Does Blue Cross Blue Shield Cover Naltrexone/Bupropion (Contrave)

Explore Blue Cross Blue Shield's coverage for Contrave. Learn application tips, costs without insurance, and answers to common questions.
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Naltrexone/Bupropion Coverage by Blue Cross Blue Shield

 

  • Coverage for Naltrexone/Bupropion (Contrave) under Blue Cross Blue Shield (BCBS) varies by plan. Some plans may fully or partially cover the medication, while others might not include it at all.
  •  

  • BCBS typically considers covering Contrave for weight management in patients with a BMI ≥30, or ≥27 with obesity-related conditions like hypertension or type 2 diabetes.
  •  

  • Prior authorization may be required, which involves verifying medical necessity through documented weight-loss attempts via diet and exercise programs.
  •  

  • Patients usually need to fulfill certain criteria, such as having tried other weight-loss medications or strategies before being approved for Contrave coverage.
  •  

  • Check your specific BCBS plan details via their website or contact BCBS directly to understand your coverage benefits and any applicable restrictions.

 

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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 Naltrexone/Bupropion (Contrave) Coverage with Blue Cross Blue Shield

 

Verify Coverage in Your Plan

 

  • Log into your Blue Cross Blue Shield member account to review your specific healthcare plan details.
  •  

  • Check if Naltrexone/Bupropion (Contrave) is included in your plan's formulary, which is the list of covered medications.
  •  

  • If it's not explicitly covered, look for any listed weight-management medications, as Contrave may be included under this category.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your weight-management plan and the potential benefits of using Naltrexone/Bupropion (Contrave).
  •  

  • Ensure your healthcare provider is prepared to provide documentation or justification for prescribing Contrave, which may be necessary for insurance approval.

 

Contact Blue Cross Blue Shield for Pre-Authorization

 

  • Call Blue Cross Blue Shield customer service using the number on the back of your insurance card to inquire about the pre-authorization process for Contrave.
  •  

  • Request the necessary forms or procedures to apply for coverage if Contrave is not automatically covered by your plan.
  •  

  • Ask about any specific documentation required, such as a letter of medical necessity from your doctor.

 

Submit a Pre-Authorization Request

 

  • Work with your healthcare provider to complete the pre-authorization forms provided by Blue Cross Blue Shield.
  •  

  • Include all required documentation, such as a diagnosis, treatment plan, and rationale for prescribing Contrave.
  •  

  • Submit the forms to Blue Cross Blue Shield as instructed, either via mail, fax, or online submission, depending on the options provided.

 

Follow Up on Your Pre-Authorization Request

 

  • Contact Blue Cross Blue Shield a few days after submission to confirm they received your request and inquire about the processing timeline.
  •  

  • Be prepared to provide additional information or documentation if requested, to facilitate the approval process.

 

Explore Alternative Assistance Programs

 

  • If coverage is denied, inquire about any appeal process available through Blue Cross Blue Shield to challenge their decision.
  •  

  • Consider direct manufacturer assistance programs for Contrave, which may offer discounts or financial help.
  •  

  • Check if your doctor's office can provide samples or alternative cost-saving options while navigating coverage challenges.
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Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
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FAQs

Does Blue Cross Blue Shield Cover Naltrexone/Bupropion (Contrave)

Explore Blue Cross Blue Shield's coverage for Contrave. Learn application tips, costs without insurance, and answers to common questions.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by Blue Cross Blue Shield

 

Naltrexone/Bupropion Coverage by Blue Cross Blue Shield

 

  • Coverage for Naltrexone/Bupropion (Contrave) under Blue Cross Blue Shield (BCBS) varies by plan. Some plans may fully or partially cover the medication, while others might not include it at all.
  •  

  • BCBS typically considers covering Contrave for weight management in patients with a BMI ≥30, or ≥27 with obesity-related conditions like hypertension or type 2 diabetes.
  •  

  • Prior authorization may be required, which involves verifying medical necessity through documented weight-loss attempts via diet and exercise programs.
  •  

  • Patients usually need to fulfill certain criteria, such as having tried other weight-loss medications or strategies before being approved for Contrave coverage.
  •  

  • Check your specific BCBS plan details via their website or contact BCBS directly to understand your coverage benefits and any applicable restrictions.

