Does Blue Cross Blue Shield of Minnesota Cover Contrave

Explore Contrave coverage by Blue Cross Blue Shield of Minnesota, learn appeals, costs without insurance, and get answers to common questions in this informative guide.
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Coverage for Contrave

 

  • Blue Cross Blue Shield of Minnesota may cover Contrave, but this depends on the specific insurance plan you have. Coverage varies based on factors like medical necessity and prior authorization results.
  •  

  • Contrave is typically covered for weight loss treatment in patients who meet specific criteria based on Body Mass Index (BMI) and related health conditions.

 

Criteria for Coverage

 

  • Patient must meet a minimum BMI requirement, often 30 or greater, or 27 with weight-related health conditions such as hypertension or Type 2 diabetes.
  •  

  • Your doctor may need to provide documentation demonstrating that other weight loss attempts have been unsuccessful.

 

Authorization and Rules

 

  • Coverage often requires prior authorization, where your healthcare provider submits a request justifying the prescription. Approval must be obtained before filling the prescription to ensure coverage.
  •  

  • Copayments or co-insurance may apply, depending on the terms of your plan.

 

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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 Contrave Coverage with Blue Cross Blue Shield of Minnesota

 

Initial Research and Preparation

 

  • Visit the official Blue Cross Blue Shield of Minnesota website to gather information about their coverage policies related to weight management medications, including Contrave.
  •  

  • Review your specific health insurance policy documents to determine if there are any exclusions, restrictions, or prior authorization requirements for coverage of weight loss medications.
  •  

  • Contact Blue Cross Blue Shield customer service via phone or through their online portal to get detailed information on Contrave coverage and any necessary steps for approval.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your weight management needs and the potential benefits of Contrave for your situation.
  •  

  • Request a written prescription for Contrave from your healthcare provider, ensuring it includes relevant medical justification that supports its necessity for your treatment.

 

Submit the Prior Authorization Request

 

  • Check if Blue Cross Blue Shield of Minnesota requires prior authorization for Contrave, as this is often mandatory for medications such as weight loss drugs.
  •  

  • If prior authorization is needed, work with your healthcare provider to complete and submit the necessary forms. These documents should detail the medical necessity of Contrave and include any supporting letters or medical records.
  •  

  • Follow up directly with Blue Cross Blue Shield to confirm receipt and processing of your prior authorization request.

 

Appeal if Necessary

 

  • If your initial request for coverage is denied, review the denial letter from Blue Cross Blue Shield carefully to understand the reasons for denial.
  •  

  • Gather any additional supporting documentation, such as further medical opinions or detailed treatment history, and file an appeal with Blue Cross Blue Shield of Minnesota.
  •  

  • Consider seeking assistance from your healthcare provider for the appeal process, as they may provide additional medical justification or clarification.

 

Check for Patient Assistance Programs

 

  • Explore manufacturer-sponsored patient assistance programs, which may offer financial assistance or discounts for Contrave if insurance coverage is incomplete or unavailable.
  •  

  • Contact the Contrave manufacturer or visit their website for information on available support programs, eligibility requirements, and application procedures.

 

Monitor and Maintain Coverage

 

  • Once Contrave is approved and covered, continuously monitor your prescriptions and Blue Cross Blue Shield statements to ensure ongoing coverage without unexpected changes.
  •  

  • Keep open communication with your healthcare provider and insurance company to stay informed about any policy updates, changes in medication needs, or renewal requirements for prior authorization.

 

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FAQs

Does Blue Cross Blue Shield of Minnesota Cover Contrave

Explore Contrave coverage by Blue Cross Blue Shield of Minnesota, learn appeals, costs without insurance, and get answers to common questions in this informative guide.
Curex allergy drops unboxing

Is Contrave Covered by Blue Cross Blue Shield of Minnesota

 

Coverage for Contrave

 

  • Blue Cross Blue Shield of Minnesota may cover Contrave, but this depends on the specific insurance plan you have. Coverage varies based on factors like medical necessity and prior authorization results.
  •  

  • Contrave is typically covered for weight loss treatment in patients who meet specific criteria based on Body Mass Index (BMI) and related health conditions.

 

Criteria for Coverage

 

  • Patient must meet a minimum BMI requirement, often 30 or greater, or 27 with weight-related health conditions such as hypertension or Type 2 diabetes.
  •  

  • Your doctor may need to provide documentation demonstrating that other weight loss attempts have been unsuccessful.

 

Authorization and Rules

 

  • Coverage often requires prior authorization, where your healthcare provider submits a request justifying the prescription. Approval must be obtained before filling the prescription to ensure coverage.
  •  

  • Copayments or co-insurance may apply, depending on the terms of your plan.

