Does Blue Cross Blue Shield of Arizona Cover Phentermine (Adipex-P, Lomaira)

Explore coverage details of Phentermine with Blue Cross Blue Shield of Arizona, costs without insurance, and FAQs. Find tips to ensure successful coverage.
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Does Blue Cross Blue Shield of Arizona Cover Phentermine?

 

  • Coverage for Phentermine (Adipex-P, Lomaira) varies based on specific health plans provided by Blue Cross Blue Shield of Arizona.
  •  

  • The medication is typically covered under plans where it is deemed medically necessary for the treatment of obesity-related conditions.
  •  

  • Patients may need to meet certain criteria, such as BMI thresholds or a documented history of attempting other weight-loss interventions.

 

Basic Rules and Criteria

 

  • Prescription by a healthcare provider is necessary, generally following a comprehensive evaluation and weight-loss plan.
  •  

  • Pre-authorization might be required, involving documentation of medical necessity and prior unsuccessful weight management.
  •  

  • Coverage may differ, so it’s advised to check specific policy details or consult directly with Blue Cross Blue Shield of Arizona for personalized information.

 

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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.

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 Phentermine (Adipex-P, Lomaira) Coverage with Blue Cross Blue Shield of Arizona

 

Contact Blue Cross Blue Shield of Arizona

 

  • Reach out to Blue Cross Blue Shield of Arizona (BCBS AZ) directly by calling the customer service number on the back of your insurance card. Verify whether your current policy covers medications like Phentermine (Adipex-P or Lomaira).
  •  

  • Explain your situation and interest in obtaining coverage for Phentermine. Ask about the relevant formulary or drug list that includes this medication.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Phentermine. Your provider can assess your condition and determine if this medication is medically necessary.
  •  

  • If Phentermine is deemed necessary, request that your provider write a prescription and provide any documentation that may support the need for this medication when seeking coverage.

 

Pre-Authorization Process

 

  • Inquire with BCBS AZ if pre-authorization is required for Phentermine coverage. If so, your healthcare provider will need to submit a pre-authorization request, including the relevant medical documentation.
  •  

  • Ensure that the pre-authorization request is detailed, highlighting why Phentermine is essential for your health condition and how it contributes to your treatment plan.

 

Gather Necessary Documentation

 

  • Collect all supportive documentation that may be required during the approval process, such as treatment history, medical evaluations, and past efforts at weight management, if applicable.
  •  

  • Organize these documents efficiently to facilitate a smooth submission process when asked for evidence.

 

Submit a Formal Request for Coverage

 

  • If your policy initially does not cover Phentermine, submit a formal request for coverage to BCBS AZ. This can often involve filling out a specific form provided by the insurer.
  •  

  • Attach all previously gathered documentation with your request to strengthen your case for coverage.

 

Follow-Up Regularly

 

  • Keep in touch with both BCBS AZ and your healthcare provider about your request status. Timely follow-ups can expedite the approval process.
  •  

  • If your request is denied, inquire about the reasons for denial and the procedure to appeal the decision. Gathering any additional required information promptly can support a successful appeal.

 

Consider Alternatives if Necessary

 

  • If coverage for Phentermine is ultimately denied, discuss alternative treatments with your healthcare provider that may not need specific approval or that fit within BCBS AZ's coverage parameters.
  •  

  • Your provider may suggest alternative medications or weight management strategies that can achieve similar outcomes.

 

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Does Blue Cross Blue Shield of Arizona Cover Phentermine (Adipex-P, Lomaira)

Explore coverage details of Phentermine with Blue Cross Blue Shield of Arizona, costs without insurance, and FAQs. Find tips to ensure successful coverage.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by Blue Cross Blue Shield of Arizona

 

Does Blue Cross Blue Shield of Arizona Cover Phentermine?

 

  • Coverage for Phentermine (Adipex-P, Lomaira) varies based on specific health plans provided by Blue Cross Blue Shield of Arizona.
  •  

  • The medication is typically covered under plans where it is deemed medically necessary for the treatment of obesity-related conditions.
  •  

  • Patients may need to meet certain criteria, such as BMI thresholds or a documented history of attempting other weight-loss interventions.

 

Basic Rules and Criteria

 

  • Prescription by a healthcare provider is necessary, generally following a comprehensive evaluation and weight-loss plan.
  •  

  • Pre-authorization might be required, involving documentation of medical necessity and prior unsuccessful weight management.
  •  

  • Coverage may differ, so it’s advised to check specific policy details or consult directly with Blue Cross Blue Shield of Arizona for personalized information.

 

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Blue Cross Blue Shield of Arizona's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Eligibility Criteria for Phentermine Coverage

 

  • Patients must have a body mass index (BMI) of 30 kg/m2 or greater, or 27 kg/m2 or greater in conjunction with a weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Patients should have documented evidence of attempting weight loss through lifestyle modifications, including diet and exercise, without achieving or maintaining adequate weight loss necessary for health improvement.

