Does Blue Cross Blue Shield of Michigan Cover Orlistat (Xenical, Alli)

Find out if Blue Cross Blue Shield of Michigan covers Orlistat, tips to secure coverage, costs without insurance, and answers to common questions.
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Coverage Details for Orlistat (Xenical, Alli)

 

  • Blue Cross Blue Shield of Michigan may cover Orlistat, including both Xenical and Alli, under certain specific medical necessity criteria.
  •  

  • Coverage typically requires a doctor's prescription and proof of enrollment in a weight management program.
  •  

  • The patient may need to meet particular BMI thresholds and have documented attempts of weight loss through diet and exercise.
  •  

  • A prior authorization might be necessary, entailing verification from a healthcare provider that Orlistat is essential for treatment.
  •  

  • It's important to consult the member's specific plan details as coverage policies can vary.

 

Getting Started with the Approval Process

 

  • Contact your healthcare provider for appropriate documentation of your weight management efforts.
  •  

  • Reach out to Blue Cross Blue Shield of Michigan for detailed plan-specific information and to begin the prior authorization if needed.
  •  

  • Appeal the decision if the initial request for coverage is denied by following the insurance company's guidelines.

 

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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.

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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 Orlistat (Xenical, Alli) Coverage with Blue Cross Blue Shield of Michigan

 

Contact Your Healthcare Provider

 

  • Discuss your weight loss goals and medical history with your healthcare provider to determine if Orlistat is an appropriate medication for you.
  •  

  • Request a prescription for Orlistat (Xenical or Alli) if recommended by your healthcare provider.

 

Review Your Insurance Policy

 

  • Log in to your Blue Cross Blue Shield of Michigan member account or review your insurance policy documents to understand your pharmacy benefits.
  •  

  • Check if Orlistat (Xenical or Alli) is included in your prescription drug program or formulary.

 

Contact Customer Service

 

  • Call the customer service number on your insurance card to confirm coverage details for Orlistat.
  •  

  • Ask about any specific requirements or restrictions, such as prior authorization, that may be in place for Orlistat coverage.

 

Obtain Prior Authorization

 

  • If prior authorization is required, have your healthcare provider submit the necessary forms and documentation to Blue Cross Blue Shield of Michigan.
  •  

  • Ensure that the documentation includes your medical history, diagnosis, and any other relevant information to support the need for Orlistat.

 

Fill Your Prescription

 

  • Once approval is obtained, fill your Orlistat prescription at a participating pharmacy within the Blue Cross Blue Shield network.
  •  

  • Present your prescription card to ensure coverage is applied and confirm any copay or out-of-pocket costs at the pharmacy.

 

Monitor Your Benefits

 

  • Keep track of any changes to your prescription coverage or benefits from Blue Cross Blue Shield of Michigan.
  •  

  • Regularly review your insurance statements to ensure that Orlistat coverage is correctly applied and address any discrepancies with customer service.

 

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FAQs

Does Blue Cross Blue Shield of Michigan Cover Orlistat (Xenical, Alli)

Find out if Blue Cross Blue Shield of Michigan covers Orlistat, tips to secure coverage, costs without insurance, and answers to common questions.
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Is Orlistat (Xenical, Alli) Covered by Blue Cross Blue Shield of Michigan

 

Coverage Details for Orlistat (Xenical, Alli)

 

  • Blue Cross Blue Shield of Michigan may cover Orlistat, including both Xenical and Alli, under certain specific medical necessity criteria.
  •  

  • Coverage typically requires a doctor's prescription and proof of enrollment in a weight management program.
  •  

  • The patient may need to meet particular BMI thresholds and have documented attempts of weight loss through diet and exercise.
  •  

  • A prior authorization might be necessary, entailing verification from a healthcare provider that Orlistat is essential for treatment.
  •  

  • It's important to consult the member's specific plan details as coverage policies can vary.

 

Getting Started with the Approval Process

 

  • Contact your healthcare provider for appropriate documentation of your weight management efforts.
  •  

  • Reach out to Blue Cross Blue Shield of Michigan for detailed plan-specific information and to begin the prior authorization if needed.
  •  

  • Appeal the decision if the initial request for coverage is denied by following the insurance company's guidelines.

