Does Blue Cross Blue Shield of Arizona Cover Phendimetrazine

Explore coverage options for Phendimetrazine with Blue Cross Blue Shield of Arizona, costs without insurance, and address common FAQs in this comprehensive guide.
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Coverage Overview

 

  • Blue Cross Blue Shield of Arizona (BCBSAZ) may cover Phendimetrazine if prescribed as part of a comprehensive weight loss program.

 

Eligibility Criteria

 

  • Coverage generally applies to adults with a BMI >30 or >27 with comorbidities like hypertension or diabetes.

 

Pre-authorization Requirements

 

  • Pre-authorization from BCBSAZ is typically required. This involves providing documentation of medical necessity and previous weight loss attempts.

 

Additional Considerations

 

  • Coverage may vary based on specific plans; reviewing the individual policy details or speaking with customer service is recommended to confirm benefits.

 

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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 Phendimetrazine Coverage with Blue Cross Blue Shield of Arizona

 

Verify Phendimetrazine Coverage

 

  • Contact Blue Cross Blue Shield of Arizona (BCBS of AZ) customer service through the phone number on the back of your insurance card to confirm if Phendimetrazine is covered under your specific plan.
  •  

  • Check BCBS of AZ's online member portal for any documents or benefit summaries that list covered medications.
  •  

  • Consult with your healthcare provider or pharmacist, who can help determine if Phendimetrazine is typically covered by your plan type.

 

Review Your Insurance Policy

 

  • Examine your health insurance policy documents or formulary list to identify the current tier placement of Phendimetrazine and any prerequisites for coverage.
  •  

  • Determine if there are specific requirements such as prior authorization, step therapy, or quantity limits for Phendimetrazine in your plan.

 

Obtain a Prescription

 

  • Schedule a visit with your healthcare provider to discuss your need for Phendimetrazine, ensuring that it’s medically necessary for your condition.
  •  

  • If deemed appropriate, have your healthcare provider write a prescription for Phendimetrazine.

 

Submit Required Documentation

 

  • If needed, have your healthcare provider complete and submit any necessary prior authorization forms to BCBS of AZ.
  •  

  • Ensure that all patient medical records and documentation supporting the medical necessity of Phendimetrazine are sent with the prior authorization request.

 

Follow Up with the Pharmacy

 

  • Provide your prescription to your pharmacy and ask them to process it through your BCBS of AZ insurance plan.
  •  

  • Contact the pharmacy to verify if the Phendimetrazine prescription has been approved by the insurance and inquire about any out-of-pocket costs you might incur.

 

Appeal a Denied Claim

 

  • If your initial coverage request is denied, carefully review the denial letter from BCBS of AZ for specific reasons and instructions on how to appeal.
  •  

  • Work with your healthcare provider to gather additional medical documentation or justification needed to support the appeal.
  •  

  • Submit the appeal following the outlined process, including all necessary forms and supporting documents, to potentially secure coverage upon reevaluation.

 

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FAQs

Does Blue Cross Blue Shield of Arizona Cover Phendimetrazine

Explore coverage options for Phendimetrazine with Blue Cross Blue Shield of Arizona, costs without insurance, and address common FAQs in this comprehensive guide.
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Is Phendimetrazine Covered by Blue Cross Blue Shield of Arizona

 

Coverage Overview

 

  • Blue Cross Blue Shield of Arizona (BCBSAZ) may cover Phendimetrazine if prescribed as part of a comprehensive weight loss program.

 

Eligibility Criteria

 

  • Coverage generally applies to adults with a BMI >30 or >27 with comorbidities like hypertension or diabetes.

 

Pre-authorization Requirements

 

  • Pre-authorization from BCBSAZ is typically required. This involves providing documentation of medical necessity and previous weight loss attempts.

 

Additional Considerations

 

  • Coverage may vary based on specific plans; reviewing the individual policy details or speaking with customer service is recommended to confirm benefits.

 

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Blue Cross Blue Shield of Arizona's Approved Criteria for Phendimetrazine Coverage

 

Eligibility Requirements for Phendimetrazine Coverage

 

  • The patient must be 18 years of age or older.
  •  

  • A diagnosis of obesity, characterized by a body mass index (BMI) of 30 kg/m² or higher, is required.
  •  

  • For patients with a BMI of 27 kg/m² or higher, there must be at least one comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia.

 

Previous Weight Management Efforts

 

  • The patient must have documented attempts to lose weight through an organized, structured weight management program, including dietary, exercise, and/or behavioral changes, for at least 3 months prior to requesting medication.
  •  

  • Documentation of weight loss goals and progress during the program is required.