 

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Blue Cross Blue Shield's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Coverage Criteria for Naltrexone/Bupropion (Contrave) by Blue Cross Blue Shield

 

  • The patient must have a documented body mass index (BMI) of 30 kg/m2 or higher, which classifies as obesity, or a BMI of 27 kg/m2 or higher with at least one weight-related comorbid condition such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • There must be documented evidence that the patient has participated unsuccessfully in a comprehensive lifestyle intervention. This should include at least three to six months of a weight management program consisting of a reduced-calorie diet, increased physical activity, and behavioral therapy.
  •  

  • The prescribing healthcare provider should provide evidence that the patient understands the continued need for lifestyle modification, even while using Naltrexone/Bupropion (Contrave). The patient’s ongoing participation in lifestyle modifications is essential for the medication's coverage.
  •  

  • A detailed medical history and physical examination should be conducted to rule out any contraindications or potential drug interactions. The patient should have no known hypersensitivity to naltrexone or bupropion.
  •  

  • Before initiating treatment, the healthcare provider must discuss the potential benefits and risks associated with the use of the medication. The patient should be fully informed about possible side effects and the importance of adherence to prescribed dosages.
  •  

  • For continued coverage, there should be documented evidence of treatment efficacy, such as a weight loss of at least 5% of total body weight within the first 12 weeks. Failure to show adequate weight loss may result in reevaluation of treatment necessity.
  •  

  • The patient must not be part of a series of trials for other weight loss medications concomitantly.
  •  

  • Renewal criteria require an annual review, where continued effectiveness of the therapy and adherence to lifestyle changes are reassessed. Documentation must reflect ongoing benefit from the medication for continued coverage.

 

Why Blue Cross Blue Shield Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Reasons for Denial of Naltrexone/Bupropion (Contrave) Coverage

 

  • The medication is not prescribed for a covered diagnosis. Blue Cross Blue Shield may deny the coverage if the prescription is for an off-label use that is not included in their list of covered indications.
  •  

  • Failure to meet the plan's medical necessity criteria. If the patient's medical records do not demonstrate a sufficient need as per Blue Cross Blue Shield's guidelines, the treatment may not be covered.
  •  

  • The patient's weight management history does not align with the insurer's prerequisites. For instance, if there is insufficient documented evidence of previous attempts to lose weight using alternative methods, coverage might be denied.
  •  

  • Lack of authorization or prior approval. If Blue Cross Blue Shield requires prior authorization for Naltrexone/Bupropion and it has not been obtained, they may reject coverage.
  •  

  • Exceeding dosage or duration limits. Prescription coverage may be refused if the amount prescribed surpasses the limits set by Blue Cross Blue Shield's policy guidelines without a proper exception documented.
  •  

  • Non-compliance with plan eligibility criteria. If the individual does not meet specific demographic criteria such as age range or body mass index (BMI) thresholds set by Blue Cross Blue Shield.
  •  

  • Exclusion under the patient's specific plan. If the insurance policy explicitly excludes coverage for weight management medications, Contrave may fall into this exclusion category.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Naltrexone/Bupropion (Contrave) Cost without Insurance?

 

Cost of Naltrexone/Bupropion (Contrave) Without Insurance

 

  • The cost of Naltrexone/Bupropion (Contrave) without insurance can vary significantly depending on the pharmacy you visit. On average, you might expect to pay around $100 to $300 for a 30-day supply.
  •  

  • The price can differ between pharmacies, so it may be beneficial to shop around or use a pharmacy discount card to potentially reduce the cost.
  •  

  • Coupons or discount programs offered by manufacturers or online platforms might further lower the expense, sometimes making it more affordable than the average cash price.
  •  

  • Factors such as generic availability or quantity prescribed also influence the price, with larger prescriptions potentially offering a lower cost per unit.

 

Ways to Lower Your Cost

 

  • Check online resources or discount programs that provide coupons applicable at various pharmacies to potentially save money.
  •  

  • Discuss with your healthcare provider about any potential lower-cost alternatives or generics, if available, which could lower your expenses.
  •  

  • Consider pharmacy loyalty programs or memberships, which often provide discounts on prescriptions.
  •  

  • Consult with your pharmacy about any special savings programs or payment plans they might offer, which can reduce financial burden.