 

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Blue Cross Blue Shield of Michigan's Approved Criteria for Orlistat (Xenical, Alli) Coverage

 

Eligibility Criteria

 

  • Patient must meet a defined BMI requirement, typically a BMI of 30 or higher for general obesity treatment, or a BMI of 27 or higher with accompanying obesity-related conditions such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Documentation of a comprehensive weight loss program that includes a reduced-calorie diet, increased physical activity, and behavior modification. The patient must demonstrate a commitment to lifestyle changes to support weight loss efforts.
  •  

 

Medical Evaluation and Documentation

 

  • Patient should have a documented history of unsuccessful attempts at weight loss with non-medicated interventions, verified through a healthcare provider's notes indicating previous weight loss regimens.
  •  

  • A thorough medical evaluation to rule out contraindications for Orlistat use, including malabsorption syndromes and cholestasis, should be completed and documented in the patient's medical records.
  •  

  • Healthcare provider must provide a comprehensive weight management plan that incorporates Orlistat as a component, not a standalone solution, emphasizing the need for concurrent dietary and lifestyle efforts.
  •  

 

Ongoing Monitoring and Compliance

 

  • Insurance coverage of Orlistat may require regular follow-up visits with the healthcare provider to monitor weight loss progress, adherence to the medication, and any potential side effects or issues in order to continue the therapy.
  •  

  • Patient compliance with both the medication regimen and the overall weight management program should be documented at regular intervals, supporting continued insurance coverage.
  •  

  • The patient’s progress should be evaluated at designated intervals, and continuation criteria may include achieving and maintaining a specified percentage of weight loss from baseline or other clinical indicators of improved health.
  •  

 

Prescription Guidelines

 

  • The prescription for Orlistat must be issued by a healthcare provider who is actively managing the patient's weight loss treatment and is aware of the prescribed medication within the context of the comprehensive plan.
  •  

  • The initial prescription might be covered for a definitive trial period, for example, 12 weeks, with continuation of coverage contingent upon demonstrating a required clinical benefit.
  •  

  • In some cases, specific documentation from the healthcare provider confirming the patient's eligibility criteria and compliance with treatment management might be required for initial prescription authorization.
  •  

 

Why Blue Cross Blue Shield of Michigan Might Deny Orlistat (Xenical, Alli) Coverage

 

Reasons for Orlistat Coverage Denial

 

  • Orlistat has not been prescribed for an FDA-approved indication, such as obesity management. Any off-label use may result in denial.
  •  

  • The patient’s body mass index (BMI) does not meet the specific threshold required by Blue Cross Blue Shield of Michigan for coverage of weight-loss medications.
  •  

  • There is insufficient documentation supporting the medical necessity of Orlistat, as required by the insurer’s policy guidelines.
  •  

  • The patient failed to adhere to alternative weight management strategies, including diet and exercise programs, prior to seeking medication coverage.
  •  

  • The prescription exceeds the dosage or quantity limits set forth by the insurer’s formulary guidelines.
  •  

  • Coverage restrictions based on the patient’s age group are not met, particularly if Orlistat is not approved for certain age categories under the plan.
  •  

  • The patient has not gone through the required step therapy protocols, potentially needing to try less expensive weight-loss medications first.
  •  

  • The policy does not include coverage for medications or services related to cosmetic or non-essential weight loss.

 

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How Much Does Orlistat (Xenical, Alli) Cost without Insurance?

 

Cost of Orlistat (Xenical, Alli) Without Insurance

 

  • Xenical: The brand-name Orlistat, Xenical, can be quite expensive without insurance. Typically, the cost is around $800 to $1,000 for a supply of 90 capsules, with each capsule being 120 mg.
  •  

  • Alli: The over-the-counter version, Alli, is generally less expensive than its prescription counterpart. The price for Alli ranges from $50 to $100 for a supply of 120 capsules, with each capsule being 60 mg.
  •  

  • Generic Orlistat: While generic options may be available, they usually do not offer significant savings over the brand-name versions. The prices for generic Orlistat are often comparable to those of Alli, varying from $50 to $100 for a similar quantity.
  •  

  • Shopping Tips: Prices can vary depending on the pharmacy, location, and availability. Consider using pharmacy discount cards, online coupons, or comparing prices at different pharmacies to obtain the best deal.
  •  

  • Considerations: Always consult a healthcare provider before starting Orlistat, and discuss any potential insurance coverage or assistance programs they might recommend.

