Does Blue Cross Blue Shield of Massachusetts Cover Liraglutide (Saxenda)

Explore BCBS Massachusetts coverage for Saxenda, reasons for denial, costs without insurance, and FAQs. Learn how to secure coverage effectively.
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Coverage for Liraglutide (Saxenda)

 

  • Blue Cross Blue Shield of Massachusetts may cover Liraglutide (Saxenda) for weight management if specific medical criteria are met.
  • Coverage typically requires a diagnosis of obesity with a BMI of 30 or higher, or a BMI of 27 or higher with weight-related comorbidities.
  • A documented history of previous weight loss attempts through diet and exercise may be necessary.

 

Authorization and Prescription

 

  • A prior authorization from a healthcare provider might be required to demonstrate medical necessity.
  • Physicians need to provide proper documentation outlining the patient’s diagnosis and previous weight management efforts.
  • Always consult with a Blue Cross Blue Shield representative to verify coverage specifics and any potential out-of-pocket costs.

 

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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.

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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.

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 Liraglutide (Saxenda) Coverage with Blue Cross Blue Shield of Massachusetts

 

Start by Reviewing Your Insurance Plan

 

  • Login to your Blue Cross Blue Shield of Massachusetts (BCBSMA) member account via their website or mobile app to access your current plan details.
  • Look through your plan documentation including the benefits booklet to determine if weight management or obesity medications are covered under your plan. Liraglutide (Saxenda) is typically classified under these categories.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Liraglutide (Saxenda) for your treatment plan.
  • Request a written recommendation or prescription from your provider. Ensure that the documentation highlights the medical necessity of Liraglutide for your condition.

 

Verify Liraglutide (Saxenda) Coverage

 

  • Contact BCBSMA customer service through the number on your insurance card to confirm if Liraglutide is covered under your policy.
  • Ask specifically about any prerequisites such as prior authorization, step therapy, or other requirements for Liraglutide coverage.
  • If it’s not covered, consider asking about appeal processes or alternative options that might be available for weight management.

 

Request Prior Authorization

 

  • If required, work with your healthcare provider to file a prior authorization request with BCBSMA. This often involves submitting detailed medical records and provider notes supporting the need for Liraglutide.
  • Make sure all required forms are correctly filled out and submitted timely as delays may impact the approval process.

 

Follow Up on the Approval Process

 

  • Keep in regular contact with BCBSMA to check the status of your authorization request. Be polite but persistent to ensure the request is being processed.
  • Prepare to supply any additional information if requested by BCBSMA to prevent delays in processing.

 

Getting Approval or Considering Alternatives

 

  • Once approved, review the approval terms including co-pays, supply limits, or any required monitoring by BCBSMA.
  • If your request is denied, discuss alternative treatments with your healthcare provider or consider lodging a formal appeal with the help of your provider's support.

 

Purchase and Pick-Up

 

  • Upon approval, fill your prescription for Liraglutide at a BCBSMA in-network pharmacy to avoid out-of-network charges.
  • Confirm the pharmacy is aware of the coverage approval to ensure they process the prescription at the correct rate.

 

Monitor Treatment and Insurance Coverage

 

  • Keep a log of any changes to your plan coverage or the status of the medication treatment to promptly handle any future insurance or treatment adjustments.
  • Schedule regular follow-ups with your healthcare provider to assess the effectiveness of Liraglutide and adjust treatment as necessary.

 

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FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Liraglutide (Saxenda)

Explore BCBS Massachusetts coverage for Saxenda, reasons for denial, costs without insurance, and FAQs. Learn how to secure coverage effectively.
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Is Liraglutide (Saxenda) Covered by Blue Cross Blue Shield of Massachusetts

 

Coverage for Liraglutide (Saxenda)

 

  • Blue Cross Blue Shield of Massachusetts may cover Liraglutide (Saxenda) for weight management if specific medical criteria are met.
  • Coverage typically requires a diagnosis of obesity with a BMI of 30 or higher, or a BMI of 27 or higher with weight-related comorbidities.
  • A documented history of previous weight loss attempts through diet and exercise may be necessary.

 

Authorization and Prescription

 

  • A prior authorization from a healthcare provider might be required to demonstrate medical necessity.
  • Physicians need to provide proper documentation outlining the patient’s diagnosis and previous weight management efforts.
  • Always consult with a Blue Cross Blue Shield representative to verify coverage specifics and any potential out-of-pocket costs.

