Does Blue Cross Blue Shield of Massachusetts Cover Contrave

Explore if Blue Cross Blue Shield of Massachusetts covers Contrave, reasons for denial, obtaining coverage, costs without insurance, and FAQs in our detailed guide.
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Coverage Details

 

  • Blue Cross Blue Shield of Massachusetts may cover Contrave for weight management in certain situations. Typically, coverage is available if the medication is deemed medically necessary and prescribed by a healthcare provider.
  •  

  • It often requires that the patient has a body mass index (BMI) of at least 30, or at least 27 with related conditions like hypertension, type 2 diabetes, or high cholesterol.

 

Criteria for Approval

 

  • Prior authorization is usually required, meaning the prescribing doctor needs to provide documentation explaining the necessity of the drug.
  •  

  • Patients may need to demonstrate previous attempts at weight loss through diet and exercise.

 

Basic Rules

 

  • Check the specific plan details, as coverage and requirements can vary.
  •  

  • There may be limitations on the amount and duration of coverage for Contrave.

 

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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 Contrave Coverage with Blue Cross Blue Shield of Massachusetts

 

Start by Consulting Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave, a prescription medication used for weight management.
  •  

  • Ask your doctor if Contrave is the right medication for you and gather any necessary medical documentation that supports your need for this treatment.

 

Check Blue Cross Blue Shield of Massachusetts Formulary

 

  • Access the Blue Cross Blue Shield of Massachusetts website or contact their customer service to obtain a copy of the drug formulary.
  •  

  • Identify if Contrave is listed on the formulary. If it's not listed, it may require additional processes for coverage approval.

 

Verify Your Insurance Plan Details

 

  • Contact Blue Cross Blue Shield of Massachusetts to verify the specific details of your insurance plan regarding prescription drug coverage.
  •  

  • Ask about any requirements or restrictions related to covering Contrave, such as prior authorization, step therapy, or specific tier classifications.

 

Get Prior Authorization

 

  • If required, work with your doctor to complete the prior authorization process. This typically involves submitting a form or letter of medical necessity to Blue Cross Blue Shield of Massachusetts.
  •  

  • Ensure that all necessary documentation is included, such as your current medical condition, previous treatments, and why Contrave is recommended.

 

File an Appeal, If Necessary

 

  • If your initial request for coverage is denied, you may file an appeal. Follow the Blue Cross Blue Shield of Massachusetts appeals process and include any additional supporting documentation.
  •  

  • Consult your healthcare provider to assist with providing a strong rationale for the necessity of Contrave in your treatment plan.

 

Utilize Pharmacy or Medication Assistance Programs

 

  • Investigate if there are any manufacturer-provided or third-party assistance programs that can help reduce your costs for Contrave.
  •  

  • Check with local pharmacies for discounts or programs that might offer savings on your medication.

 

Monitor Your Coverage Regularly

 

  • Regularly review your benefits and coverage updates from Blue Cross Blue Shield of Massachusetts to stay informed about any changes that might affect your prescription coverage.
  •  

  • Maintain open communication with both your healthcare provider and insurer to ensure ongoing coverage of Contrave if it remains a part of your treatment plan.

 

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FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Contrave

Explore if Blue Cross Blue Shield of Massachusetts covers Contrave, reasons for denial, obtaining coverage, costs without insurance, and FAQs in our detailed guide.
Curex allergy drops unboxing

Is Contrave Covered by Blue Cross Blue Shield of Massachusetts

 

Coverage Details

 

  • Blue Cross Blue Shield of Massachusetts may cover Contrave for weight management in certain situations. Typically, coverage is available if the medication is deemed medically necessary and prescribed by a healthcare provider.
  •  

  • It often requires that the patient has a body mass index (BMI) of at least 30, or at least 27 with related conditions like hypertension, type 2 diabetes, or high cholesterol.

 

Criteria for Approval

 

  • Prior authorization is usually required, meaning the prescribing doctor needs to provide documentation explaining the necessity of the drug.
  •  

  • Patients may need to demonstrate previous attempts at weight loss through diet and exercise.

 

Basic Rules

 

  • Check the specific plan details, as coverage and requirements can vary.
  •  

  • There may be limitations on the amount and duration of coverage for Contrave.

