Does Blue Cross Blue Shield Cover Diethylpropion (Tenuate)

Explore how to secure coverage for Diethylpropion with Blue Cross Blue Shield and understand the potential costs without insurance in this comprehensive guide.
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Does Blue Cross Blue Shield Cover Diethylpropion (Tenuate)?

 

  • Coverage for Diethylpropion (Tenuate) varies by specific Blue Cross Blue Shield (BCBS) plan. It is essential to check your individual plan details or contact customer service to confirm if your policy includes this medication.
  •  

  • Typically, Diethylpropion may be covered under plans that include prescription drug benefits for weight management medications.
  •  

  • The requirement for coverage often includes a diagnosis of obesity or related weight problems that are not adequately managed with diet and exercise alone.
  •  

  • Prior authorization might be necessary to demonstrate the medical necessity of Diethylpropion and to confirm that other weight loss measures have been attempted.
  •  

  • Your healthcare provider may need to provide documentation or evidence supporting the need for Diethylpropion as part of your treatment plan.
  •  

  • Co-payments, deductibles, or co-insurance will likely apply, depending on your plan's specific terms.
  •  

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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 Diethylpropion (Tenuate) Coverage with Blue Cross Blue Shield

 

Verify Your Coverage

 

  • Contact Blue Cross Blue Shield (BCBS) customer service using the number on your insurance card to confirm if Diethylpropion (Tenuate) is included in your plan's prescription coverage.
  •  

  • Review your BCBS plan's formulary online, which lists covered medications, to see if Tenuate is included.

 

Consult Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss the necessity and appropriateness of Diethylpropion for your condition.
  •  

  • If Diethylpropion is appropriate, request a prescription and inquire if your provider's office can initiate a prior authorization process if necessary.

 

Check for Prior Authorization

 

  • Determine if BCBS requires prior authorization for Diethylpropion. This can often be confirmed through your provider or by contacting BCBS directly.
  •  

  • If prior authorization is needed, your provider will need to submit medical justification to BCBS.

 

Submit Prior Authorization

 

  • Your healthcare provider should submit the prior authorization request to BCBS, along with any necessary medical documentation justifying the need for Diethylpropion.
  •  

  • Follow up with your provider to ensure the authorization is sent, and confirm receipt with BCBS.

 

Appeal if Necessary

 

  • If BCBS denies coverage for Diethylpropion, request the reason for the denial in writing.
  •  

  • Work with your healthcare provider to gather additional evidence and submit a formal appeal. This may include letters of medical necessity or supporting documentation demonstrating prior treatments and their outcomes.

 

Confirm Coverage and Fill Prescription

 

  • Once authorization is granted, confirm with BCBS and your pharmacy that Diethylpropion is covered.
  •  

  • Proceed to fill your prescription at a pharmacy that works with your BCBS plan for covered medications.

 

Review Your Explanation of Benefits

 

  • After your prescription is processed, review your Explanation of Benefits (EOB) from BCBS to ensure it reflects the coverage for Diethylpropion as per your plan's terms.
  •  

  • If there are discrepancies, contact BCBS to clarify and resolve any issues.

 

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FAQs

Does Blue Cross Blue Shield Cover Diethylpropion (Tenuate)

Explore how to secure coverage for Diethylpropion with Blue Cross Blue Shield and understand the potential costs without insurance in this comprehensive guide.
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Is Diethylpropion (Tenuate) Covered by Blue Cross Blue Shield

 

Does Blue Cross Blue Shield Cover Diethylpropion (Tenuate)?

 

  • Coverage for Diethylpropion (Tenuate) varies by specific Blue Cross Blue Shield (BCBS) plan. It is essential to check your individual plan details or contact customer service to confirm if your policy includes this medication.
  •  

  • Typically, Diethylpropion may be covered under plans that include prescription drug benefits for weight management medications.
  •  

  • The requirement for coverage often includes a diagnosis of obesity or related weight problems that are not adequately managed with diet and exercise alone.
  •  

  • Prior authorization might be necessary to demonstrate the medical necessity of Diethylpropion and to confirm that other weight loss measures have been attempted.
  •  

  • Your healthcare provider may need to provide documentation or evidence supporting the need for Diethylpropion as part of your treatment plan.
  •  

  • Co-payments, deductibles, or co-insurance will likely apply, depending on your plan's specific terms.
  •  

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Blue Cross Blue Shield'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 higher, OR a BMI of 27 or higher with at least one obesity-related comorbid condition such as hypertension, Type 2 diabetes, or dyslipidemia.
  •  

  • Documentation must indicate a comprehensive assessment and diagnosis of obesity by a healthcare provider, highlighting the necessity of pharmacotherapy for weight management.