 

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Blue Cross Blue Shield of Minnesota's Approved Criteria for Contrave Coverage

 

Eligibility Criteria for Contrave Coverage

 

  • Member must have a body mass index (BMI) of 30 kg/m² or greater, OR a BMI of 27 kg/m² or greater with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Documentation of previous weight loss attempts such as lifestyle changes, dietary modifications, or other pharmacological interventions that were unsuccessful, as submitted by a healthcare professional.
  •  

  • Contrave must be prescribed by a healthcare provider with expertise in managing obesity, ensuring patient suitability for the medication.
  •  

  • A comprehensive weight loss plan that includes Contrave as part of a broader strategy involving diet, physical activity, and behavioral modification, must be in place and agreed upon.
  •  

  • Initial coverage may require a trial period of 12 weeks, during which clinical documentation of body weight reduction is required to demonstrate effectiveness.

 

Continuation Criteria for Contrave Coverage

 

  • Significant weight loss must be documented during the 12-week trial period. Typically, a minimum of 5% of body weight reduction from baseline is required to continue therapy.
  •  

  • Regular follow-up consultations with the prescribing healthcare provider must be maintained for ongoing assessment of efficacy and safety.
  •  

  • Renewal of coverage may also require demonstration of maintained or continued weight loss beyond the initial period.

 

General Requirements

 

  • Members must be at least 18 years of age to be eligible for coverage.
  •  

  • Contrave is expected to be used in conjunction with a reduced-calorie diet and increased physical activity.
  •  

  • Documentation provided must be in alignment with Blue Cross Blue Shield of Minnesota's guidelines and submitted for review and approval by the insurance provider.

 

Why Blue Cross Blue Shield of Minnesota Might Deny Contrave Coverage

 

Contrave Non-Coverage Criteria by Blue Cross Blue Shield of Minnesota

 

  • Contrave is considered experimental or investigational for the insured individual's condition, meaning sufficient clinical evidence demonstrating its safety and efficacy for a particular use has not been established.
  •  

  • The patient does not meet the specific body mass index (BMI) criteria set by Blue Cross Blue Shield of Minnesota for obesity treatment coverage, often requiring a BMI of 30 or higher, or 27 with related comorbidities.
  •  

  • The prescription is for the treatment of conditions other than weight management, such as off-label use, where FDA approval for the specific condition is absent.
  •  

  • There's failure to document a comprehensive weight management program or lifestyle modification, which usually involves evidence of dietary, physical activity, and behavioral changes.
  •  

  • The patient has a known hypersensitivity or contraindication to either of Contrave's components, naltrexone or bupropion, as documented in medical records.
  •  

  • The request for Contrave does not align with the treatment duration limits specified by Blue Cross Blue Shield of Minnesota, typically exceeding the coverage guideline period.

 

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing costs.

 

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 Contrave Coverage with Blue Cross Blue Shield of Minnesota

 

Initial Research and Preparation

 

  • Visit the official Blue Cross Blue Shield of Minnesota website to gather information about their coverage policies related to weight management medications, including Contrave.
  •  

  • Review your specific health insurance policy documents to determine if there are any exclusions, restrictions, or prior authorization requirements for coverage of weight loss medications.
  •  

  • Contact Blue Cross Blue Shield customer service via phone or through their online portal to get detailed information on Contrave coverage and any necessary steps for approval.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your weight management needs and the potential benefits of Contrave for your situation.
  •  

  • Request a written prescription for Contrave from your healthcare provider, ensuring it includes relevant medical justification that supports its necessity for your treatment.

 

Submit the Prior Authorization Request

 

  • Check if Blue Cross Blue Shield of Minnesota requires prior authorization for Contrave, as this is often mandatory for medications such as weight loss drugs.
  •  

  • If prior authorization is needed, work with your healthcare provider to complete and submit the necessary forms. These documents should detail the medical necessity of Contrave and include any supporting letters or medical records.
  •  

  • Follow up directly with Blue Cross Blue Shield to confirm receipt and processing of your prior authorization request.

 

Appeal if Necessary

 

  • If your initial request for coverage is denied, review the denial letter from Blue Cross Blue Shield carefully to understand the reasons for denial.
  •  

  • Gather any additional supporting documentation, such as further medical opinions or detailed treatment history, and file an appeal with Blue Cross Blue Shield of Minnesota.
  •  

  • Consider seeking assistance from your healthcare provider for the appeal process, as they may provide additional medical justification or clarification.

 

Check for Patient Assistance Programs

 

  • Explore manufacturer-sponsored patient assistance programs, which may offer financial assistance or discounts for Contrave if insurance coverage is incomplete or unavailable.
  •  

  • Contact the Contrave manufacturer or visit their website for information on available support programs, eligibility requirements, and application procedures.

 

Monitor and Maintain Coverage

 

  • Once Contrave is approved and covered, continuously monitor your prescriptions and Blue Cross Blue Shield statements to ensure ongoing coverage without unexpected changes.
  •  

  • Keep open communication with your healthcare provider and insurance company to stay informed about any policy updates, changes in medication needs, or renewal requirements for prior authorization.

 

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.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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Everything you need is included:

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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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