Does Blue Cross Blue Shield of Illinois Cover Saxenda

Explore Saxenda coverage by Blue Cross Blue Shield of Illinois, denial reasons, securing coverage, out-of-pocket costs, and FAQ on this weight loss medication.
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Coverage Criteria for Saxenda

 

  • Blue Cross Blue Shield of Illinois may cover Saxenda if it is deemed medically necessary for individuals with a BMI over 30, or over 27 with weight-related conditions such as hypertension, diabetes, or dyslipidemia.
  •  

  • Coverage usually requires prior authorization, where a healthcare provider must demonstrate the necessity of Saxenda based on clinical guidelines.

 

Basic Rules for Coverage

 

  • Patients may need to provide a detailed history of previous weight loss treatments that were tried and did not achieve significant results.
  •  

  • The prescription must typically be part of a comprehensive weight management program, including lifestyle interventions like diet and exercise.

 

Additional Considerations

 

  • Coverage and criteria can vary, so it's advisable for patients to directly contact Blue Cross Blue Shield of Illinois or review their specific policy documents for detailed information.
  •  

  • Patients should work closely with their healthcare provider to navigate insurance requirements and obtain necessary authorizations.

 

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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 Illinois

 

Verify Coverage Eligibility

 

  • Visit the official Blue Cross Blue Shield of Illinois (BCBSIL) website or call their customer service to confirm if Saxenda is covered under your specific health plan. Coverage can vary between plans.
  • Refer to your plan's benefits document or formulary for specific information regarding weight loss medications like Saxenda.

 

Consult with Your Healthcare Provider

 

  • Discuss your weight management goals with your healthcare provider. A healthcare professional must prescribe Saxenda for it to be eligible for coverage.
  • Ensure your healthcare provider documents your medical need for Saxenda and provides the necessary medical records if requested by BCBSIL.

 

Pre-Authorization Requirement

 

  • Check if Saxenda requires prior authorization by reaching out to BCBSIL. This may be necessary before you can fill a prescription.
  • If pre-authorization is needed, ask your healthcare provider to complete and submit a prior authorization request on your behalf.

 

Gather Necessary Documentation

 

  • Prepare any required documentation, such as your healthcare provider’s statement of medical necessity, your medical history, and any previous treatments that were tried and not successful.
  • Have your insurance card details ready, as these will be necessary for any formal requests or discussions.

 

Submitting a Coverage Request

 

  • Contact BCBSIL directly by phone or through their online portal to initiate a prescription coverage request for Saxenda.
  • Ensure you fill out all required forms accurately and provide any supporting documents as requested by BCBSIL.

 

Appeal a Denied Request

 

  • In case your initial request for coverage is denied, review the reason for denial provided by BCBSIL carefully.
  • Work with your healthcare provider to submit an appeal, addressing the specific reasons for denial and providing additional support or alternative documentation, if necessary.

 

Follow-Up and Stay Informed

 

  • Regularly check the status of your request or appeal. Contact BCBSIL for updates if you do not receive a response within their specified timeframe.
  • Keep informed about any changes to your health plan benefits and how they may affect coverage for medications like Saxenda.

 

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Saxenda

Explore Saxenda coverage by Blue Cross Blue Shield of Illinois, denial reasons, securing coverage, out-of-pocket costs, and FAQ on this weight loss medication.
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Is Saxenda Covered by Blue Cross Blue Shield of Illinois

 

Coverage Criteria for Saxenda

 

  • Blue Cross Blue Shield of Illinois may cover Saxenda if it is deemed medically necessary for individuals with a BMI over 30, or over 27 with weight-related conditions such as hypertension, diabetes, or dyslipidemia.
  •  

  • Coverage usually requires prior authorization, where a healthcare provider must demonstrate the necessity of Saxenda based on clinical guidelines.

 

Basic Rules for Coverage

 

  • Patients may need to provide a detailed history of previous weight loss treatments that were tried and did not achieve significant results.
  •  

  • The prescription must typically be part of a comprehensive weight management program, including lifestyle interventions like diet and exercise.

 

Additional Considerations

 

  • Coverage and criteria can vary, so it's advisable for patients to directly contact Blue Cross Blue Shield of Illinois or review their specific policy documents for detailed information.
  •  

  • Patients should work closely with their healthcare provider to navigate insurance requirements and obtain necessary authorizations.