 

A weight management program tailored to you

Start with Curex

Blue Cross Blue Shield of Massachusetts's Approved Criteria for Contrave Coverage

 

Eligibility Criteria for Contrave Coverage

 

  • Member must be 18 years of age or older.
  •  

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

  • Member must have attempted to lose weight through a comprehensive weight management program for at least six months, which includes dietary modification, increased physical activity, and behavioral interventions.
  •  

  • Documentation of the comprehensive weight management program and its outcomes must be provided.
  •  

  • Prescriber must confirm that other causes of obesity are ruled out, such as endocrinological disorders.
  •  

  • The member's prescription is initiated and re-evaluated by an appropriate healthcare provider specializing in weight management.

 

Continuing Coverage Criteria

 

  • Continued coverage is subject to documented weight loss of at least 5% of initial body weight within the first 12 weeks of therapy.
  •  

  • Regular follow-up appointments must be conducted to monitor the member’s progress with Contrave therapy.
  •  

  • Continuous enrollment in a weight management program is required to maintain coverage eligibility.

 

Step Therapy Requirement

 

  • Member must have failed to achieve sufficient weight loss with a three-month trial of at least one other anti-obesity medication, unless contraindicated or not tolerated.

 

Documentation and Authorization

 

  • Healthcare provider must submit clinical records, including progress notes and lab results, demonstrating that the eligibility criteria for Contrave therapy are met.
  •  

  • Initial authorization is typically granted for a period of three months, and subsequent reauthorizations require evidence of efficacy and adherence to therapy.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Contrave Coverage

 

Reasons Blue Cross Blue Shield of Massachusetts Might Deny Contrave Coverage

 

  • Contrave is not deemed medically necessary based on the company's specific policy guidelines.
  •  

  • The patient has a body mass index (BMI) measurement that does not meet the company's specified threshold for coverage.
  •  

  • Usage of Contrave is not supported by substantial clinical evidence for the patient's specific condition as determined by Blue Cross Blue Shield of Massachusetts.
  •  

  • There are less expensive, equally effective treatment options available that the insurer prefers over Contrave.
  •  

  • The patient has not met any required prior authorization criteria, such as previous attempts with other weight management strategies.
  •  

  • Exclusion under the terms of the insurance policy, which might explicitly not include weight loss medications.
  •  

  • Contrave is used outside of the FDA-approved indications, which the insurance policy does not cover.

 

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing 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 Contrave Coverage with Blue Cross Blue Shield of Massachusetts

 

Start by Consulting Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave, a prescription medication used for weight management.
  •  

  • Ask your doctor if Contrave is the right medication for you and gather any necessary medical documentation that supports your need for this treatment.

 

Check Blue Cross Blue Shield of Massachusetts Formulary

 

  • Access the Blue Cross Blue Shield of Massachusetts website or contact their customer service to obtain a copy of the drug formulary.
  •  

  • Identify if Contrave is listed on the formulary. If it's not listed, it may require additional processes for coverage approval.

 

Verify Your Insurance Plan Details

 

  • Contact Blue Cross Blue Shield of Massachusetts to verify the specific details of your insurance plan regarding prescription drug coverage.
  •  

  • Ask about any requirements or restrictions related to covering Contrave, such as prior authorization, step therapy, or specific tier classifications.

 

Get Prior Authorization

 

  • If required, work with your doctor to complete the prior authorization process. This typically involves submitting a form or letter of medical necessity to Blue Cross Blue Shield of Massachusetts.
  •  

  • Ensure that all necessary documentation is included, such as your current medical condition, previous treatments, and why Contrave is recommended.

 

File an Appeal, If Necessary

 

  • If your initial request for coverage is denied, you may file an appeal. Follow the Blue Cross Blue Shield of Massachusetts appeals process and include any additional supporting documentation.
  •  

  • Consult your healthcare provider to assist with providing a strong rationale for the necessity of Contrave in your treatment plan.

 

Utilize Pharmacy or Medication Assistance Programs

 

  • Investigate if there are any manufacturer-provided or third-party assistance programs that can help reduce your costs for Contrave.
  •  

  • Check with local pharmacies for discounts or programs that might offer savings on your medication.

 

Monitor Your Coverage Regularly

 

  • Regularly review your benefits and coverage updates from Blue Cross Blue Shield of Massachusetts to stay informed about any changes that might affect your prescription coverage.
  •  

  • Maintain open communication with both your healthcare provider and insurer to ensure ongoing coverage of Contrave if it remains a part of your treatment plan.

 

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.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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Everything you need is included:

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A weight management program tailored to you

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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