Does Blue Cross Blue Shield of Arizona Cover Saxenda

Explore Saxenda coverage with Blue Cross Blue Shield of Arizona, potential denials, coverage tips, cost without insurance, and FAQ.
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Blue Cross Blue Shield of Arizona Coverage for Saxenda

 

  • Saxenda, a medication for weight management, may be covered by Blue Cross Blue Shield of Arizona under certain conditions. Coverage typically requires the medication to be medically necessary.
  •  

  • Prior authorization is usually needed, meaning that your healthcare provider must demonstrate that Saxenda is appropriate for your condition based on medical criteria.
  •  

  • Eligibility often depends on BMI criteria or diagnosis of obesity-related conditions such as type 2 diabetes. Patients may be required to engage in a weight management program as part of the coverage criteria.
  •  

  • It's essential to check your specific policy details or contact Blue Cross Blue Shield of Arizona directly, as coverage can vary by plan.
  •  

 

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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 Saxenda Coverage with Blue Cross Blue Shield of Arizona

 

Understand Your Coverage

 

  • Contact Blue Cross Blue Shield (BCBS) of Arizona Customer Service to inquire about pharmacy benefits and confirm if Saxenda is covered under your specific plan.
  •  

  • Review your insurance policy documents, focusing on the pharmacy benefits segment to verify the inclusion and coverage criteria for Saxenda.
  •  

  • Check BCBS of Arizona's website for any online resources or tools that may list Saxenda as a covered medication under your plan.

 

Consult Your Healthcare Provider

 

  • Set an appointment with your healthcare provider to discuss your need for Saxenda as part of your treatment plan.
  •  

  • Request a formal prescription for Saxenda from your healthcare provider, and obtain any necessary documentation, like a Letter of Medical Necessity, if required by the insurance plan.

 

Prior Authorization Process

 

  • Contact BCBS of Arizona to determine if Saxenda requires prior authorization before coverage is provided.
  •  

  • Have your doctor submit a Prior Authorization Request to BCBS of Arizona, which may include documentation of your medical condition, previous treatments, and rationale for using Saxenda.
  •  

  • Follow up with BCBS of Arizona and your doctor's office to ensure the prior authorization request is being processed timely.

 

Appeal a Denial

 

  • If your Saxenda coverage request is denied, review the denial letter for specific reasons and information on the appeals process.
  •  

  • Work closely with your healthcare provider to gather any additional information or documentation required to support your appeal.
  •  

  • Submit a formal appeal to BCBS of Arizona, following the instructions provided in the denial letter, and keep copies of all correspondence for your records.

 

Explore Other Financial Assistance

 

  • Contact SaxendaCare, the official support service for Saxenda, to inquire about savings cards, copay assistance, or patient assistance programs they may offer.
  •  

  • Inquire with your healthcare provider or local pharmacy about any additional discounts or assistance programs available for Saxenda patients.

 

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FAQs

Does Blue Cross Blue Shield of Arizona Cover Saxenda

Explore Saxenda coverage with Blue Cross Blue Shield of Arizona, potential denials, coverage tips, cost without insurance, and FAQ.
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Is Saxenda Covered by Blue Cross Blue Shield of Arizona

 

Blue Cross Blue Shield of Arizona Coverage for Saxenda

 

  • Saxenda, a medication for weight management, may be covered by Blue Cross Blue Shield of Arizona under certain conditions. Coverage typically requires the medication to be medically necessary.
  •  

  • Prior authorization is usually needed, meaning that your healthcare provider must demonstrate that Saxenda is appropriate for your condition based on medical criteria.
  •  

  • Eligibility often depends on BMI criteria or diagnosis of obesity-related conditions such as type 2 diabetes. Patients may be required to engage in a weight management program as part of the coverage criteria.
  •  

  • It's essential to check your specific policy details or contact Blue Cross Blue Shield of Arizona directly, as coverage can vary by plan.
  •  

 

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

 

Eligibility Criteria for Saxenda Coverage

 

  • Patient must have a documented diagnosis of obesity with a body mass index (BMI) of 30 kg/m² or greater.
  •  

  • Alternatively, the patient may qualify if they have a BMI of 27 kg/m² or greater, accompanied by at least one weight-related comorbidity such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

 

Documentation and Evaluation

 

  • The healthcare provider must provide detailed clinical documentation supporting the necessity for Saxenda, including prior weight management interventions tried.
  •  

