Does Blue Cross Blue Shield of Massachusetts Cover Naltrexone/Bupropion (Contrave)

Explore coverage for Contrave by Blue Cross Blue Shield MA, reasons for denial, tips to secure coverage, costs without insurance, and FAQs.
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Naltrexone/Bupropion (Contrave) Coverage

 

  • Blue Cross Blue Shield of Massachusetts (BCBSMA) may cover Naltrexone/Bupropion (Contrave) under certain conditions, primarily when it is deemed medically necessary for weight management in adults who are overweight/obese with related health conditions.
  •  

  • The medication might be covered if the patient has a Body Mass Index (BMI) of 30 kg/m² or greater or a BMI of 27 kg/m² or greater with weight-related medical problems such as diabetes or hypertension.
  •  

 

Basic Rules and Criteria

 

  • Prior authorization may be required, indicating that BCBSMA must approve the prescription before covering it. This typically involves documentation from a healthcare provider outlining the necessity based on health conditions and previous treatment attempts.
  •  

  • Patients may need to demonstrate unsuccessful attempts with diet and exercise alone or other weight management therapies before Contrave is approved.
  •  

  • Coverage specifics can vary based on the individual's plan, so contacting BCBSMA directly or reviewing the member benefits handbook is advisable for precise details.

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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 Naltrexone/Bupropion (Contrave) Coverage with Blue Cross Blue Shield of Massachusetts

 

Contact Your Doctor

 

  • Discuss with your healthcare provider about the necessity of taking Naltrexone/Bupropion (Contrave) for your condition.
  •  

  • Ensure that your doctor is aware of the coverage policies associated with Blue Cross Blue Shield of Massachusetts.

 

Verify Coverage

 

  • Log into your Blue Cross Blue Shield of Massachusetts member account online or contact their customer service to determine if Naltrexone/Bupropion (Contrave) is covered under your plan.
  •  

  • Check for any specific guidelines or restrictions regarding weight management medications.

 

Request Prior Authorization (if applicable)

 

  • If required, ask your healthcare provider to submit a prior authorization request to Blue Cross Blue Shield of Massachusetts. This usually includes providing medical justification for the prescription.
  •  

  • Gather necessary documentation to support the case, such as BMI records, other weight management strategies attempted, and related health conditions.

 

Understand Your Benefits

 

  • Review your health plan benefits to understand copayments, deductibles, or any out-of-pocket costs associated with Naltrexone/Bupropion (Contrave).
  •  

  • Be aware of any yearly limits or required approvals for continuing the medication coverage.

 

Fill Your Prescription

 

  • Once authorization is approved, take your prescription to a pharmacy that is within the network preferred by Blue Cross Blue Shield of Massachusetts.
  •  

  • Ensure the pharmacy understands your coverage for Naltrexone/Bupropion (Contrave) to avoid unexpected costs.

 

Appeal Denials

 

  • If your request for coverage is denied, review the denial letter to understand the reasons provided.
  •  

  • Work with your healthcare provider to gather more evidence or documentation and submit an appeal through Blue Cross Blue Shield of Massachusetts' appeal process.
  •  

  • Follow up regularly to check the status of your appeal.

 

Track Any Changes

 

  • Keep informed about any changes to drug formularies and updates to the coverage policies from Blue Cross Blue Shield of Massachusetts.
  •  

  • Regularly check your member portal or communication materials for any notifications or updates related to medication coverage.

 

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FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Naltrexone/Bupropion (Contrave)

Explore coverage for Contrave by Blue Cross Blue Shield MA, reasons for denial, tips to secure coverage, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by Blue Cross Blue Shield of Massachusetts

 

Naltrexone/Bupropion (Contrave) Coverage

 

  • Blue Cross Blue Shield of Massachusetts (BCBSMA) may cover Naltrexone/Bupropion (Contrave) under certain conditions, primarily when it is deemed medically necessary for weight management in adults who are overweight/obese with related health conditions.
  •  

  • The medication might be covered if the patient has a Body Mass Index (BMI) of 30 kg/m² or greater or a BMI of 27 kg/m² or greater with weight-related medical problems such as diabetes or hypertension.
  •  

 

Basic Rules and Criteria

 

  • Prior authorization may be required, indicating that BCBSMA must approve the prescription before covering it. This typically involves documentation from a healthcare provider outlining the necessity based on health conditions and previous treatment attempts.
  •  

  • Patients may need to demonstrate unsuccessful attempts with diet and exercise alone or other weight management therapies before Contrave is approved.
  •  

  • Coverage specifics can vary based on the individual's plan, so contacting BCBSMA directly or reviewing the member benefits handbook is advisable for precise details.