 

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

 

Eligibility Criteria for Saxenda Coverage

 

  • **Diagnosis of Obesity**: The patient must have a documented diagnosis of obesity, defined as having a Body Mass Index (BMI) of 30 kg/m2 or greater.
  •  

  • **Comorbid Conditions**: If the patient's BMI is between 27 kg/m2 and 29.9 kg/m2, they must have at least one weight-related comorbid condition, such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • **Age Requirement**: The patient should be at least 18 years of age.
  •  

  • **Documentation of Previous Weight Management Efforts**: There must be documented evidence that the patient has attempted weight loss through diet and exercise modifications prior to Saxenda initiation. This should show insufficient weight loss results or health improvement.
  •  

  • **Physician Evaluation**: The prescribing physician must evaluate and document that Saxenda is an appropriate therapeutic option for the patient based on their medical history and current health status.
  •  

  • **FDA Guidelines Compliance**: The patient must meet all the FDA-approved indications for Saxenda usage, including any safety and effective use guidelines.

 

Continued Coverage for Saxenda

 

  • **Initial Treatment Success**: The patient should demonstrate a minimum of 4% weight loss from baseline within the first 16 weeks of treatment to continue with Saxenda therapy.
  •  

  • **Regular Medical Evaluations**: The patient must undergo regular evaluations with their healthcare provider, assessing the effectiveness and safety of ongoing Saxenda treatment. Documentation of such evaluations will be required for continued coverage.
  •  

  • **Active Participation in Weight Management Program**: The patient must actively participate in a structured weight management program, including regular dietary, physical activity, and behavioral modifications.
  •  

  • **Continued Compliance with Comorbid Condition Management**: For those with weight-related comorbid conditions, ongoing management and treatment of these conditions must be consistently demonstrated alongside Saxenda therapy.

 

Why Blue Cross Blue Shield of Illinois Might Deny Saxenda Coverage

 

Non-Medical Necessity

 

  • Treatment does not meet the company's specific medical necessity criteria for weight loss medications.

 

Non-Approved Indications

 

  • Prescribed for a condition or indication that is not approved by Blue Cross Blue Shield of Illinois.

 

Lack of Prior Authorization

 

  • A prior authorization for the medication was not obtained before beginning treatment.

 

Experimental or Investigational Use

 

  • Usage of Saxenda is deemed experimental or investigational for the condition being treated.

 

Absence of BMI Requirement

 

  • The patient's body mass index (BMI) does not meet the minimum criteria set by the insurer for coverage.

 

Age Limitations

 

  • Patient does not fall within the covered age range for Saxenda.

 

Duplicate Therapy

 

  • Concurrent use with other weight management drugs that breach policy guidelines.

 

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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 Illinois

 

Verify Coverage Eligibility

 

  • Visit the official Blue Cross Blue Shield of Illinois (BCBSIL) website or call their customer service to confirm if Saxenda is covered under your specific health plan. Coverage can vary between plans.
  • Refer to your plan's benefits document or formulary for specific information regarding weight loss medications like Saxenda.

 

Consult with Your Healthcare Provider

 

  • Discuss your weight management goals with your healthcare provider. A healthcare professional must prescribe Saxenda for it to be eligible for coverage.
  • Ensure your healthcare provider documents your medical need for Saxenda and provides the necessary medical records if requested by BCBSIL.

 

Pre-Authorization Requirement

 

  • Check if Saxenda requires prior authorization by reaching out to BCBSIL. This may be necessary before you can fill a prescription.
  • If pre-authorization is needed, ask your healthcare provider to complete and submit a prior authorization request on your behalf.

 

Gather Necessary Documentation

 

  • Prepare any required documentation, such as your healthcare provider’s statement of medical necessity, your medical history, and any previous treatments that were tried and not successful.
  • Have your insurance card details ready, as these will be necessary for any formal requests or discussions.

 

Submitting a Coverage Request

 

  • Contact BCBSIL directly by phone or through their online portal to initiate a prescription coverage request for Saxenda.
  • Ensure you fill out all required forms accurately and provide any supporting documents as requested by BCBSIL.

 

Appeal a Denied Request

 

  • In case your initial request for coverage is denied, review the reason for denial provided by BCBSIL carefully.
  • Work with your healthcare provider to submit an appeal, addressing the specific reasons for denial and providing additional support or alternative documentation, if necessary.

 

Follow-Up and Stay Informed

 

  • Regularly check the status of your request or appeal. Contact BCBSIL for updates if you do not receive a response within their specified timeframe.
  • Keep informed about any changes to your health plan benefits and how they may affect coverage for medications like Saxenda.

 

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.

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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