Does Anthem Cover Diethylpropion (Tenuate)

Discover if Anthem covers Diethylpropion (Tenuate) and learn how to gain approval, explore costs without insurance, and get answers to common questions.
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Coverage for Diethylpropion (Tenuate)

 

  • Anthem insurance may cover Diethylpropion for weight loss if deemed medically necessary.
  •  

  • Coverage varies by plan; contacting Anthem directly is recommended for specifics.

 

Basic Rules and Criteria

 

  • Approval often requires documentation of medical necessity.
  •  

  • Many plans demand failure or contraindication of lifestyle modifications or other weight-loss medications.
  •  

  • Patients often need to meet specific BMI criteria (typically over 30, or over 27 with weight-related comorbidities).

 

Getting Approval

 

  • Physician must provide documentation supporting the need for Diethylpropion.
  •  

  • Pre-authorization processes may differ across plans, check policy terms carefully.
  •  

  • Utilize Anthem's provider portal for streamlined authorization submissions.

 

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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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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 Diethylpropion (Tenuate) Coverage with Anthem

 

Verify Your Plan Details

 

  • Log into your Anthem member account online or through the mobile app to access your plan benefits and formulary details.
  •  

  • Check if Diethylpropion (Tenuate) is listed on your plan's formulary. This will provide preliminary information about whether the medication is covered.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your doctor to discuss the necessity of Diethylpropion for your condition. Ensure they understand your insurance details to help facilitate coverage discussions.
  •  

  • Ask your healthcare provider to provide a diagnosis and a medical justification letter if necessary. This documentation can support your request for medication coverage.

 

Contact Anthem Customer Service for Preauthorization

 

  • Call the customer service number found on your Anthem insurance card and inquire if a prior authorization is needed for Diethylpropion.
  •  

  • Submit any necessary preauthorization forms required by Anthem. Your doctor can assist with this process by filling out and sending the necessary documentation.

 

Submit a Prescription Claim

 

  • If your medication is covered, obtain the prescription from your healthcare provider and fill it at a pharmacy that accepts your insurance plan.
  •  

  • If you have to pay out-of-pocket initially, make sure to keep all receipts and submit them through your Anthem member portal or by mail to request reimbursement, if applicable.

 

Appeal a Denial if Necessary

 

  • If your preauthorization request or prescription claim is denied, refer to the denial letter which outlines the reasons and the process for filing an appeal.
  •  

  • Work with your doctor to provide additional medical justification during the appeal process if required.

 

Monitor Your Coverage Status

 

  • Regularly check your Anthem account for updates related to your medication claims and preauthorization requests.
  •  

  • Contact Anthem customer service for further assistance or clarification on your coverage status if needed.

 

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FAQs

Does Anthem Cover Diethylpropion (Tenuate)

Discover if Anthem covers Diethylpropion (Tenuate) and learn how to gain approval, explore costs without insurance, and get answers to common questions.
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Is Diethylpropion (Tenuate) Covered by Anthem

 

Coverage for Diethylpropion (Tenuate)

 

  • Anthem insurance may cover Diethylpropion for weight loss if deemed medically necessary.
  •  

  • Coverage varies by plan; contacting Anthem directly is recommended for specifics.

 

Basic Rules and Criteria

 

  • Approval often requires documentation of medical necessity.
  •  

  • Many plans demand failure or contraindication of lifestyle modifications or other weight-loss medications.
  •  

  • Patients often need to meet specific BMI criteria (typically over 30, or over 27 with weight-related comorbidities).

 

Getting Approval

 

  • Physician must provide documentation supporting the need for Diethylpropion.
  •  

  • Pre-authorization processes may differ across plans, check policy terms carefully.
  •  

  • Utilize Anthem's provider portal for streamlined authorization submissions.

