Does Anthem Cover Orlistat (Xenical, Alli)

Explore Anthem coverage for Orlistat, learn how to secure it, and discover costs without insurance. Find FAQs and reasons for possible coverage denial.
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Does Anthem Cover Orlistat (Xenical, Alli)?

 

  • Anthem may cover Orlistat (Xenical, Alli) for individuals diagnosed with obesity, generally defined as having a BMI of 30 or higher.
  •  

  • Coverage is evaluated on a case-by-case basis, and Anthem often requires documentation demonstrating the need for the medication.
  •  

  • Prior authorization from Anthem is generally necessary, which involves a healthcare provider's request and justification of the prescription.
  •  

  • It is typically required that patients have attempted lifestyle changes, such as diet and exercise, prior to approval for coverage.
  •  

  • Specific coverage rules and criteria vary by policy and region, so contacting Anthem directly is recommended to obtain the most accurate information.

 

Basic Rules and Criteria for Coverage

 

  • Proof of medical necessity and failure of other weight loss methods may be required.
  •  

  • Documentation of adherence to a comprehensive weight management program is often essential.
  •  

  • Continuation of coverage usually depends on evidence of significant weight loss and health improvement while taking Orlistat.

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

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

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

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

Kayla Mardaga, NP

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

How to Get Orlistat (Xenical, Alli) Coverage with Anthem

 

Research Orlistat Coverage under Anthem

 

  • Visit Anthem's official website to search for their coverage policies, particularly details about prescription drugs and their formulary lists.
  •  

  • Contact Anthem's customer service for specific information on Orlistat coverage, identifying it under its brand names, Xenical and Alli.

 

Consult Your Healthcare Provider

 

  • Discuss with your doctor whether Orlistat is necessary for your health and make sure they document the medical necessity in your file.
  •  

  • Obtain a prescription from your healthcare provider that clearly states why Orlistat (Xenical, Alli) is needed for your treatment plan.

 

Review Your Anthem Plan Details

 

  • Log in to your Anthem member account online and review your plan's benefit details to understand existing coverage for prescription medications.
  •  

  • Check if Orlistat is included in your prescription drug plan or if there are any exceptions or requirements for coverage.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to fill out and submit a prior authorization form to Anthem, which is often required for medications like Orlistat.
  •  

  • Ensure that all necessary medical documentation and justification for the use of Orlistat are included in the submission.

 

Follow Up with Anthem

 

  • After submission, regularly check the status of your prior authorization request through Anthem’s customer service or online portal.
  •  

  • If your request is approved, learn about the specifics of coverage including the co-pays, any step therapy, or limitation on doses.

 

Appeal a Denied Request

 

  • If coverage is denied, reach out to Anthem's appeals department to understand the reasons for denial.
  •  

  • Work with your healthcare provider to gather additional documentation and submit an appeal, addressing all points raised in the denial.

 

Explore Alternative Options

 

  • Consider discussing alternatives or supplemental weight management plans with your healthcare provider that might not require Orlistat.
  •  

  • Research financial assistance programs, discounts, or generic versions of the medication that might be more affordable if coverage remains an issue.

 

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FAQs

Does Anthem Cover Orlistat (Xenical, Alli)

Explore Anthem coverage for Orlistat, learn how to secure it, and discover costs without insurance. Find FAQs and reasons for possible coverage denial.
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Is Orlistat (Xenical, Alli) Covered by Anthem

 

Does Anthem Cover Orlistat (Xenical, Alli)?

 

  • Anthem may cover Orlistat (Xenical, Alli) for individuals diagnosed with obesity, generally defined as having a BMI of 30 or higher.
  •  

  • Coverage is evaluated on a case-by-case basis, and Anthem often requires documentation demonstrating the need for the medication.
  •  

  • Prior authorization from Anthem is generally necessary, which involves a healthcare provider's request and justification of the prescription.
  •  

  • It is typically required that patients have attempted lifestyle changes, such as diet and exercise, prior to approval for coverage.
  •  

  • Specific coverage rules and criteria vary by policy and region, so contacting Anthem directly is recommended to obtain the most accurate information.