 

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 Orlistat (Xenical, Alli) Coverage with Blue Cross Blue Shield of Michigan

 

Contact Your Healthcare Provider

 

  • Discuss your weight loss goals and medical history with your healthcare provider to determine if Orlistat is an appropriate medication for you.
  •  

  • Request a prescription for Orlistat (Xenical or Alli) if recommended by your healthcare provider.

 

Review Your Insurance Policy

 

  • Log in to your Blue Cross Blue Shield of Michigan member account or review your insurance policy documents to understand your pharmacy benefits.
  •  

  • Check if Orlistat (Xenical or Alli) is included in your prescription drug program or formulary.

 

Contact Customer Service

 

  • Call the customer service number on your insurance card to confirm coverage details for Orlistat.
  •  

  • Ask about any specific requirements or restrictions, such as prior authorization, that may be in place for Orlistat coverage.

 

Obtain Prior Authorization

 

  • If prior authorization is required, have your healthcare provider submit the necessary forms and documentation to Blue Cross Blue Shield of Michigan.
  •  

  • Ensure that the documentation includes your medical history, diagnosis, and any other relevant information to support the need for Orlistat.

 

Fill Your Prescription

 

  • Once approval is obtained, fill your Orlistat prescription at a participating pharmacy within the Blue Cross Blue Shield network.
  •  

  • Present your prescription card to ensure coverage is applied and confirm any copay or out-of-pocket costs at the pharmacy.

 

Monitor Your Benefits

 

  • Keep track of any changes to your prescription coverage or benefits from Blue Cross Blue Shield of Michigan.
  •  

  • Regularly review your insurance statements to ensure that Orlistat coverage is correctly applied and address any discrepancies with customer service.

 

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.

Orlistat (Xenical, Alli) FAQ

1. What are the side effects of taking Orlistat?

 

Possible Side Effects of Orlistat

 

  • Gastrointestinal issues: Common effects include oily or fatty stools, increased defecation, and the urgent or difficult need to control bowel movements.
  •  

  • Abdominal discomfort: Some users experience pain or discomfort in the abdomen region.
  •  

  • Reduced absorption of fat-soluble vitamins: Orlistat can interfere with the absorption of vitamins A, D, E, and K. A multivitamin supplement is often recommended.
  •  

  • Allergic reactions: Though rare, symptoms may include itching, rash, or swelling, especially of the face, tongue, or throat.
  •  

  • Others: Some users report headaches, back pain, or flu-like symptoms.

 

2. How effective is Orlistat for weight loss?

 

Effectiveness of Orlistat

 

  • Orlistat aids weight loss by blocking the absorption of fats from the diet, reducing caloric intake. It can block approximately 25-30% of dietary fat.
  •  

  • Clinical studies suggest that Orlistat use for one year can result in an average weight loss of about 5-10% of initial body weight, when combined with a calorie-reduced diet.
  •  

  • It promotes modest weight loss over time and helps maintain weight loss. The effectiveness can improve with lifestyle changes such as increased physical activity and diet modifications.
  •  

  • Orlistat also has beneficial effects on cholesterol levels and may help reduce blood pressure.

 

3. Can I buy Orlistat over the counter?

 

Can I Buy Orlistat Over the Counter?

 

  • Orlistat is available in two forms: prescription strength (Xenical) and over-the-counter (Alli).
  •  

  • **Xenical**: This is the 120 mg version and requires a doctor's prescription. It's typically used for patients with a higher body mass index (BMI) or more specific medical conditions.
  •  

  • **Alli**: The 60 mg variant can be purchased over the counter in many countries, including the United States and the UK.
  •  

  • Even though Alli is accessible without a prescription, it is advised to consult with a healthcare professional before starting, to discuss its suitability and ensure proper usage.
  •  

 

Considerations Before Using Orlistat

 

  • Proper dietary changes are necessary when taking Orlistat to maximize effectiveness and reduce side effects.
  •  

  • Discuss your complete medical history and any other medications you are taking with your healthcare provider.

 

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A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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