Does Blue Cross Blue Shield of North Carolina Cover Contrave

Explore Contrave coverage with Blue Cross NC, why claims may be denied, how to secure approval, costs without insurance, and FAQs.
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Coverage for Contrave

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) may cover Contrave, an FDA-approved weight-loss medication. However, coverage often depends on specific plan details.
  •  

  • Patients may need to meet certain criteria such as a minimum BMI, or they may be required to have specific health conditions like hypertension, type 2 diabetes, or elevated cholesterol levels.

 

Rules and Criteria

 

  • Prior authorization might be necessary, meaning your healthcare provider must verify that the medication is clinically necessary.
  •  

  • Some plans may require patients to have tried and not succeeded with other weight management programs before covering Contrave.
  •  

  • Patients should consult their BCBSNC plan details and work with their healthcare provider to determine coverage eligibility and required steps.

 

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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 North Carolina

 

Verify Coverage with Blue Cross Blue Shield of North Carolina

 

  • Begin by reviewing your specific health insurance plan documents or the Blue Cross Blue Shield of North Carolina (BCBSNC) member portal for any mention of prescription weight-loss medication coverage.
  •  

  • Contact BCBSNC customer service directly. Use the number on your insurance card to speak with a representative who can provide detailed information on whether Contrave is covered under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Contrave with your healthcare provider. Ensure they believe it is medically necessary for your weight management plan.
  •  

  • Ask your healthcare provider to supply any necessary documentation. This may include your prescription, detailed medical history, and the statement of medical necessity to support your request for insurance coverage.

 

Submit a Prior Authorization Request

 

  • If required by BCBSNC, work with your healthcare provider to submit a prior authorization request for Contrave. This step is crucial if considered a tiered or special medication.
  •  

  • Ensure all forms are filled out correctly and completely. Missing information can delay the approval process.

 

Receive a Determination

 

  • Once submitted, wait for BCBSNC to review your request. Approval times can vary, so contact them if you do not receive a response within the expected time frame.
  •  

  • If approved, review any stipulations or co-pays that may apply. Take notes of any usage requirements or preferred pharmacy networks.

 

Address Denials or Appeals

 

  • If your request is denied, reach out to BCBSNC to understand their reasoning. You have the right to appeal a denial.
  •  

  • Work with your healthcare provider to gather additional supporting documentation or alternative arguments to aid your appeal.

 

Utilize Alternative Options

 

  • If BCBSNC ultimately denies coverage, discuss alternative medications or weight management programs with your healthcare provider.
  •  

  • Consider manufacturer savings programs or patient assistance programs offered by Contrave’s manufacturer to reduce out-of-pocket costs.

 

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Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Contrave

Explore Contrave coverage with Blue Cross NC, why claims may be denied, how to secure approval, costs without insurance, and FAQs.
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Is Contrave Covered by Blue Cross Blue Shield of North Carolina

 

Coverage for Contrave

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) may cover Contrave, an FDA-approved weight-loss medication. However, coverage often depends on specific plan details.
  •  

  • Patients may need to meet certain criteria such as a minimum BMI, or they may be required to have specific health conditions like hypertension, type 2 diabetes, or elevated cholesterol levels.

 

Rules and Criteria

 

  • Prior authorization might be necessary, meaning your healthcare provider must verify that the medication is clinically necessary.
  •  

  • Some plans may require patients to have tried and not succeeded with other weight management programs before covering Contrave.
  •  

  • Patients should consult their BCBSNC plan details and work with their healthcare provider to determine coverage eligibility and required steps.

 

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Blue Cross Blue Shield of North Carolina's Approved Criteria for Contrave Coverage

 

Criteria for Contrave Coverage

 

  • Members are required to 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.
  • The patient must have attempted to lose weight through diet, exercise, and lifestyle interventions for at least six months prior to consideration for Contrave coverage.
  •  

  • Documentation from the healthcare provider must indicate that these lifestyle changes were insufficient to achieve or maintain clinically significant weight loss.
  • A prescription for Contrave must be issued by a licensed healthcare provider, and the use of the medication must be consistent with FDA-approved labeling.
  •  

  • Patients must have a complete medical assessment to rule out contraindications for the use of Contrave, such as uncontrolled hypertension or seizure disorders.
  • Regular monitoring and documentation of the patient's weight and health status by their healthcare provider must be established to ensure the medication’s effectiveness and safety.
  •  

Why Blue Cross Blue Shield of North Carolina Might Deny Contrave Coverage

 

Situations Where Coverage May Be Denied for Contrave

 

  • If Contrave is deemed not medically necessary based on the patient's health profile and history. Insurers often require proof that the medication is necessary for the health and well-being of the patient.
  •  

  • When prescribed for off-label uses that are not approved by health authorities. Blue Cross Blue Shield of North Carolina is likely to cover medications for specific, approved conditions only.
  •  

  • If a patient does not meet the specific coverage criteria, such as age restrictions, weight management metrics, or previous unsuccessful weight management attempts.
  •  

  • When less expensive drug alternatives are available and have not yet been tried. Insurance plans often have a step-therapy policy that requires patients to try more cost-effective treatments before approving expensive medications like Contrave.
  •  

  • Prescription failure to meet any pre-authorization requirements where specific approvals from Blue Cross Blue Shield of North Carolina must be obtained before treatment begins.
  •  

  • If used in combination with other medications that have not been approved for concurrent use according to the insurer's policy guidelines.

 

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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 North Carolina

 

Verify Coverage with Blue Cross Blue Shield of North Carolina

 

  • Begin by reviewing your specific health insurance plan documents or the Blue Cross Blue Shield of North Carolina (BCBSNC) member portal for any mention of prescription weight-loss medication coverage.
  •  

  • Contact BCBSNC customer service directly. Use the number on your insurance card to speak with a representative who can provide detailed information on whether Contrave is covered under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Contrave with your healthcare provider. Ensure they believe it is medically necessary for your weight management plan.
  •  

  • Ask your healthcare provider to supply any necessary documentation. This may include your prescription, detailed medical history, and the statement of medical necessity to support your request for insurance coverage.

 

Submit a Prior Authorization Request

 

  • If required by BCBSNC, work with your healthcare provider to submit a prior authorization request for Contrave. This step is crucial if considered a tiered or special medication.
  •  

  • Ensure all forms are filled out correctly and completely. Missing information can delay the approval process.

 

Receive a Determination

 

  • Once submitted, wait for BCBSNC to review your request. Approval times can vary, so contact them if you do not receive a response within the expected time frame.
  •  

  • If approved, review any stipulations or co-pays that may apply. Take notes of any usage requirements or preferred pharmacy networks.

 

Address Denials or Appeals

 

  • If your request is denied, reach out to BCBSNC to understand their reasoning. You have the right to appeal a denial.
  •  

  • Work with your healthcare provider to gather additional supporting documentation or alternative arguments to aid your appeal.

 

Utilize Alternative Options

 

  • If BCBSNC ultimately denies coverage, discuss alternative medications or weight management programs with your healthcare provider.
  •  

  • Consider manufacturer savings programs or patient assistance programs offered by Contrave’s manufacturer to reduce out-of-pocket costs.

 

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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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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