Does Blue Cross Blue Shield of North Carolina Cover Liraglutide (Saxenda)

Explore if Blue Cross NC covers Liraglutide (Saxenda), potential denial reasons, how to secure coverage, costs without insurance, and FAQs in this insightful guide.
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Liraglutide (Saxenda) Coverage

 

  • Blue Cross Blue Shield of North Carolina may cover Liraglutide (Saxenda) under specific situations as outlined in their coverage policy for weight management drugs.
  •  

  • Saxenda is indicated for adults with a BMI of 30 or greater, or 27 with related comorbidities, such as hypertension or diabetes.
  •  

  • Prior authorization is typically required. Members may need to demonstrate previous weight loss efforts or other weight-related health issues.
  •  

    Criteria for Coverage

     

  • Members may need to participate in a weight management program along with the use of Saxenda.
  •  

  • The coverage usually requires documented history or diagnosed conditions aligning with policy guidelines.
  •  

  • Regular follow-ups might be needed to continue receiving coverage, coupled with documented health improvements or weight loss.

 

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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.

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 North Carolina

 

Check Your Health Plan Details

 

  • Log in to your Blue Cross Blue Shield of North Carolina (BCBSNC) member account on their website or mobile app to access your health plan details.
  • Review your Summary of Benefits and Coverage to understand what is covered under your plan. Look for the section detailing prescription medication coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Liraglutide (Saxenda) as part of your treatment plan.
  • Ensure your healthcare provider documents the medical necessity for Saxenda, as this information will be crucial for obtaining insurance coverage.

 

Get a Prescription

 

  • Ask your healthcare provider to write a prescription for Saxenda and obtain any necessary medical documentation that supports the prescription.

 

Verify Coverage

 

  • Contact BCBSNC customer service via the number on your insurance card to confirm if Saxenda is covered under your specific plan.
  • Inquire about any pre-authorization requirements or necessary steps to ensure coverage of the medication.

 

Submit a Prior Authorization Request

 

  • If required, work with your healthcare provider to submit a prior authorization request to BCBSNC. This typically involves providing medical documentation and justification for the prescription.
  • Follow up with both your healthcare provider and BCBSNC to check the status of your prior authorization request.

 

Explore Formulary Alternatives

 

  • Ask BCBSNC about preferred alternatives if Saxenda is not on the formulary. Sometimes, similar medications might be covered.
  • Discuss with your healthcare provider whether these alternatives are suitable for your condition, should Saxenda not be covered.

 

Appeal a Denied Claim

 

  • If your request for coverage is denied, review the denial letter carefully to understand the reason for the decision.
  • Prepare an appeal by working with your healthcare provider to gather additional documentation or justification for the medication.
  • Submit your appeal as directed in the denial letter and follow up regularly with BCBSNC for updates on the appeal process.

 

Consider Manufacturer Assistance Programs

 

  • Visit the official Saxenda website to see if there are any manufacturer-sponsored patient assistance programs or discounts available for uninsured or underinsured patients.
  • Apply for these programs if eligible to help reduce out-of-pocket costs while you work on obtaining coverage through BCBSNC.

 

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Liraglutide (Saxenda)

Explore if Blue Cross NC covers Liraglutide (Saxenda), potential denial reasons, how to secure coverage, costs without insurance, and FAQs in this insightful guide.
Curex allergy drops unboxing

Is Liraglutide (Saxenda) Covered by Blue Cross Blue Shield of North Carolina

 

Liraglutide (Saxenda) Coverage

 

  • Blue Cross Blue Shield of North Carolina may cover Liraglutide (Saxenda) under specific situations as outlined in their coverage policy for weight management drugs.
  •  

  • Saxenda is indicated for adults with a BMI of 30 or greater, or 27 with related comorbidities, such as hypertension or diabetes.
  •  

  • Prior authorization is typically required. Members may need to demonstrate previous weight loss efforts or other weight-related health issues.
  •  

    Criteria for Coverage

     

  • Members may need to participate in a weight management program along with the use of Saxenda.
  •  

  • The coverage usually requires documented history or diagnosed conditions aligning with policy guidelines.
  •  

  • Regular follow-ups might be needed to continue receiving coverage, coupled with documented health improvements or weight loss.