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Blue Cross Blue Shield of Massachusetts's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Qualifying Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

  • The patient must be 18 years of age or older.
  •  

  • A diagnosis of obesity or overweight with a related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia is required.
  •  

  • A documented history of previous weight management efforts, such as a medically supervised weight loss program or pharmacotherapy, must be provided.
  •  

  • The patient should have a body mass index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with one or more obesity-related conditions.

 

Documentation Requirements

 

  • Submission of an initiated and updated medical record detailing the patient's history, diagnosis, and clinical status.
  •  

  • Evidence of the patient's engagement in a comprehensive weight loss program, which includes dietary modifications, physical activity, and behavior therapy.
  •  

  • Rationale for the prescription: an explicit statement from the prescriber explaining the therapeutic need and rationale for using Naltrexone/Bupropion.

 

Additional Guidelines

 

  • The medication must be prescribed by or in consultation with a healthcare provider specializing in obesity or endocrinology.
  •  

  • Continuous evaluation of the patient's response to therapy is required. Coverage may be contingent upon progress as determined by the provider.
  •  

  • Compliance with prescribed regimen and attendance in follow-up appointments should be demonstrated.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Situations When Coverage is Denied for Naltrexone/Bupropion (Contrave)

 

  • Non-compliance with prior authorization requirements, where the prescriber must document the medical necessity before the insurance provides coverage.
  •  

  • Failure to meet specific medical criteria such as a Body Mass Index (BMI) under a certain threshold, indicating that the drug is not medically necessary for weight management based on standardized guidelines.
  •  

  • Lack of documented trial and failure or contraindication to lower-cost alternatives that may be required under the insurance policy before using more expensive medications like Contrave.
  •  

  • Prescribing the medication for non-FDA-approved uses, which can include scenarios beyond its intended use for managing obesity or weight-related conditions.
  •  

  • Requests outside of safety and clinical guidelines, including dosages or durations of therapy that exceed recommended or approved protocols.
  •  

  • Using the medication in a population not covered by the policy, such as age groups or other demographics specifically excluded in the plan stipulations.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Naltrexone/Bupropion (Contrave) Cost without Insurance?

 

Cost of Naltrexone/Bupropion (Contrave) Without Insurance

 

  • The cost of Naltrexone/Bupropion (Contrave) without insurance can vary significantly depending on the pharmacy you visit. On average, you might expect to pay around $100 to $300 for a 30-day supply.
  •  

  • The price can differ between pharmacies, so it may be beneficial to shop around or use a pharmacy discount card to potentially reduce the cost.
  •  

  • Coupons or discount programs offered by manufacturers or online platforms might further lower the expense, sometimes making it more affordable than the average cash price.
  •  

  • Factors such as generic availability or quantity prescribed also influence the price, with larger prescriptions potentially offering a lower cost per unit.

 

Ways to Lower Your Cost

 

  • Check online resources or discount programs that provide coupons applicable at various pharmacies to potentially save money.
  •  

  • Discuss with your healthcare provider about any potential lower-cost alternatives or generics, if available, which could lower your expenses.
  •  

  • Consider pharmacy loyalty programs or memberships, which often provide discounts on prescriptions.
  •  

  • Consult with your pharmacy about any special savings programs or payment plans they might offer, which can reduce financial burden.

 

Conclusion

 

  • Naltrexone/Bupropion (Contrave) is a medication whose price can vary widely without insurance, typically costing around $100 to $300 per month.
  •  

  • Utilize discounts, coupons, and comparison shopping to find the most cost-effective option.
  •  

  • Consult with healthcare professionals for advice on managing these costs and addressing any financial concerns related to prescriptions.