 

Conclusion

 

  • Naltrexone/Bupropion (Contrave) is a medication whose price can vary widely without insurance, typically costing around $100 to $300 per month.
  •  

  • Utilize discounts, coupons, and comparison shopping to find the most cost-effective option.
  •  

  • Consult with healthcare professionals for advice on managing these costs and addressing any financial concerns related to prescriptions.

 

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 Naltrexone/Bupropion (Contrave) Coverage with Blue Cross Blue Shield

 

Verify Coverage in Your Plan

 

  • Log into your Blue Cross Blue Shield member account to review your specific healthcare plan details.
  •  

  • Check if Naltrexone/Bupropion (Contrave) is included in your plan's formulary, which is the list of covered medications.
  •  

  • If it's not explicitly covered, look for any listed weight-management medications, as Contrave may be included under this category.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your weight-management plan and the potential benefits of using Naltrexone/Bupropion (Contrave).
  •  

  • Ensure your healthcare provider is prepared to provide documentation or justification for prescribing Contrave, which may be necessary for insurance approval.

 

Contact Blue Cross Blue Shield for Pre-Authorization

 

  • Call Blue Cross Blue Shield customer service using the number on the back of your insurance card to inquire about the pre-authorization process for Contrave.
  •  

  • Request the necessary forms or procedures to apply for coverage if Contrave is not automatically covered by your plan.
  •  

  • Ask about any specific documentation required, such as a letter of medical necessity from your doctor.

 

Submit a Pre-Authorization Request

 

  • Work with your healthcare provider to complete the pre-authorization forms provided by Blue Cross Blue Shield.
  •  

  • Include all required documentation, such as a diagnosis, treatment plan, and rationale for prescribing Contrave.
  •  

  • Submit the forms to Blue Cross Blue Shield as instructed, either via mail, fax, or online submission, depending on the options provided.

 

Follow Up on Your Pre-Authorization Request

 

  • Contact Blue Cross Blue Shield a few days after submission to confirm they received your request and inquire about the processing timeline.
  •  

  • Be prepared to provide additional information or documentation if requested, to facilitate the approval process.

 

Explore Alternative Assistance Programs

 

  • If coverage is denied, inquire about any appeal process available through Blue Cross Blue Shield to challenge their decision.
  •  

  • Consider direct manufacturer assistance programs for Contrave, which may offer discounts or financial help.
  •  

  • Check if your doctor's office can provide samples or alternative cost-saving options while navigating coverage challenges.

Premium Medication you can trust

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.

Naltrexone/Bupropion (Contrave) FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting can occur, often diminishing over time.
  • Headaches or dizziness are also common, especially early in treatment.
  • Constipation or diarrhea may affect some users.
  • Insomnia and a higher heart rate can occur with usage.

 

Serious Side Effects

 

  • Risk of seizures, especially if there's a history of seizures.
  • Suicidal thoughts or behaviors can increase in some individuals.
  • Increased blood pressure; monitoring is advised.
  • Allergic reactions are possible, presenting as rash, itching, or swelling.

 

Precautions

 

  • Ensure no history of seizure disorders before starting.
  • Disclose any mental health history to your healthcare provider.
  • Assess any medications for potential interactions.
  • Regularly monitor blood pressure when on this medication.

 

How fast can you lose weight with Contrave?

 

What is Contrave?

 

  • Contrave is a combination of naltrexone and bupropion, approved for chronic weight management in adults.

 

How Fast Can You Lose Weight?

 

  • Clinical studies show patients can lose 5-10% of their body weight over 12-24 weeks.
  • Weight loss varies due to individual factors like diet, exercise, and adherence.
  • Initial results might be seen in 4 weeks, with more significant loss over months.

 

Important Considerations

 

  • Must be combined with a reduced-calorie diet and increased physical activity.
  • Not suitable for everyone; consult your healthcare provider before starting.
  • Monitoring for side effects like nausea or dizziness is crucial.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Drinking alcohol while taking Contrave is generally not recommended. Contrave contains naltrexone and bupropion, which may interact negatively with alcohol.
  •  

  • Naltrexone may increase the risk of liver damage when combined with alcohol, and bupropion may heighten seizure risk, both exacerbated by alcohol consumption.
  •  

  • Alcohol can counteract Contrave's effects on weight management and addiction control, undermining its efficacy.
  •  

  • Consult your healthcare provider for personalized advice, as they can determine safe alcohol usage considering your specific health conditions and medication dosage.

 

Have questions left?

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

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

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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