Does Blue Cross Blue Shield of Massachusetts Cover Phentermine (Adipex-P, Lomaira)

Explore if Blue Cross Blue Shield MA covers Phentermine, reasons for denial, coverage tips, costs without insurance, and FAQs in our detailed article.
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Coverage Overview

 

  • Blue Cross Blue Shield of Massachusetts may cover Phentermine (Adipex-P, Lomaira) under specific conditions.
  •  

  • Prescription is generally required for obesity management when other weight loss methods have failed.

 

Eligibility Criteria

 

  • Patient must typically have a BMI of 30 or higher, or 27 with related health conditions.
  •  

  • A documented history of unsuccessful weight loss attempts through diet and exercise is often necessary.

 

Prescription Rules

 

  • Phentermine should only be prescribed by a licensed healthcare provider.
  •  

  • Coverage may require prior authorization or additional documentation from the prescribing physician.

 

Steps to Ensure Coverage

 

  • Consult with your healthcare provider to discuss whether Phentermine is appropriate for your situation.
  •  

  • Contact Blue Cross Blue Shield of Massachusetts to verify coverage details and obtain any necessary pre-authorizations.

 

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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 Phentermine (Adipex-P, Lomaira) Coverage with Blue Cross Blue Shield of Massachusetts

 

Initial Research and Preparation

 

  • Review your current Blue Cross Blue Shield of Massachusetts (BCBS MA) health plan policy to understand prescription drug coverage specifics.
  • Check if your policy includes weight loss medications and any specific criteria for phentermine coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about your need for Phentermine (Adipex-P, Lomaira) and discuss potential benefits and side effects.
  • Ensure your doctor is willing to provide medical documentation supporting the necessity for Phentermine treatment.

 

Verify Prescription Benefits

 

  • Contact BCBS MA customer service for detailed information about prescription drug benefits and confirm if Phentermine is covered under your plan.
  • Ask about any requirements such as prior authorization, step therapy, or specific medical criteria that need to be met for coverage approval.

 

Prior Authorization Process

 

  • If BCBS MA requires prior authorization, have your healthcare provider submit a request with necessary medical justification and any required forms.
  • Ensure your provider includes comprehensive documentation of your medical condition and attempts at alternative treatments, if applicable.

 

Follow Up on Authorization Request

 

  • Stay in contact with your healthcare provider and BCBS MA to monitor the status of your prior authorization request.
  • Provide any additional information promptly if requested by BCBS MA to expedite the process.

 

Appeal if Necessary

 

  • If your request for coverage is denied, review the denial letter carefully to understand the reasons.
  • Work with your healthcare provider to gather additional evidence or documentation and submit an appeal to BCBS MA for reconsideration.

 

Purchase and Reimbursement

 

  • Once approved, fill your prescription through a pharmacy that is in-network with BCBS MA to ensure optimal coverage and pricing.
  • If you have any out-of-pocket costs, keep all receipts and documentation for potential reimbursement claims, if such options are available under your plan.

 

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FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Phentermine (Adipex-P, Lomaira)

Explore if Blue Cross Blue Shield MA covers Phentermine, reasons for denial, coverage tips, costs without insurance, and FAQs in our detailed article.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by Blue Cross Blue Shield of Massachusetts

 

Coverage Overview

 

  • Blue Cross Blue Shield of Massachusetts may cover Phentermine (Adipex-P, Lomaira) under specific conditions.
  •  

  • Prescription is generally required for obesity management when other weight loss methods have failed.

 

Eligibility Criteria

 

  • Patient must typically have a BMI of 30 or higher, or 27 with related health conditions.
  •  

  • A documented history of unsuccessful weight loss attempts through diet and exercise is often necessary.

 

Prescription Rules

 

  • Phentermine should only be prescribed by a licensed healthcare provider.
  •  

  • Coverage may require prior authorization or additional documentation from the prescribing physician.

 

Steps to Ensure Coverage

 

  • Consult with your healthcare provider to discuss whether Phentermine is appropriate for your situation.
  •  

  • Contact Blue Cross Blue Shield of Massachusetts to verify coverage details and obtain any necessary pre-authorizations.

 

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Blue Cross Blue Shield of Massachusetts's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Eligibility for Coverage of Phentermine

 

  • The patient must have a Body Mass Index (BMI) of 30 kg/m2 or higher, which classifies them as obese.
  •  

  • In some cases, patients with a BMI of 27 kg/m2 or higher may qualify if they have obesity-related comorbidities such as hypertension, type 2 diabetes, or dyslipidemia.