 

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 Naltrexone/Bupropion (Contrave) Coverage with Blue Cross Blue Shield of Massachusetts

 

Contact Your Doctor

 

  • Discuss with your healthcare provider about the necessity of taking Naltrexone/Bupropion (Contrave) for your condition.
  •  

  • Ensure that your doctor is aware of the coverage policies associated with Blue Cross Blue Shield of Massachusetts.

 

Verify Coverage

 

  • Log into your Blue Cross Blue Shield of Massachusetts member account online or contact their customer service to determine if Naltrexone/Bupropion (Contrave) is covered under your plan.
  •  

  • Check for any specific guidelines or restrictions regarding weight management medications.

 

Request Prior Authorization (if applicable)

 

  • If required, ask your healthcare provider to submit a prior authorization request to Blue Cross Blue Shield of Massachusetts. This usually includes providing medical justification for the prescription.
  •  

  • Gather necessary documentation to support the case, such as BMI records, other weight management strategies attempted, and related health conditions.

 

Understand Your Benefits

 

  • Review your health plan benefits to understand copayments, deductibles, or any out-of-pocket costs associated with Naltrexone/Bupropion (Contrave).
  •  

  • Be aware of any yearly limits or required approvals for continuing the medication coverage.

 

Fill Your Prescription

 

  • Once authorization is approved, take your prescription to a pharmacy that is within the network preferred by Blue Cross Blue Shield of Massachusetts.
  •  

  • Ensure the pharmacy understands your coverage for Naltrexone/Bupropion (Contrave) to avoid unexpected costs.

 

Appeal Denials

 

  • If your request for coverage is denied, review the denial letter to understand the reasons provided.
  •  

  • Work with your healthcare provider to gather more evidence or documentation and submit an appeal through Blue Cross Blue Shield of Massachusetts' appeal process.
  •  

  • Follow up regularly to check the status of your appeal.

 

Track Any Changes

 

  • Keep informed about any changes to drug formularies and updates to the coverage policies from Blue Cross Blue Shield of Massachusetts.
  •  

  • Regularly check your member portal or communication materials for any notifications or updates related to medication coverage.

 

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.

Naltrexone/Bupropion (Contrave) FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting can occur, often diminishing over time.
  • Headaches or dizziness are also common, especially early in treatment.
  • Constipation or diarrhea may affect some users.
  • Insomnia and a higher heart rate can occur with usage.

 

Serious Side Effects

 

  • Risk of seizures, especially if there's a history of seizures.
  • Suicidal thoughts or behaviors can increase in some individuals.
  • Increased blood pressure; monitoring is advised.
  • Allergic reactions are possible, presenting as rash, itching, or swelling.

 

Precautions

 

  • Ensure no history of seizure disorders before starting.
  • Disclose any mental health history to your healthcare provider.
  • Assess any medications for potential interactions.
  • Regularly monitor blood pressure when on this medication.

 

How fast can you lose weight with Contrave?

 

What is Contrave?

 

  • Contrave is a combination of naltrexone and bupropion, approved for chronic weight management in adults.

 

How Fast Can You Lose Weight?

 

  • Clinical studies show patients can lose 5-10% of their body weight over 12-24 weeks.
  • Weight loss varies due to individual factors like diet, exercise, and adherence.
  • Initial results might be seen in 4 weeks, with more significant loss over months.

 

Important Considerations

 

  • Must be combined with a reduced-calorie diet and increased physical activity.
  • Not suitable for everyone; consult your healthcare provider before starting.
  • Monitoring for side effects like nausea or dizziness is crucial.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Drinking alcohol while taking Contrave is generally not recommended. Contrave contains naltrexone and bupropion, which may interact negatively with alcohol.
  •  

  • Naltrexone may increase the risk of liver damage when combined with alcohol, and bupropion may heighten seizure risk, both exacerbated by alcohol consumption.
  •  

  • Alcohol can counteract Contrave's effects on weight management and addiction control, undermining its efficacy.
  •  

  • Consult your healthcare provider for personalized advice, as they can determine safe alcohol usage considering your specific health conditions and medication dosage.

 

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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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