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

Discover if Blue Cross Blue Shield of Michigan covers Liraglutide (Saxenda), reasons for denial, ways to secure coverage, costs, and FAQs.
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Coverage for Liraglutide (Saxenda)

 

  • Blue Cross Blue Shield of Michigan may cover Liraglutide (Saxenda) as a weight-loss medication under certain conditions.
  •  

  • Eligibility often requires a diagnosis of obesity or being overweight with a related health issue such as type 2 diabetes, high blood pressure, or high cholesterol.
  •  

  • Approval typically involves prior authorization, requiring detailed information from your healthcare provider justifying the medical necessity and expected outcomes of the treatment.
  •  

  • Patients may need to provide documentation of previous unsuccessful weight-loss efforts through lifestyle changes like diet and exercise.
  •  

  • Additional criteria may include BMI thresholds, with a BMI of 30 or higher for obesity or 27 with a related comorbid condition.

 

Basic Rules and Criteria

 

  • Verify your specific plan details, as coverage can vary widely.
  •  

  • Consult your healthcare provider and a BCBS customer service representative to ensure all documentation and required information is properly submitted.

 

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

 

Verify Your Insurance Benefits

 

  • Contact Blue Cross Blue Shield of Michigan customer service via the phone number on the back of your insurance card.
  •  

  • Ask a representative about your specific plan's coverage for prescription medications and, specifically, for Liraglutide (Saxenda).
  •  

  • Inquire if pre-authorization is required for Liraglutide (Saxenda) coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the potential benefits of Liraglutide (Saxenda) for your condition.
  •  

  • Ensure your healthcare provider is aware of your insurance plan with Blue Cross Blue Shield of Michigan and understands their coverage policies.
  •  

  • If required, ask your provider to write a letter of medical necessity, explaining why Liraglutide (Saxenda) is appropriate for you.

 

Obtain Pre-Authorization

 

  • If pre-authorization is necessary, your healthcare provider will need to initiate this process with Blue Cross Blue Shield of Michigan.
  •  

  • Your provider may need to provide medical records and the letter of medical necessity to support the request.
  •  

  • Follow up regularly with both your provider and insurance company to ensure the pre-authorization is progressing.

 

Check for Patient Assistance Programs

 

  • Research if there are patient assistance programs for Liraglutide (Saxenda) that could reduce your out-of-pocket expenses.
  •  

  • Pharmaceutical companies often have programs to help cover part of the medication's cost for eligible patients.
  •  

  • Apply for any applicable patient assistance programs or rebates.

 

Submit Your Prescription

 

  • Once pre-authorization is approved (if needed), have your healthcare provider send the prescription for Liraglutide (Saxenda) to a pharmacy in your insurance network.
  •  

  • Ensure all necessary documentation accompanies the prescription to avoid delays in processing.
  •  

  • Contact Blue Cross Blue Shield of Michigan if you encounter issues at the pharmacy related to coverage.

 

Monitor Your Coverage and Costs

 

  • Review your insurance statements and pharmacy receipts to ensure the correct coverage is applied to your medication.
  •  

  • Keep track of your out-of-pocket expenses and balance them against any maximums your insurance plan might have.
  •  

  • Contact Blue Cross Blue Shield of Michigan customer service for any discrepancies in billing and coverage details.

 

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FAQs

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

Discover if Blue Cross Blue Shield of Michigan covers Liraglutide (Saxenda), reasons for denial, ways to secure coverage, costs, and FAQs.
Curex allergy drops unboxing

Is Liraglutide (Saxenda) Covered by Blue Cross Blue Shield of Michigan

 

Coverage for Liraglutide (Saxenda)

 

  • Blue Cross Blue Shield of Michigan may cover Liraglutide (Saxenda) as a weight-loss medication under certain conditions.
  •  

  • Eligibility often requires a diagnosis of obesity or being overweight with a related health issue such as type 2 diabetes, high blood pressure, or high cholesterol.
  •  

  • Approval typically involves prior authorization, requiring detailed information from your healthcare provider justifying the medical necessity and expected outcomes of the treatment.
  •  

  • Patients may need to provide documentation of previous unsuccessful weight-loss efforts through lifestyle changes like diet and exercise.
  •  

  • Additional criteria may include BMI thresholds, with a BMI of 30 or higher for obesity or 27 with a related comorbid condition.

 

Basic Rules and Criteria

 

  • Verify your specific plan details, as coverage can vary widely.
  •  

  • Consult your healthcare provider and a BCBS customer service representative to ensure all documentation and required information is properly submitted.