 

Basic Rules and Criteria for Coverage

 

  • Proof of medical necessity and failure of other weight loss methods may be required.
  •  

  • Documentation of adherence to a comprehensive weight management program is often essential.
  •  

  • Continuation of coverage usually depends on evidence of significant weight loss and health improvement while taking Orlistat.

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

 

Criteria for Coverage of Orlistat (Xenical, Alli)

 

  • The patient must have a documented body mass index (BMI) of 30 kg/m² or higher, indicating obesity, to qualify for coverage.
  •  

  • If the patient's BMI is between 27 and 29.9 kg/m², there must be an additional obesity-related condition such as hypertension, type 2 diabetes, or dyslipidemia to qualify for coverage.
  •  

  • A comprehensive weight management program must be in place. This program should include a reduced-calorie, nutritionally balanced diet and exercise regimen.
  •  

  • The patient must have attempted weight loss through diet and exercise alone. Documentation of at least six months of an organized weight loss effort is required.
  •  

  • The prescribing clinician must provide evidence that the patient has responded inadequately to the diet and exercise program alone, demonstrating the need for pharmacotherapy.
  •  

  • Continuous re-evaluation is required to continue coverage. There should be documented evidence of weight loss or maintenance of weight loss after starting Orlistat therapy.
  •  

  • The patient must be 18 years of age or older unless there is special consideration for younger patients under the discretion of a healthcare provider.

 

Why Anthem Might Deny Orlistat (Xenical, Alli) Coverage

 

Reasons Anthem Might Deny Orlistat (Xenical, Alli) Coverage

 

  • Orlistat is sought for cosmetic weight loss or for non-medical reasons, rather than medically necessary treatment.
  •  

  • The patient fails to meet Body Mass Index (BMI) criteria as specified by Anthem. This includes having a BMI under the threshold defined in their coverage policies when coupled with specific comorbid conditions.
  •  

  • Lack of documented evidence of prior attempts to lose weight through diet and exercise, indicating non-compliance with established weight loss strategies before seeking medication assistance.
  •  

  • Prescribed usage exceeds the FDA-approved duration of therapy without demonstration of continued medical necessity or inability to achieve weight loss goals through alternative methods.
  •  

  • The patient fails to undergo recommended medical evaluations or follow-up consultations that are part of a structured weight loss program specified by Anthem.
  •  

  • The request for Orlistat does not have the necessary prior authorization from Anthem, or the prior authorization request was denied due to insufficient documentation.

 

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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 Anthem

 

Research Orlistat Coverage under Anthem

 

  • Visit Anthem's official website to search for their coverage policies, particularly details about prescription drugs and their formulary lists.
  •  

  • Contact Anthem's customer service for specific information on Orlistat coverage, identifying it under its brand names, Xenical and Alli.

 

Consult Your Healthcare Provider

 

  • Discuss with your doctor whether Orlistat is necessary for your health and make sure they document the medical necessity in your file.
  •  

  • Obtain a prescription from your healthcare provider that clearly states why Orlistat (Xenical, Alli) is needed for your treatment plan.

 

Review Your Anthem Plan Details

 

  • Log in to your Anthem member account online and review your plan's benefit details to understand existing coverage for prescription medications.
  •  

  • Check if Orlistat is included in your prescription drug plan or if there are any exceptions or requirements for coverage.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to fill out and submit a prior authorization form to Anthem, which is often required for medications like Orlistat.
  •  

  • Ensure that all necessary medical documentation and justification for the use of Orlistat are included in the submission.

 

Follow Up with Anthem

 

  • After submission, regularly check the status of your prior authorization request through Anthem’s customer service or online portal.
  •  

  • If your request is approved, learn about the specifics of coverage including the co-pays, any step therapy, or limitation on doses.

 

Appeal a Denied Request

 

  • If coverage is denied, reach out to Anthem's appeals department to understand the reasons for denial.
  •  

  • Work with your healthcare provider to gather additional documentation and submit an appeal, addressing all points raised in the denial.

 

Explore Alternative Options

 

  • Consider discussing alternatives or supplemental weight management plans with your healthcare provider that might not require Orlistat.
  •  

  • Research financial assistance programs, discounts, or generic versions of the medication that might be more affordable if coverage remains an issue.

 

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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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