 

Required Documentation

 

  • A recent and comprehensive medical history that confirms the diagnosis of obesity or overweight status with associated comorbidities if applicable.
  •  

  • A documented history of previous weight loss attempts through lifestyle modification, including any supervised diet and exercise programs, with detailed outcomes.
  •  

  • Physician documentation that supports the medical necessity of pharmacotherapy for weight management in conjunction with continued lifestyle modifications.

 

Prescription Criteria

 

  • The prescription must be provided by a healthcare professional who is qualified and recognized under state guidelines to prescribe weight management medications.
  •  

  • Initial prescription authorization typically covers a limited period (e.g., one month) to assess the patient's clinical response to the medication and adherence to a comprehensive weight management program.
  •  

  • Continued coverage beyond the initial period generally requires documentation showing the patient achieved a clinically significant weight loss and is adhering to lifestyle modifications.

 

Monitoring and Evaluation

 

  • Regular follow-up appointments must be scheduled to monitor progress, assess effectiveness, and identify any potential side effects of the medication.
  •  

  • Healthcare providers may be required to submit progress reports demonstrating sustained weight loss, ongoing lifestyle changes, and continued medical necessity for ongoing phentermine therapy.

 

Why Blue Cross Blue Shield of Arizona Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Reasons for Denial of Phentermine Coverage

 

  • Phentermine is prescribed for individuals who do not meet the obesity criteria outlined by health guidelines (usually BMI of 30 or more, or BMI of 27 or more with associated health conditions).
  •  

  • The prescription does not align with FDA-approved indications or Blue Cross Blue Shield of Arizona's clinical criteria for weight management medications.
  •  

  • The patient has a history of cardiovascular disease, hyperthyroidism, glaucoma, or drug abuse, making phentermine therapy clinically inappropriate.
  •  

  • The medication request is for long-term use beyond the recommended short-term period (typically a few weeks), and there is insufficient documentation supporting extended use.
  •  

  • The request is part of a weight loss regimen that does not include comprehensive behavioral interventions, lifestyle modification plans, or is not under the supervision of a healthcare provider specializing in obesity treatment.
  •  

  • Repeated requests or refill requests without documented evidence of adequate weight loss progression or health benefit as assessed by clinical criteria.
  •  

  • The request for phentermine is made without fulfilling prior authorization requirements, which include submitting clinical records supporting its use.
  •  

  • The individual is enrolled in a health plan that explicitly excludes coverage for appetite suppressants or medications deemed non-essential for health maintenance within the policy.

 

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How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 Phentermine (Adipex-P, Lomaira) Coverage with Blue Cross Blue Shield of Arizona

 

Contact Blue Cross Blue Shield of Arizona

 

  • Reach out to Blue Cross Blue Shield of Arizona (BCBS AZ) directly by calling the customer service number on the back of your insurance card. Verify whether your current policy covers medications like Phentermine (Adipex-P or Lomaira).
  •  

  • Explain your situation and interest in obtaining coverage for Phentermine. Ask about the relevant formulary or drug list that includes this medication.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Phentermine. Your provider can assess your condition and determine if this medication is medically necessary.
  •  

  • If Phentermine is deemed necessary, request that your provider write a prescription and provide any documentation that may support the need for this medication when seeking coverage.

 

Pre-Authorization Process

 

  • Inquire with BCBS AZ if pre-authorization is required for Phentermine coverage. If so, your healthcare provider will need to submit a pre-authorization request, including the relevant medical documentation.
  •  

  • Ensure that the pre-authorization request is detailed, highlighting why Phentermine is essential for your health condition and how it contributes to your treatment plan.

 

Gather Necessary Documentation

 

  • Collect all supportive documentation that may be required during the approval process, such as treatment history, medical evaluations, and past efforts at weight management, if applicable.
  •  

  • Organize these documents efficiently to facilitate a smooth submission process when asked for evidence.

 

Submit a Formal Request for Coverage

 

  • If your policy initially does not cover Phentermine, submit a formal request for coverage to BCBS AZ. This can often involve filling out a specific form provided by the insurer.
  •  

  • Attach all previously gathered documentation with your request to strengthen your case for coverage.

 

Follow-Up Regularly

 

  • Keep in touch with both BCBS AZ and your healthcare provider about your request status. Timely follow-ups can expedite the approval process.
  •  

  • If your request is denied, inquire about the reasons for denial and the procedure to appeal the decision. Gathering any additional required information promptly can support a successful appeal.

 

Consider Alternatives if Necessary

 

  • If coverage for Phentermine is ultimately denied, discuss alternative treatments with your healthcare provider that may not need specific approval or that fit within BCBS AZ's coverage parameters.
  •  

  • Your provider may suggest alternative medications or weight management strategies that can achieve similar outcomes.

 

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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.

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.

Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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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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