Does Blue Cross Blue Shield of Alabama Cover Diethylpropion (Tenuate)

Explore Diethylpropion coverage by Blue Cross Blue Shield Alabama. Learn why it might be denied, how to gain approval, pricing, and FAQs.
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Coverage Overview

 

  • Blue Cross Blue Shield of Alabama generally covers Diethylpropion (Tenuate) when prescribed for obesity management.
  •  

  • Eligibility often requires that the medication is deemed medically necessary by a healthcare provider.

 

Criteria and Authorization

 

  • Patients typically need to have a body mass index (BMI) of 30 or higher, or 27 with additional risk factors like hypertension or diabetes.
  •  

  • Prior authorization from Blue Cross Blue Shield of Alabama might be required to ascertain the necessity for the medication.
  •  

  • The prescription should follow an evaluation and recommendation from a licensed healthcare provider.

 

General Rules

 

  • The coverage might be contingent on using prescribed diets and exercise programs in conjunction with the medication.
  •  

  • There may be limits on the maximum dosage and duration, often requiring periodic reassessment for continued coverage.

 

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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 of Alabama

 

Verify Prescription Coverage

 

  • Contact Blue Cross Blue Shield of Alabama customer service to inquire about specific coverage options for Diethylpropion (Tenuate). Check if it's included in your current health plan's formulary.
  •  

  • Log into your Blue Cross Blue Shield of Alabama member portal to review your policy benefits concerning weight loss medications, specifically Diethylpropion.

 

Consult with Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Diethylpropion for your treatment. Ensure your provider is aware of your Blue Cross Blue Shield of Alabama insurance.
  •  

  • Request your healthcare provider to document medical necessity, which is crucial for getting insurance approval for prescription medications not commonly covered.

 

Gain Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to Blue Cross Blue Shield of Alabama. Include all required documentation, such as medical reports and necessity justification.
  •  

  • Follow up with Blue Cross Blue Shield of Alabama to ensure the request is under review and inquire about any additional documentation needed.

 

Review Coverage Decisions

 

  • Once the prior authorization request is submitted, await a coverage decision. This decision will be communicated to both you and your healthcare provider.
  •  

  • If approved, your prescription coverage details including copayment amounts will be provided. If denied, review the explanation and consider contacting your healthcare provider for further assistance or explore alternative options.

 

File an Appeal if Necessary

 

  • If coverage for Diethylpropion is denied, you can file an appeal. Gather any additional information or reports that can support your case.
  •  

  • Contact Blue Cross Blue Shield of Alabama for their specific appeals process and submit your appeal within their mentioned timeframe.

 

Fill Your Prescription

 

  • If coverage is approved, visit a participating pharmacy in Blue Cross Blue Shield of Alabama’s network to fill your prescription for Diethylpropion.
  •  

  • Ensure that your pharmacy has all necessary details about your insurance coverage to apply any applicable discounts or copay assistance.

 

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FAQs

Does Blue Cross Blue Shield of Alabama Cover Diethylpropion (Tenuate)

Explore Diethylpropion coverage by Blue Cross Blue Shield Alabama. Learn why it might be denied, how to gain approval, pricing, and FAQs.
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Is Diethylpropion (Tenuate) Covered by Blue Cross Blue Shield of Alabama

 

Coverage Overview

 

  • Blue Cross Blue Shield of Alabama generally covers Diethylpropion (Tenuate) when prescribed for obesity management.
  •  

  • Eligibility often requires that the medication is deemed medically necessary by a healthcare provider.

 

Criteria and Authorization

 

  • Patients typically need to have a body mass index (BMI) of 30 or higher, or 27 with additional risk factors like hypertension or diabetes.
  •  

  • Prior authorization from Blue Cross Blue Shield of Alabama might be required to ascertain the necessity for the medication.
  •  

  • The prescription should follow an evaluation and recommendation from a licensed healthcare provider.

 

General Rules

 

  • The coverage might be contingent on using prescribed diets and exercise programs in conjunction with the medication.
  •  

  • There may be limits on the maximum dosage and duration, often requiring periodic reassessment for continued coverage.

