorization processes.

 

Preauthorization and Documentation

 

  • Work with your healthcare provider to submit a preauthorization request to Amerigroup. This often includes a letter of medical necessity and any relevant medical documentation that supports your need for the medication.
  •  

  • Ensure that all paperwork is complete and accurately filled out to avoid delays in processing the preauthorization request.

 

Follow Up with Amerigroup

 

  • Contact Amerigroup to confirm receipt of your preauthorization request and inquire about the estimated timeline for a decision.
  •  

  • If your request is approved, ask about any specific conditions or requirements that you must follow while the prescription is covered.
  •  

  • If your request is denied, inquire about the appeals process and gather necessary evidence to support your case for coverage.

 

Use In-Network Pharmacies

 

  • Once approved, fill your prescription through an Amerigroup in-network pharmacy to ensure maximum coverage benefits and the lowest out-of-pocket costs.
  •  

  • Consult Amerigroup's online resources or customer support to locate an in-network pharmacy near your location.

 

Monitor Your Coverage

 

  • Regularly review your Amerigroup coverage information and statements to ensure continued coverage of Phentermine (Adipex-P, Lomaira) and to remain aware of any policy changes.
  •  

  • Communicate with your healthcare provider periodically to update Amerigroup on the progress and continued need for Phentermine, if necessary.

 

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FAQs

Does Amerigroup Cover Phentermine (Adipex-P, Lomaira)

Discover why Amerigroup might deny Phentermine coverage, how to secure it, pricing without insurance, and answers to FAQs in this informative guide.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by Amerigroup

 

Coverage Criteria for Phentermine

 

  • Amerigroup may cover Phentermine (Adipex-P, Lomaira) as part of its prescription drug benefits, but specific coverage depends on individual plans and state regulations.
  •  

  • Typically, coverage is for patients who have failed to lose weight with diet and exercise alone and have a BMI ≥ 30, or ≥ 27 with weight-related conditions.

 

Approval and Prior Authorization

 

  • Members usually need prior authorization for Phentermine. Physicians must provide documentation showing that the patient meets the criteria for medical necessity.
  •  

  • Phentermine is often approved for short-term use when integrated with a comprehensive weight management program.

 

Consult with Healthcare Providers

 

  • Verify coverage specifics directly with Amerigroup or through plan documents.
  •  

  • Healthcare providers can help submit the necessary paperwork for authorization.

 

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Start with Curex

Amerigroup's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Amerigroup's Approved Criteria for Phentermine Coverage

 

  • **Clinical Diagnosis**: The patient must have a documented diagnosis of obesity, defined by a body mass index (BMI) greater than or equal to 30 kg/m². Alternatively, a BMI of ≥27 kg/m² with at least one weight-related comorbidity, such as hypertension, type 2 diabetes, or dyslipidemia, is also acceptable.
  •  

  • **Age Requirement**: The patient must be at least 16 years of age or older to qualify for coverage under the adult dosing guidelines.
  •  

  • **Prior Weight-Loss Efforts**: There must be evidence that the patient has attempted to lose weight through a structured diet and exercise program. Documentation of previous weight-loss efforts under healthcare supervision is required.
  •  

  • **Therapeutic Necessity**: The prescribing healthcare provider must indicate the necessity of medical intervention with phentermine for weight reduction, based on the patient's health condition and unsuccessful weight-loss attempts through lifestyle modifications alone.
  •  

  • **Treatment Plan**: The patient must be enrolled in a comprehensive weight management program that includes dietary modification, exercise, and behavior therapy as part of the treatment strategy.
  •  

  • **Duration Limit**: Approval for phentermine treatment is typically limited to a short-term period, often up to 12 weeks, given its intended use for short-term weight management. Continuous evaluation and monitoring of the patient's progress and potential need for extended therapy must be documented.
  •  

  • **Exclusion of Contraindications**: There must be no contraindications for phentermine use, such as a history of cardiovascular disease, uncontrolled hypertension, hyperthyroidism, glaucoma, or a known hypersensitivity to sympathomimetic amines.
  •  

  • **Provider Qualifications**: Phentermine must be prescribed by a qualified healthcare provider, such as a physician specializing in obesity management or endocrinology, who is equipped to monitor and adjust treatment based on patient response.
  •  

 

Why Amerigroup Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Specific Criteria for Denying Coverage of Phentermine

 

  • Phentermine usage for purposes not FDA-approved or not considered medically necessary might not be covered.
  •  

  • Requests where the prescriber does not provide proper documentation of the patient meeting the necessary health criteria for usage could lead to denial.
  •  

  • Patients who do not meet specific BMI or other health condition criteria may have their medication requests denied.
  •  

  • The medication being prescribed for weight loss in individuals without comorbid conditions that justify its necessity might be excluded from coverage.
  •  

  • Requests for extended use beyond the typically approved short-term treatment duration of a few weeks might not be covered.
  •  

  • Patients with a history of substance abuse may face denials based on risk factors related to the stimulant nature of the drug.
  •  

  • Submitting requests without required prior authorization forms or necessary additional health documentation might result in denial.

 

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How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 Phentermine (Adipex-P, Lomaira) Coverage with Amerigroup

 

Verify Your Coverage

 

  • Contact Amerigroup directly through their customer service hotline or use their online portal to understand if Phentermine is covered under your current plan.
  •  

  • Review your specific policy documents for any mentions of weight loss medication coverage or exclusions.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Phentermine (Adipex-P, Lomaira) and obtain a prescription if deemed appropriate.
  •  

  • Ask your healthcare provider to document the medical necessity for Phentermine in your health records, as this may help with authorization processes.

 

Preauthorization and Documentation

 

  • Work with your healthcare provider to submit a preauthorization request to Amerigroup. This often includes a letter of medical necessity and any relevant medical documentation that supports your need for the medication.
  •  

  • Ensure that all paperwork is complete and accurately filled out to avoid delays in processing the preauthorization request.

 

Follow Up with Amerigroup

 

  • Contact Amerigroup to confirm receipt of your preauthorization request and inquire about the estimated timeline for a decision.
  •  

  • If your request is approved, ask about any specific conditions or requirements that you must follow while the prescription is covered.
  •  

  • If your request is denied, inquire about the appeals process and gather necessary evidence to support your case for coverage.

 

Use In-Network Pharmacies

 

  • Once approved, fill your prescription through an Amerigroup in-network pharmacy to ensure maximum coverage benefits and the lowest out-of-pocket costs.
  •  

  • Consult Amerigroup's online resources or customer support to locate an in-network pharmacy near your location.

 

Monitor Your Coverage

 

  • Regularly review your Amerigroup coverage information and statements to ensure continued coverage of Phentermine (Adipex-P, Lomaira) and to remain aware of any policy changes.
  •  

  • Communicate with your healthcare provider periodically to update Amerigroup on the progress and continued need for Phentermine, if necessary.

 

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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.

Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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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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