 

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Blue Cross Blue Shield of Massachusetts's Approved Criteria for Liraglutide (Saxenda) Coverage

 

Criteria for Initial Approval

 

  • The patient must be at least 18 years old.
  •  

  • A diagnosis of obesity, defined as a Body Mass Index (BMI) of 30 kg/m² or higher, is required.
  •  

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

  • The patient must have tried and failed to reduce their body weight through a structured diet and exercise regimen, supervised by a healthcare professional, either alone or in combination with other interventions, for a duration of at least six months.

 

Considerations for Continued Coverage

 

  • Demonstration of at least a 4% reduction in initial body weight after 16 weeks of therapy is necessary for continued approval of coverage.
  •  

  • The patient must continue to adhere to a comprehensive lifestyle intervention, which includes dietary, physical activity, and behavioral changes for weight management.
  •  

  • Follow-up assessments by the healthcare provider are required at regular intervals to monitor efficacy and appropriateness of therapy.

 

Healthcare Provider Responsibilities

 

  • A healthcare provider must evaluate regimen adherence and effectiveness throughout the treatment period.
  •  

  • The prescribing physician is responsible for documenting the patient's progress and other relevant medical information to justify the need for continued treatment.

 

Criteria for Special Populations

 

  • For individuals with a history of major cardiovascular events, a cardiology consultation to assess risks versus benefits is recommended before approval.
  •  

  • Patients with severe hepatic impairment or severe renal impairment may require alternative weight management strategies per clinical guidelines, which should be documented by the treating physician.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Liraglutide (Saxenda) Coverage

 

Criteria for Denial of Liraglutide (Saxenda) Coverage by Blue Cross Blue Shield of Massachusetts

 

  • **Patient does not meet the specific BMI (Body Mass Index) criteria**: Coverage may be denied if the patient does not have a BMI of 30 or greater, or 27 or greater with an associated condition.
  •  

  • **Lack of associated comorbid conditions**: If a patient's BMI is between 27 and 30, and they do not have a qualifying comorbid condition such as type 2 diabetes, hypertension, or dyslipidemia, coverage may be denied.
  •  

  • **Absence of prior weight management efforts**: Denial can occur if there is no documented evidence that the patient has attempted weight management through lifestyle interventions such as diet and exercise.
  •  

  • **Use for non-FDA approved indications**: Saxenda may be denied if it is being used for purposes not approved by the U.S. Food and Drug Administration, such as off-label use.
  •  

  • **Lack of necessary documentation**: Coverage can be denied if there is insufficient medical documentation to support the necessity of Saxenda for the patient's treatment plan.
  •  

  • **Requests exceeding approved treatment duration**: If a request is made for a duration of Saxenda treatment that exceeds the approved or typical treatment timeline without appropriate justification, it may be denied.
  •  

  • **Failure to meet age requirements**: Coverage might be denied if the patient is outside the age range indicated in the Blue Cross Blue Shield policy guidelines.
  •  

  • **Concurrent use with other weight loss medications**: If the patient is using Saxenda alongside other medications designed for weight loss, coverage might be denied unless specified by policy.

 

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How Much Does Liraglutide (Saxenda) Cost without Insurance?

 

Liraglutide (Saxenda) Cost without Insurance

 

  • The cost of Liraglutide, commonly marketed under the brand name Saxenda, can vary based on location and pharmacy, but it typically ranges between $1,300 and $1,500 for a 30-day supply, which includes five injectable pens.
  •  

  • Prices can fluctuate due to factors like pharmacy pricing policies, manufacturer offers, and location. It is advisable to compare prices from various pharmacies or online sources.
  •  

  • Pharmacies may offer discount programs or coupons that could reduce the out-of-pocket cost. It's a good idea to inquire about available savings options.
  •  

  • Some online pharmacy platforms may provide competitive pricing and discounts, so checking these can be beneficial for finding better deals.
  •  

  • Prescription assistance programs, sometimes offered by the manufacturer, can provide help for individuals who meet certain income or insurance criteria. Exploring these options might also lead to cost savings.

