Does Anthem Cover Saxenda

Explore why Anthem may deny Saxenda coverage, learn how to secure it, discover costs without insurance, and find answers to common Saxenda questions.
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Does Anthem Cover Saxenda?

 

  • Coverage varies based on individual Anthem plans. Check your specific policy details or contact Anthem directly for confirmation.
  •  

  • Saxenda might be covered under weight management programs if deemed medically necessary.
  •  

  • To qualify, patients often need a diagnosis of obesity or overweight with weight-related health conditions.
  •  

  • A prescription from a healthcare provider is typically required.
  •  

  • Anthem may require prior authorization, which involves providing documentation of medical necessity and history of weight management attempts.

 

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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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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 Saxenda Coverage with Anthem

 

Verify Your Prescription Benefits

 

  • Log in to your Anthem member portal. Locate the 'Prescription Benefits' section to check if Saxenda is listed under covered medications.
  •  

  • If Saxenda is not visible, contact Anthem’s customer service for clarification or further instructions on obtaining coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Saxenda with your healthcare provider. Ensure they provide a medically necessary prescription and include any relevant medical history or details that support your case.
  •  

  • Ask your provider if they have experience working with Anthem’s specific process for approvals or prescription coverage.

 

Submit a Prior Authorization Request

 

  • Request your healthcare provider to complete a prior authorization form, which is necessary for medications like Saxenda that often require approval before coverage.
  •  

  • Ensure the form includes detailed medical justification for Saxenda. It should be thoroughly completed and signed by your healthcare provider.

 

Follow Up on Authorization Status

 

  • Contact Anthem to verify receipt of your prior authorization request. Request an estimated timeline for processing if possible.
  •  

  • Monitor your Anthem member portal or contact their customer service periodically to check the status of your authorization request.

 

Appeal if Necessary

 

  • If your initial request is denied, review the denial letter which typically includes the reason and instructions for the appeal process.
  •  

  • Work with your healthcare provider to submit an appeal, including any additional documentation or information that may strengthen your case.

 

Explore Additional Savings Programs

 

  • Inquire about any additional savings programs or manufacturer discounts for Saxenda that may be offered through Anthem or directly from the manufacturer.
  •  

  • Look into any state or local assistance programs that might help cover the cost not addressed by Anthem.

 

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FAQs

Does Anthem Cover Saxenda

Explore why Anthem may deny Saxenda coverage, learn how to secure it, discover costs without insurance, and find answers to common Saxenda questions.
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Is Saxenda Covered by Anthem

 

Does Anthem Cover Saxenda?

 

  • Coverage varies based on individual Anthem plans. Check your specific policy details or contact Anthem directly for confirmation.
  •  

  • Saxenda might be covered under weight management programs if deemed medically necessary.
  •  

  • To qualify, patients often need a diagnosis of obesity or overweight with weight-related health conditions.
  •  

  • A prescription from a healthcare provider is typically required.
  •  

  • Anthem may require prior authorization, which involves providing documentation of medical necessity and history of weight management attempts.

 

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Anthem's Approved Criteria for Saxenda Coverage

 

Saxenda Coverage Criteria

 

  • **Age Requirement:** The individual must be 18 years of age or older.
  •  

  • **Indication for Use:** Saxenda may be covered if prescribed for chronic weight management in the context of an appropriate care plan. This implies that the medication should be part of a comprehensive weight management program, including diet, exercise, and behavioral counseling.
  •  

  • **Body Mass Index (BMI) Requirement:** The patient must have a BMI greater than or equal to 30 kg/m². Alternatively, patients with a BMI of 27 kg/m² or more may be eligible if they present with at least one weight-related comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • **Previous Weight Loss Method Attempts:** Documentation should reflect that the patient has attempted weight loss through diet and exercise and found these methods insufficient. This prior attempt should have occurred within a reasonable timeframe before seeking Saxenda coverage.
  •  