 

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

 

Approved Criteria for Liraglutide (Saxenda) Coverage

 

  • **Diagnosis of Obesity**: The member must be diagnosed with obesity, which is defined as a Body Mass Index (BMI) of 30 kg/m2 or greater.
  •  

  • **Previous Weight Loss Efforts**: Documentation of prior unsuccessful weight loss efforts through lifestyle modifications such as diet and exercise is required.
  •  

  • **Co-morbid Conditions**: Members with a BMI of 27 kg/m2 or greater may also qualify if they have at least one weight-related co-morbid condition, such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • **Physician Evaluation and Prescription**: A healthcare provider must evaluate the member and provide a prescription for Liraglutide (Saxenda) as part of a comprehensive weight management program.
  •  

  • **Age Requirement**: Coverage is typically available for adult members 18 years of age and older.
  •  

  • **Continued Coverage**: Continued coverage requires documentation of weight loss after a trial period as specified by Blue Cross Blue Shield of Michigan.

 

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

 

Non-Medically Necessary Criteria

 

  • Blue Cross Blue Shield of Michigan may deny coverage for Liraglutide (Saxenda) if it is determined that the treatment is not medically necessary. This includes cases where the patient does not meet the defined medical criteria that justify the need for this medication.

 

Off-Label Usage

 

  • Coverage can be denied if Liraglutide (Saxenda) is prescribed for uses not approved by the Food and Drug Administration (FDA). Saxenda must be used strictly for its approved indications.

 

Lack of Documentation

 

  • If sufficient medical documentation is not provided to support the need for Liraglutide, Blue Cross Blue Shield of Michigan might deny the claim. Proper documentation includes a valid diagnosis and evidence of previous treatments and outcomes.

 

Age Restrictions

 

  • Certain age restrictions could apply, and Saxenda may not be covered for individuals outside these age limitations, especially if they are younger than the ages specified in the coverage guidelines.

 

Exclusion of Obesity Treatment

 

  • Liraglutide (Saxenda) might not be covered if the insurance plan specifically excludes treatments for obesity or weight loss, as some plans do not offer benefits for weight management medications.

 

Failure to Meet BMI Requirements

 

  • If the patient does not meet specific Body Mass Index (BMI) criteria set by the insurance policy, coverage for Saxenda may be denied. This typically includes a minimum BMI threshold to qualify for treatment.

 

Prior Authorization Denial

 

  • Cases where prior authorization is required but not obtained can lead to a denial. If the necessary approval procedures are not followed, Blue Cross Blue Shield of Michigan might refuse to cover the medication.

 

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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 Michigan

 

Verify Your Insurance Benefits

 

  • Contact Blue Cross Blue Shield of Michigan customer service via the phone number on the back of your insurance card.
  •  

  • Ask a representative about your specific plan's coverage for prescription medications and, specifically, for Liraglutide (Saxenda).
  •  

  • Inquire if pre-authorization is required for Liraglutide (Saxenda) coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the potential benefits of Liraglutide (Saxenda) for your condition.
  •  

  • Ensure your healthcare provider is aware of your insurance plan with Blue Cross Blue Shield of Michigan and understands their coverage policies.
  •  

  • If required, ask your provider to write a letter of medical necessity, explaining why Liraglutide (Saxenda) is appropriate for you.

 

Obtain Pre-Authorization

 

  • If pre-authorization is necessary, your healthcare provider will need to initiate this process with Blue Cross Blue Shield of Michigan.
  •  

  • Your provider may need to provide medical records and the letter of medical necessity to support the request.
  •  

  • Follow up regularly with both your provider and insurance company to ensure the pre-authorization is progressing.

 

Check for Patient Assistance Programs

 

  • Research if there are patient assistance programs for Liraglutide (Saxenda) that could reduce your out-of-pocket expenses.
  •  

  • Pharmaceutical companies often have programs to help cover part of the medication's cost for eligible patients.
  •  

  • Apply for any applicable patient assistance programs or rebates.

 

Submit Your Prescription

 

  • Once pre-authorization is approved (if needed), have your healthcare provider send the prescription for Liraglutide (Saxenda) to a pharmacy in your insurance network.
  •  

  • Ensure all necessary documentation accompanies the prescription to avoid delays in processing.
  •  

  • Contact Blue Cross Blue Shield of Michigan if you encounter issues at the pharmacy related to coverage.

 

Monitor Your Coverage and Costs

 

  • Review your insurance statements and pharmacy receipts to ensure the correct coverage is applied to your medication.
  •  

  • Keep track of your out-of-pocket expenses and balance them against any maximums your insurance plan might have.
  •  

  • Contact Blue Cross Blue Shield of Michigan customer service for any discrepancies in billing and coverage details.

 

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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.

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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