 

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 Liraglutide (Saxenda) Coverage with Blue Cross Blue Shield of Massachusetts

 

Start by Reviewing Your Insurance Plan

 

  • Login to your Blue Cross Blue Shield of Massachusetts (BCBSMA) member account via their website or mobile app to access your current plan details.
  • Look through your plan documentation including the benefits booklet to determine if weight management or obesity medications are covered under your plan. Liraglutide (Saxenda) is typically classified under these categories.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Liraglutide (Saxenda) for your treatment plan.
  • Request a written recommendation or prescription from your provider. Ensure that the documentation highlights the medical necessity of Liraglutide for your condition.

 

Verify Liraglutide (Saxenda) Coverage

 

  • Contact BCBSMA customer service through the number on your insurance card to confirm if Liraglutide is covered under your policy.
  • Ask specifically about any prerequisites such as prior authorization, step therapy, or other requirements for Liraglutide coverage.
  • If it’s not covered, consider asking about appeal processes or alternative options that might be available for weight management.

 

Request Prior Authorization

 

  • If required, work with your healthcare provider to file a prior authorization request with BCBSMA. This often involves submitting detailed medical records and provider notes supporting the need for Liraglutide.
  • Make sure all required forms are correctly filled out and submitted timely as delays may impact the approval process.

 

Follow Up on the Approval Process

 

  • Keep in regular contact with BCBSMA to check the status of your authorization request. Be polite but persistent to ensure the request is being processed.
  • Prepare to supply any additional information if requested by BCBSMA to prevent delays in processing.

 

Getting Approval or Considering Alternatives

 

  • Once approved, review the approval terms including co-pays, supply limits, or any required monitoring by BCBSMA.
  • If your request is denied, discuss alternative treatments with your healthcare provider or consider lodging a formal appeal with the help of your provider's support.

 

Purchase and Pick-Up

 

  • Upon approval, fill your prescription for Liraglutide at a BCBSMA in-network pharmacy to avoid out-of-network charges.
  • Confirm the pharmacy is aware of the coverage approval to ensure they process the prescription at the correct rate.

 

Monitor Treatment and Insurance Coverage

 

  • Keep a log of any changes to your plan coverage or the status of the medication treatment to promptly handle any future insurance or treatment adjustments.
  • Schedule regular follow-ups with your healthcare provider to assess the effectiveness of Liraglutide and adjust treatment as necessary.

 

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.

Liraglutide (Saxenda) FAQ

How much weight can you lose with Saxenda?

 

Weight Loss with Saxenda

 

  • Clinical trials show Saxenda users can lose an average of 5-10% of their initial body weight over 56 weeks.
  •  

  • Weight loss can vary depending on factors such as initial weight, diet, and physical activity.
  •  

  • Combining Saxenda with a reduced-calorie diet and increased physical activity enhances results.
  •  

  • It's important to monitor progress and consult with a healthcare provider to tailor the plan to individual needs.
  •  

  • Results are not guaranteed, and lifestyle changes significantly influence effectiveness.

What are the side effects of Liraglutide?

 

Common Side Effects

 

  • Nausea, particularly when starting treatment.
  • Vomiting or diarrhea, which can lead to dehydration.
  • Reduced appetite, a desired effect for weight management.
  • Headaches and dizziness, usually mild to moderate.

 

Serious Side Effects

 

  • Severe abdominal pain, signaling possible pancreatitis.
  • Symptoms of thyroid tumors, such as neck swelling or difficulty swallowing.
  • Serious allergic reactions, including hives or breath difficulty.
  • Elevated heart rate or palpitations.

 

Recommendations

 

  • Alert healthcare providers about any side effects.
  • Hydrate well to minimize dehydration from gastrointestinal effects.
  • Monitor blood sugar if diabetic, as levels may change.

 

How does Saxenda work for weight loss?

 

Mechanism of Action

 

  • Saxenda (liraglutide) is a GLP-1 receptor agonist. It mimics the action of the glucagon-like peptide-1, a hormone involved in appetite regulation.
  •  

  • It enhances insulin secretion and delays gastric emptying, promoting a feeling of fullness.

 

Appetite Suppression

 

  • Saxenda targets areas of the brain that control hunger, reducing appetite and calorie intake.
  •  

  • This helps in forming healthier eating habits and better portion control.

 

Additional Benefits

 

  • Besides weight loss, it assists in improving glycemic control for type 2 diabetes patients.
  •  

  • May lead to reductions in waist circumference and improvements in cardiovascular measures.

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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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