 

Documented Lifestyle Changes

 

  • The patient should have demonstrated engagement in a comprehensive weight management program, which typically includes a reduced-calorie diet and increased physical activity, for a minimum of 6 months prior to initiating Diethylpropion therapy.
  •  

  • Progress in lifestyle modification efforts, supported by concurrent healthcare provider supervision, should be clearly documented and presented.

 

Monitoring and Continued Use Requirements

 

  • Provision of coverage is contingent upon regular weight monitoring by the prescribing healthcare provider to ensure that the patient achieves a minimum of 4-pound weight loss in the first 4 weeks of therapy.
  •  

  • Continued prescription authorization will require evidence of ongoing engagement in the weight management program and satisfactory weight loss progression as determined by the healthcare provider.

 

Excluded Populations

 

  • Coverage specifically applies to adult patients aged 18 years and older; therefore, pediatric patients are not eligible for Diethylpropion coverage.
  •  

  • Prescribers must ensure that there are no contraindications, such as pregnancy, breastfeeding, or history of cardiovascular diseases, before authorizing Diethylpropion therapy.

 

Why Blue Cross Blue Shield Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons for Diethylpropion (Tenuate) Coverage Denial by Blue Cross Blue Shield

 

  • Diethylpropion (Tenuate) is not prescribed for FDA-approved indications. Blue Cross Blue Shield may deny coverage if the medication is prescribed for weight loss without specific medical comorbidities.
  •  

  • Coverage may be denied if there is insufficient documentation showing a clinically significant body weight reduction with a BMI (Body Mass Index) higher than the medically relevant thresholds for coverage according to their guidelines.
  •  

  • The absence of previous unsuccessful trials with alternative weight management strategies might lead to denial. Blue Cross Blue Shield often requires evidence of tried and failed non-pharmacological interventions, such as dietary or exercise programs, before approving medication.
  •  

  • Blue Cross Blue Shield might not cover Diethylpropion if the medication is prescribed outside of their formulary guidelines. The lack of formulary inclusion often reflects coverage decisions.
  •  

  • Duplicate therapy is another reason for denial. If the patient is already receiving another weight management prescription medication, coverage for Diethylpropion may not be provided simultaneously.
  •  

  • Prescriptions without validation of medical necessity might be denied. This validation often requires detailed physician notes or supporting documents that align with the justification for the medication.
  •  

  • Blue Cross Blue Shield may deny coverage for long-term use of Diethylpropion, as it is generally approved only for short-term use under specific circumstances.

 

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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 Blue Cross Blue Shield

 

Verify Your Coverage

 

  • Contact Blue Cross Blue Shield (BCBS) customer service using the number on your insurance card to confirm if Diethylpropion (Tenuate) is included in your plan's prescription coverage.
  •  

  • Review your BCBS plan's formulary online, which lists covered medications, to see if Tenuate is included.

 

Consult Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss the necessity and appropriateness of Diethylpropion for your condition.
  •  

  • If Diethylpropion is appropriate, request a prescription and inquire if your provider's office can initiate a prior authorization process if necessary.

 

Check for Prior Authorization

 

  • Determine if BCBS requires prior authorization for Diethylpropion. This can often be confirmed through your provider or by contacting BCBS directly.
  •  

  • If prior authorization is needed, your provider will need to submit medical justification to BCBS.

 

Submit Prior Authorization

 

  • Your healthcare provider should submit the prior authorization request to BCBS, along with any necessary medical documentation justifying the need for Diethylpropion.
  •  

  • Follow up with your provider to ensure the authorization is sent, and confirm receipt with BCBS.

 

Appeal if Necessary

 

  • If BCBS denies coverage for Diethylpropion, request the reason for the denial in writing.
  •  

  • Work with your healthcare provider to gather additional evidence and submit a formal appeal. This may include letters of medical necessity or supporting documentation demonstrating prior treatments and their outcomes.

 

Confirm Coverage and Fill Prescription

 

  • Once authorization is granted, confirm with BCBS and your pharmacy that Diethylpropion is covered.
  •  

  • Proceed to fill your prescription at a pharmacy that works with your BCBS plan for covered medications.

 

Review Your Explanation of Benefits

 

  • After your prescription is processed, review your Explanation of Benefits (EOB) from BCBS to ensure it reflects the coverage for Diethylpropion as per your plan's terms.
  •  

  • If there are discrepancies, contact BCBS to clarify and resolve any issues.

 

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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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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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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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