 

Required Documentation

 

  • A comprehensive medical examination report establishing the need for pharmacological intervention as part of the weight loss strategy.
  •  

  • A documented history of obesity management and any associated comorbid conditions by the treating physician.
  •  

  • Records of previous weight loss strategies, including results and duration of the attempts.
  •  

  • An assessment of the risks versus benefits of phendimetrazine use for the specific patient, provided by a healthcare provider.

 

Monitoring Requirements

 

  • The patient must agree to regular follow-up visits to monitor weight loss progress, potential side effects, and the effectiveness of phendimetrazine in their treatment plan.
  •  

  • Documentation of ongoing lifestyle modifications in conjunction with medication use is required.

 

Provider Qualifications

 

  • Prescription of phendimetrazine must be made by a licensed healthcare provider specializing in the treatment of obesity or weight management.

 

Coverage Limitations

 

  • The insurance coverage may have duration limits or require periodic reviews to confirm the continuation of phendimetrazine is appropriate for the patient’s treatment plan.
  •  

  • Coverage is contingent upon fulfilling and adhering to the aforementioned criteria and any additional plan-specific requirements as outlined by Blue Cross Blue Shield of Arizona.

 

Why Blue Cross Blue Shield of Arizona Might Deny Phendimetrazine Coverage

 

Non-Medical Necessity

 

  • Blue Cross Blue Shield of Arizona might deny Phendimetrazine coverage if the medication is not deemed medically necessary for the treatment of a patient's condition.

 

Lack of Prior Authorization

 

  • If prior authorization is required and not obtained, Blue Cross Blue Shield of Arizona may deny coverage for Phendimetrazine.

 

Exceeding Dosage Limits

 

  • Coverage may be denied if the prescribed dosage exceeds recommended limits according to plan guidelines.

 

Off-Label Use

 

  • If Phendimetrazine is prescribed for a use not approved by the FDA or not covered under Blue Cross Blue Shield of Arizona's policy, coverage may be denied.

 

Inappropriate Diagnosis

 

  • If the diagnosis is not included in the policy criteria for Phendimetrazine coverage, the claim might be denied.

 

Lack of Documented Weight Loss Efforts

 

  • Blue Cross Blue Shield of Arizona may require documentation of previous weight loss attempts. Without sufficient documentation, coverage could be denied.

 

Age Restrictions

 

  • Coverage might be denied if the patient does not meet the age restrictions specified in the policy for Phendimetrazine.

 

Duplicate Therapy

 

  • If Phendimetrazine is being prescribed concurrently with other similar medications without proper justification, Blue Cross Blue Shield of Arizona might deny coverage.

 

Non-Plan Providers

 

  • Coverage may be denied if the medication is prescribed by or intended to be dispensed by a provider outside of the approved network.

 

Policy Exclusions

 

  • Any exclusions specified in the individual's policy agreement may lead to denial of Phendimetrazine coverage.

 

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How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

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 Phendimetrazine Coverage with Blue Cross Blue Shield of Arizona

 

Verify Phendimetrazine Coverage

 

  • Contact Blue Cross Blue Shield of Arizona (BCBS of AZ) customer service through the phone number on the back of your insurance card to confirm if Phendimetrazine is covered under your specific plan.
  •  

  • Check BCBS of AZ's online member portal for any documents or benefit summaries that list covered medications.
  •  

  • Consult with your healthcare provider or pharmacist, who can help determine if Phendimetrazine is typically covered by your plan type.

 

Review Your Insurance Policy

 

  • Examine your health insurance policy documents or formulary list to identify the current tier placement of Phendimetrazine and any prerequisites for coverage.
  •  

  • Determine if there are specific requirements such as prior authorization, step therapy, or quantity limits for Phendimetrazine in your plan.

 

Obtain a Prescription

 

  • Schedule a visit with your healthcare provider to discuss your need for Phendimetrazine, ensuring that it’s medically necessary for your condition.
  •  

  • If deemed appropriate, have your healthcare provider write a prescription for Phendimetrazine.

 

Submit Required Documentation

 

  • If needed, have your healthcare provider complete and submit any necessary prior authorization forms to BCBS of AZ.
  •  

  • Ensure that all patient medical records and documentation supporting the medical necessity of Phendimetrazine are sent with the prior authorization request.

 

Follow Up with the Pharmacy

 

  • Provide your prescription to your pharmacy and ask them to process it through your BCBS of AZ insurance plan.
  •  

  • Contact the pharmacy to verify if the Phendimetrazine prescription has been approved by the insurance and inquire about any out-of-pocket costs you might incur.

 

Appeal a Denied Claim

 

  • If your initial coverage request is denied, carefully review the denial letter from BCBS of AZ for specific reasons and instructions on how to appeal.
  •  

  • Work with your healthcare provider to gather additional medical documentation or justification needed to support the appeal.
  •  

  • Submit the appeal following the outlined process, including all necessary forms and supporting documents, to potentially secure coverage upon reevaluation.

 

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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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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

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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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