 

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Anthem's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Eligibility Criteria for Diethylpropion (Tenuate) Coverage

 

  • The patient must have a Body Mass Index (BMI) of 30 or greater, indicating obesity. Alternatively, a BMI of 27 or greater with two or more obesity-related comorbidities such as hypertension, type 2 diabetes, or dyslipidemia may also qualify.
  •  

  • Patients should be at least 16 years old as the safety and efficacy of diethylpropion have been established for this age group and older.
  •  

  • The individual must demonstrate previous attempts to lose weight through lifestyle interventions such as diet, exercise, or behavioral changes, which have not been successful.
  •  

  • Diethylpropion should be prescribed as part of a comprehensive weight management program that includes strategies like a reduced-calorie diet and increased physical activity. Patients should be willing to actively participate in these components.
  •  

  • A physician specializing in obesity management or a primary care provider who is experienced in treating obesity must evaluate and prescribe Diethylpropion. Regular follow-up appointments should be scheduled to assess the effectiveness and safety of the treatment.
  •  

  • Before approval, the patient's medical history should be reviewed to ensure no contraindications like uncontrolled hypertension, advanced arteriosclerosis, or hyperthyroidism are present. For any history of drug abuse, additional oversight is required.
  •  

  • An initial coverage approval is often granted for a limited duration, typically up to 12 weeks, with the requirement that continued coverage is contingent upon demonstrating a meaningful clinical response, defined as a specific percentage of weight loss achieved.

 

Why Anthem Might Deny Diethylpropion (Tenuate) Coverage

 

Situations When Anthem Does Not Cover Diethylpropion (Tenuate)

 

  • **Non-FDA Approved Use**: Anthem does not cover Diethylpropion if it is prescribed for uses that are not approved by the FDA. Off-label uses are generally not approved for coverage.
  •  

  • **Pre-existing Exclusions Clause**: If the member's policy includes a clause excluding coverage for specific conditions or medications like diet drugs, Anthem may deny coverage accordingly.
  •  

  • **Lack of Medical Necessity**: Coverage will be denied if Diethylpropion is deemed not medically necessary. If a patient fails to meet the specific medical criteria outlined by Anthem (such as required BMI thresholds or comorbid conditions), coverage can be refused.
  •  

  • **Excluded from Formulary**: If Diethylpropion is not included in Anthem's formulary, it may not be covered unless a formulary exception is granted, which is itself not guaranteed.
  •  

  • **Experimental or Investigational Use**: Diethylpropion may be denied if Anthem considers the use of the drug as experimental or investigational for the patient's condition.
  •  

  • **Coverage Limitations by State or Local Laws**: Certain state or local laws may impose limits or restrictions on coverage for weight loss drugs, including Diethylpropion, which Anthem adheres to.
  •  

  • **Previous Authorization not Obtained**: If prior authorization is required and not obtained before the prescription, Anthem may deny coverage for Diethylpropion.
  •  

  • **Age Restrictions**: Anthem might have age restrictions for the prescription of Diethylpropion, such as not covering it for minors under a certain age who do not meet specific criteria.

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with Anthem

 

Verify Your Plan Details

 

  • Log into your Anthem member account online or through the mobile app to access your plan benefits and formulary details.
  •  

  • Check if Diethylpropion (Tenuate) is listed on your plan's formulary. This will provide preliminary information about whether the medication is covered.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your doctor to discuss the necessity of Diethylpropion for your condition. Ensure they understand your insurance details to help facilitate coverage discussions.
  •  

  • Ask your healthcare provider to provide a diagnosis and a medical justification letter if necessary. This documentation can support your request for medication coverage.

 

Contact Anthem Customer Service for Preauthorization

 

  • Call the customer service number found on your Anthem insurance card and inquire if a prior authorization is needed for Diethylpropion.
  •  

  • Submit any necessary preauthorization forms required by Anthem. Your doctor can assist with this process by filling out and sending the necessary documentation.

 

Submit a Prescription Claim

 

  • If your medication is covered, obtain the prescription from your healthcare provider and fill it at a pharmacy that accepts your insurance plan.
  •  

  • If you have to pay out-of-pocket initially, make sure to keep all receipts and submit them through your Anthem member portal or by mail to request reimbursement, if applicable.

 

Appeal a Denial if Necessary

 

  • If your preauthorization request or prescription claim is denied, refer to the denial letter which outlines the reasons and the process for filing an appeal.
  •  

  • Work with your doctor to provide additional medical justification during the appeal process if required.

 

Monitor Your Coverage Status

 

  • Regularly check your Anthem account for updates related to your medication claims and preauthorization requests.
  •  

  • Contact Anthem customer service for further assistance or clarification on your coverage status if needed.

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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

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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?

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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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