 

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

 

Eligibility Criteria for Liraglutide (Saxenda)

 

  • Applicant must be an adult with a Body Mass Index (BMI) of 30 kg/m² or greater, classifying them as obese.
  •  

  • Alternatively, applicant can have a BMI of 27 kg/m² or greater if accompanied by weight-related comorbid conditions such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Demonstration of unsuccessful weight management with previous attempts at weight loss through diet and exercise alone is needed.
  •  

  • Approval requires documentation of a comprehensive weight management program, including a reduced-calorie diet and increased physical activity.
  •  

  • A prescription from an endocrinologist, cardiologist, or other specialized healthcare provider is necessary for approval.

 

Follow-Up and Monitoring Requirements

 

  • Regular follow-up appointments must be scheduled to monitor progress, side effects, and continued health benefits.
  •  

  • Documented weight loss of at least 4% of baseline body weight within the initial 16 weeks of treatment must be demonstrated for ongoing coverage.
  •  

  • Continued coverage is subject to periodic assessment of the individual's health status and adherence to the personalized weight management plan.

 

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

 

Reasons for Liraglutide (Saxenda) Denial by Blue Cross Blue Shield of North Carolina

 

  • **Non-Compliance with Usage Guidelines**: Blue Cross Blue Shield of North Carolina may deny coverage if the requested use of Liraglutide (Saxenda) is not in line with FDA-approved indications.
  •  

  • **Medical Necessity Not Demonstrated**: If the prescribing physician does not adequately demonstrate that Liraglutide is medically necessary for the patient, coverage may be denied. Thorough documentation of need and prior relevant medical history is needed to avoid denial.
  •  

  • **Lack of Previous Weight Management Attempts**: The insurer might deny coverage if there is no evidence of previous attempts at weight management, including lifestyle changes and the use of other medications, where appropriate.
  •  

  • **Inappropriate Patient Age**: Coverage may be denied if Saxenda is prescribed to patients outside the approved age range of 18 and older, as per FDA guidelines.
  •  

  • **Pre-existing Exclusions**: Individuals whose insurance plans have specific exclusions for weight management medications might not receive coverage for Liraglutide (Saxenda).
  •  

  • **Non-Preferred Drug Status**: If Saxenda is classified as a non-preferred medication on the patient's specific plan formulary, coverage might be denied unless justified through an exception process.
  •  

  • **Failure to Follow Plan Requirements**: Not fulfilling pre-authorization, step therapy requirements, or failing to provide documented reasons why alternatives are unsuitable could lead to denials.

 

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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 North Carolina

 

Check Your Health Plan Details

 

  • Log in to your Blue Cross Blue Shield of North Carolina (BCBSNC) member account on their website or mobile app to access your health plan details.
  • Review your Summary of Benefits and Coverage to understand what is covered under your plan. Look for the section detailing prescription medication coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Liraglutide (Saxenda) as part of your treatment plan.
  • Ensure your healthcare provider documents the medical necessity for Saxenda, as this information will be crucial for obtaining insurance coverage.

 

Get a Prescription

 

  • Ask your healthcare provider to write a prescription for Saxenda and obtain any necessary medical documentation that supports the prescription.

 

Verify Coverage

 

  • Contact BCBSNC customer service via the number on your insurance card to confirm if Saxenda is covered under your specific plan.
  • Inquire about any pre-authorization requirements or necessary steps to ensure coverage of the medication.

 

Submit a Prior Authorization Request

 

  • If required, work with your healthcare provider to submit a prior authorization request to BCBSNC. This typically involves providing medical documentation and justification for the prescription.
  • Follow up with both your healthcare provider and BCBSNC to check the status of your prior authorization request.

 

Explore Formulary Alternatives

 

  • Ask BCBSNC about preferred alternatives if Saxenda is not on the formulary. Sometimes, similar medications might be covered.
  • Discuss with your healthcare provider whether these alternatives are suitable for your condition, should Saxenda not be covered.

 

Appeal a Denied Claim

 

  • If your request for coverage is denied, review the denial letter carefully to understand the reason for the decision.
  • Prepare an appeal by working with your healthcare provider to gather additional documentation or justification for the medication.
  • Submit your appeal as directed in the denial letter and follow up regularly with BCBSNC for updates on the appeal process.

 

Consider Manufacturer Assistance Programs

 

  • Visit the official Saxenda website to see if there are any manufacturer-sponsored patient assistance programs or discounts available for uninsured or underinsured patients.
  • Apply for these programs if eligible to help reduce out-of-pocket costs while you work on obtaining coverage through BCBSNC.

 

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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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