 

Age Requirements

 

  • Phentermine is typically covered for patients aged 16 to 64. Patients outside this age range may require additional justification for coverage.

 

Treatment Plan Documentation

 

  • The prescribing physician must provide documentation of a comprehensive weight management program that includes lifestyle modification strategies focused on diet, exercise, and behavioral changes, in conjunction with Phentermine use.
  •  

  • Evidence of previous trials and responses to other weight loss medications, if applicable, may be required to support the necessity for Phentermine.

 

Duration of Therapy

 

  • Coverage is typically approved for a short-term duration of up to 12 weeks due to the drug's potential for dependency and side effects.
  •  

  • Requests for extended use beyond 12 weeks require documentation of significant weight loss achievements and continued medical supervision.

 

Follow-Up and Monitoring

 

  • Ongoing monitoring by the prescribing physician is required, with documentation of weight loss progress, side effects, and overall health improvements.
  •  

  • Regular follow-up appointments should be part of the treatment plan to assess the patient's health status and adjust the therapy if necessary.

 

Pharmacy Requirements

 

  • The medication must be dispensed through a participating pharmacy that complies with Blue Cross Blue Shield of Massachusetts's preferred network setup.
  •  

  • Prescription must include the planned dosage and any other prescribing information deemed necessary.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Situations Where Blue Cross Blue Shield of Massachusetts Might Deny Phentermine Coverage

 

  • Phentermine is not approved for use beyond a short-term duration, typically a few weeks, and prescriptions extending beyond this may not be covered.
  •  

  • Coverage is often denied for patients using Phentermine if it is prescribed for purposes other than weight loss in conjunction with a reduced-calorie diet and exercise.
  •  

  • Patients without a documented Body Mass Index (BMI) of 30 or higher, or 27 with related health conditions such as hypertension, might face a denial of coverage.
  •  

  • Individuals who have not attempted alternative weight loss methods prior to seeking Phentermine may not meet the coverage criteria set by the insurer.
  •  

  • Usage of Phentermine is not covered if there are contraindications noted in the patient's medical history, such as prior cardiovascular issues or hyperthyroidism.
  •  

  • Patients with a history of drug abuse or dependency may be denied coverage for Phentermine due to its potential for addiction.
  •  

  • Claims for Phentermine may be rejected if proper documentation, like the prescribing physician’s rationale and patient’s weight management history, is not provided.

 

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How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 Phentermine (Adipex-P, Lomaira) Coverage with Blue Cross Blue Shield of Massachusetts

 

Initial Research and Preparation

 

  • Review your current Blue Cross Blue Shield of Massachusetts (BCBS MA) health plan policy to understand prescription drug coverage specifics.
  • Check if your policy includes weight loss medications and any specific criteria for phentermine coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about your need for Phentermine (Adipex-P, Lomaira) and discuss potential benefits and side effects.
  • Ensure your doctor is willing to provide medical documentation supporting the necessity for Phentermine treatment.

 

Verify Prescription Benefits

 

  • Contact BCBS MA customer service for detailed information about prescription drug benefits and confirm if Phentermine is covered under your plan.
  • Ask about any requirements such as prior authorization, step therapy, or specific medical criteria that need to be met for coverage approval.

 

Prior Authorization Process

 

  • If BCBS MA requires prior authorization, have your healthcare provider submit a request with necessary medical justification and any required forms.
  • Ensure your provider includes comprehensive documentation of your medical condition and attempts at alternative treatments, if applicable.

 

Follow Up on Authorization Request

 

  • Stay in contact with your healthcare provider and BCBS MA to monitor the status of your prior authorization request.
  • Provide any additional information promptly if requested by BCBS MA to expedite the process.

 

Appeal if Necessary

 

  • If your request for coverage is denied, review the denial letter carefully to understand the reasons.
  • Work with your healthcare provider to gather additional evidence or documentation and submit an appeal to BCBS MA for reconsideration.

 

Purchase and Reimbursement

 

  • Once approved, fill your prescription through a pharmacy that is in-network with BCBS MA to ensure optimal coverage and pricing.
  • If you have any out-of-pocket costs, keep all receipts and documentation for potential reimbursement claims, if such options are available under your plan.

 

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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.

Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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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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