  • **Prescriber Qualifications:** A qualified healthcare provider must prescribe Saxenda. This provider should ideally specialize in treatments related to obesity or metabolic disorders, indicating their expertise in managing complex weight management cases.
  •  

  • **Ongoing Monitoring and Follow-up:** There should be a planned follow-up schedule with the healthcare provider to monitor the patient's progress, efficacy of the treatment, and to adjust dosage if necessary. This includes regular assessments of weight and BMI, as well as monitoring for potential side effects.
  •  

  • **Exclusion of Pregnancy and Nursing:** Coverage is applicable if the patient is not pregnant and not nursing. Saxenda is not approved for these conditions, and women of childbearing potential should use effective contraception during treatment.
  •  

  • **Consideration of Other Treatments:** Saxenda may be favored if other weight management medications were not suitable due to contraindications or lack of efficacy in previous attempts as documented in the patient's medical history.

 

Why Anthem Might Deny Saxenda Coverage

 

Situations Where Anthem Might Deny Saxenda Coverage

 

  • **Non-FDA Approved Indications**: Anthem does not cover Saxenda if it is prescribed for indications that are not approved by the FDA. This includes any off-label uses not sanctioned by regulatory guidelines.
  •  

  • **Lack of Medical Necessity**: If the use of Saxenda is determined not to be medically necessary according to Anthem's guidelines, coverage may be denied. This includes instances where weight loss is not sufficient to warrant medical intervention.
  •  

  • **Failure to Meet Body Mass Index (BMI) Criteria**: Coverage may be denied if the patient does not meet the specific BMI criteria set forth by Anthem, usually requiring a BMI of 30 or higher, or 27 or higher with associated comorbid conditions.
  •  

  • **Inadequate Documentation**: If there is a lack of adequate documentation supporting the need for Saxenda, such as insufficient evidence of previous weight loss attempts or health assessments, Anthem might deny coverage.
  •  

  • **Non-Compliance with Lifestyle Modification Requirements**: Patients must often demonstrate compliance with lifestyle interventions such as diet and exercise. Failure to document or adhere to these interventions can result in denial of coverage.
  •  

  • **Pre-existing Exclusions in Policy**: Some policies may have specific exclusions regarding weight loss treatments. If Saxenda falls under a pre-existing exclusion, coverage will be denied.
  •  

  • **Age Restrictions**: Saxenda may not be covered if prescribed to individuals outside the age range approved by the policy or guidelines, often focusing on adult use.

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket costs.

 

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 Saxenda Coverage with Anthem

 

Verify Your Prescription Benefits

 

  • Log in to your Anthem member portal. Locate the 'Prescription Benefits' section to check if Saxenda is listed under covered medications.
  •  

  • If Saxenda is not visible, contact Anthem’s customer service for clarification or further instructions on obtaining coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Saxenda with your healthcare provider. Ensure they provide a medically necessary prescription and include any relevant medical history or details that support your case.
  •  

  • Ask your provider if they have experience working with Anthem’s specific process for approvals or prescription coverage.

 

Submit a Prior Authorization Request

 

  • Request your healthcare provider to complete a prior authorization form, which is necessary for medications like Saxenda that often require approval before coverage.
  •  

  • Ensure the form includes detailed medical justification for Saxenda. It should be thoroughly completed and signed by your healthcare provider.

 

Follow Up on Authorization Status

 

  • Contact Anthem to verify receipt of your prior authorization request. Request an estimated timeline for processing if possible.
  •  

  • Monitor your Anthem member portal or contact their customer service periodically to check the status of your authorization request.

 

Appeal if Necessary

 

  • If your initial request is denied, review the denial letter which typically includes the reason and instructions for the appeal process.
  •  

  • Work with your healthcare provider to submit an appeal, including any additional documentation or information that may strengthen your case.

 

Explore Additional Savings Programs

 

  • Inquire about any additional savings programs or manufacturer discounts for Saxenda that may be offered through Anthem or directly from the manufacturer.
  •  

  • Look into any state or local assistance programs that might help cover the cost not addressed by Anthem.

 

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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.

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Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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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