  • A full clinical evaluation, including a measurement of current BMI and any associated comorbid conditions, is required.
  •  

  • Evidence of active participation in a comprehensive lifestyle intervention program, including diet, physical activity, and behavior change, is required.
  •  

 

Prescriber Requirements

 

  • The prescribing healthcare professional must be an endocrinologist, bariatric specialist, or other qualified healthcare practitioner experienced in the treatment of obesity.
  •  

  • They must demonstrate that Saxenda is prescribed as part of a broader obesity management program.
  •  

 

Treatment Plan

 

  • An initial treatment plan should be submitted, which includes dosing regimen, goals for weight reduction, and planned follow-up assessments.
  •  

  • Continuous coverage of Saxenda is contingent upon documented weight loss as specified by the insurer, which is typically a minimum percentage of baseline weight.
  •  

  • Regular follow-up visits must be documented, indicating patient's adherence to the treatment plan and progress in weight management.
  •  

Why Blue Cross Blue Shield of Arizona Might Deny Saxenda Coverage

 

Situations Where Blue Cross Blue Shield of Arizona Might Deny Saxenda Coverage

 

  • **Experimental or Investigational Use**: Saxenda may be deemed experimental or investigational for certain off-label conditions that are not approved indications by the FDA.
  •  

  • **Lack of Medical Necessity**: If the patient's medical records do not demonstrate a necessity for Saxenda as per the insurer's criteria, such as corresponding comorbidities or failed attempts with alternative therapies.
  •  

  • **Non-Compliance with BMI Requirement**: Saxenda is generally indicated for patients with a certain Body Mass Index. Failure to meet or exceed this BMI threshold can result in denial.
  •  

  • **Absence of Documented Weight Management Programs**: Lack of participation or documentation in a structured weight management program might lead to a denial of coverage since it often accompanies treatment protocols.
  •  

  • **Exceeding Prescribed Dosage**: If Saxenda is prescribed in dosages higher than approved, or outside the recommended treatment duration, coverage may be denied.
  •  

  • **Age Restrictions**: Use of Saxenda may be limited by age, and prescriptions for patients outside the covered age range may be denied.
  •  

  • **Duplicate Therapies**: Coverage can be denied if Saxenda is prescribed alongside other similar drugs, reflecting a therapy overlap, unless specifically warranted and documented.
  •  

  • **Inadequate Provider Documentation**: Incomplete or insufficient documentation from the prescribing healthcare provider might lead to coverage denial.

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket costs.

 

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 Saxenda Coverage with Blue Cross Blue Shield of Arizona

 

Understand Your Coverage

 

  • Contact Blue Cross Blue Shield (BCBS) of Arizona Customer Service to inquire about pharmacy benefits and confirm if Saxenda is covered under your specific plan.
  •  

  • Review your insurance policy documents, focusing on the pharmacy benefits segment to verify the inclusion and coverage criteria for Saxenda.
  •  

  • Check BCBS of Arizona's website for any online resources or tools that may list Saxenda as a covered medication under your plan.

 

Consult Your Healthcare Provider

 

  • Set an appointment with your healthcare provider to discuss your need for Saxenda as part of your treatment plan.
  •  

  • Request a formal prescription for Saxenda from your healthcare provider, and obtain any necessary documentation, like a Letter of Medical Necessity, if required by the insurance plan.

 

Prior Authorization Process

 

  • Contact BCBS of Arizona to determine if Saxenda requires prior authorization before coverage is provided.
  •  

  • Have your doctor submit a Prior Authorization Request to BCBS of Arizona, which may include documentation of your medical condition, previous treatments, and rationale for using Saxenda.
  •  

  • Follow up with BCBS of Arizona and your doctor's office to ensure the prior authorization request is being processed timely.

 

Appeal a Denial

 

  • If your Saxenda coverage request is denied, review the denial letter for specific reasons and information on the appeals process.
  •  

  • Work closely with your healthcare provider to gather any additional information or documentation required to support your appeal.
  •  

  • Submit a formal appeal to BCBS of Arizona, following the instructions provided in the denial letter, and keep copies of all correspondence for your records.

 

Explore Other Financial Assistance

 

  • Contact SaxendaCare, the official support service for Saxenda, to inquire about savings cards, copay assistance, or patient assistance programs they may offer.
  •  

  • Inquire with your healthcare provider or local pharmacy about any additional discounts or assistance programs available for Saxenda patients.

 

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.

Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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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