 

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Blue Cross Blue Shield of Alabama's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Criteria for Diethylpropion (Tenuate) Coverage by Blue Cross Blue Shield of Alabama

 

  • The patient must have a Body Mass Index (BMI) of 30 kg/m2 or higher, indicating obesity, or a BMI of 27 kg/m2 or higher with at least one weight-related comorbid condition, such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Prescription of Diethylpropion (Tenuate) must be part of an integrated weight management program that includes dietary modification, physical activity, and behavioral therapy aimed at sustainable weight loss.
  •  

  • Approval for coverage may require documentation of attempted weight loss through other methods such as diet, exercise, and lifestyle changes prior to initiating treatment with Diethylpropion (Tenuate).
  •  

  • The prescribing healthcare provider must monitor the patient's weight loss progress, and treatment efficacy should be assessed regularly. This includes documentation of weight loss achievements at specific intervals.
  •  

  • The treatment duration covered by Blue Cross Blue Shield of Alabama usually requires periodic reviews, and continuation is based on satisfactory weight loss progress as determined by the healthcare provider.
  •  

  • Diethylpropion (Tenuate) prescription should be by a healthcare provider experienced in managing obesity and its medication treatments.
  •  

 

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

 

Exclusion Criteria for Diethylpropion (Tenuate) Coverage

 

  • The prescription is intended primarily for cosmetic weight loss purposes rather than medically necessary treatment.
  •  

  • There is insufficient documentation provided by the healthcare provider to justify its medical necessity based on the patient’s health condition or treatment plan.
  •  

  • The patient's body mass index (BMI) is below the specified threshold for obesity treatment as defined by Blue Cross Blue Shield of Alabama’s guidelines.
  •  

  • The patient has not met the required criteria of attempting and failing at other weight management programs or lifestyle changes prior to the prescription of Diethylpropion.
  •  

  • The prescription does not adhere to the approved dosage or recommended treatment duration by Blue Cross Blue Shield of Alabama’s policies.
  •  

  • The patient has known contraindications or potential adverse interactions identified in their medical history that contraindicate the use of Diethylpropion.
  •  

  • The prescription is for children or adolescents where the medication is not approved for use by the relevant health authority and within plan rules.
  •  

  • The use of Diethylpropion is not in compliance with federal or state regulations governing controlled substances.

 

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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 of Alabama

 

Verify Prescription Coverage

 

  • Contact Blue Cross Blue Shield of Alabama customer service to inquire about specific coverage options for Diethylpropion (Tenuate). Check if it's included in your current health plan's formulary.
  •  

  • Log into your Blue Cross Blue Shield of Alabama member portal to review your policy benefits concerning weight loss medications, specifically Diethylpropion.

 

Consult with Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Diethylpropion for your treatment. Ensure your provider is aware of your Blue Cross Blue Shield of Alabama insurance.
  •  

  • Request your healthcare provider to document medical necessity, which is crucial for getting insurance approval for prescription medications not commonly covered.

 

Gain Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to Blue Cross Blue Shield of Alabama. Include all required documentation, such as medical reports and necessity justification.
  •  

  • Follow up with Blue Cross Blue Shield of Alabama to ensure the request is under review and inquire about any additional documentation needed.

 

Review Coverage Decisions

 

  • Once the prior authorization request is submitted, await a coverage decision. This decision will be communicated to both you and your healthcare provider.
  •  

  • If approved, your prescription coverage details including copayment amounts will be provided. If denied, review the explanation and consider contacting your healthcare provider for further assistance or explore alternative options.

 

File an Appeal if Necessary

 

  • If coverage for Diethylpropion is denied, you can file an appeal. Gather any additional information or reports that can support your case.
  •  

  • Contact Blue Cross Blue Shield of Alabama for their specific appeals process and submit your appeal within their mentioned timeframe.

 

Fill Your Prescription

 

  • If coverage is approved, visit a participating pharmacy in Blue Cross Blue Shield of Alabama’s network to fill your prescription for Diethylpropion.
  •  

  • Ensure that your pharmacy has all necessary details about your insurance coverage to apply any applicable discounts or copay assistance.

 

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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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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.

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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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