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

Explore Orlistat coverage by Blue Cross NC, reasons for denial, cost without insurance, and FAQs. Learn how to secure coverage effectively.
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Coverage for Orlistat (Xenical, Alli)

 

  • Blue Cross Blue Shield of North Carolina may cover Orlistat (Xenical, Alli) under certain circumstances. Coverage is often dependent on the individual's policy details and medical necessity.
  •  

  • Orlistat is typically covered if prescribed as part of a comprehensive weight management program that includes diet, exercise, and behavioral interventions.
  •  

  • A doctor may need to provide documentation that alternative weight loss measures have not been effective before Orlistat is approved.

 

Basic Eligibility Criteria

 

  • Patients usually must have a Body Mass Index (BMI) of 30 or higher, or a BMI of 27 or higher with existing comorbidities such as diabetes or hypertension.
  •  

  • Potential candidates generally need prior authorization, confirming the medication's necessity and expected benefits.
  •  

  • It is crucial for patients to contact their insurance provider directly to verify specific coverage details and any out-of-pocket costs they might incur.

 

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

 

Verify Coverage in Your Plan

 

  • Log in to your Blue Cross Blue Shield of North Carolina account through their website or mobile app to access your plan details.
  •  

  • Review your benefits to check if prescription drug coverage includes Orlistat. Look at any specific sections for weight management or diet medications.
  •  

  • Contact Blue Cross Blue Shield customer service directly for detailed inquiries about Orlistat coverage. They can provide specifics based on your plan.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Orlistat.
  •  

  • Your doctor should provide medical documentation or a prescription that justifies the use of Orlistat based on your health status.
  •  

  • Ask your doctor to write a letter of medical necessity if your insurance provider requires additional documentation for coverage.

 

Submit a Prior Authorization Request

 

  • If Orlistat requires prior authorization under your plan, your healthcare provider's office will usually handle this process.
  •  

  • Ensure all required forms and documentation are completed and submitted. This typically includes your prescription and any supporting medical information justifying the medication's necessity.
  •  

  • Follow up with your healthcare provider or insurance company to confirm the submission status and verify if any further information is needed.

 

Explore Generic or Alternative Options

 

  • If Orlistat is not covered under your specific plan, inquire about generic alternatives that might be covered.
  •  

  • Discuss possible over-the-counter alternatives like Alli with your healthcare provider, as these might not require prescription coverage.
  •  

  • Consider asking your healthcare provider for assistance in exploring patient assistance programs or discounts that may offset costs if coverage is denied.

 

Appeal a Denied Claim

 

  • Should your insurance company deny the coverage claim, review the denial letter thoroughly to understand the reason.
  •  

  • Gather any additional documentation or evidence required to support your case for needing Orlistat.
  •  

  • Submit an appeal through the formal process outlined in the denial letter, including all necessary documentation and support from your healthcare provider.
  •  

  • Follow up on the appeal process and consult with a healthcare advocate or legal advisor if additional support is needed.

 

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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 Orlistat (Xenical, Alli)

Explore Orlistat coverage by Blue Cross NC, reasons for denial, cost without insurance, and FAQs. Learn how to secure coverage effectively.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Blue Cross Blue Shield of North Carolina

 

Coverage for Orlistat (Xenical, Alli)

 

  • Blue Cross Blue Shield of North Carolina may cover Orlistat (Xenical, Alli) under certain circumstances. Coverage is often dependent on the individual's policy details and medical necessity.
  •  

  • Orlistat is typically covered if prescribed as part of a comprehensive weight management program that includes diet, exercise, and behavioral interventions.
  •  

  • A doctor may need to provide documentation that alternative weight loss measures have not been effective before Orlistat is approved.

 

Basic Eligibility Criteria

 

  • Patients usually must have a Body Mass Index (BMI) of 30 or higher, or a BMI of 27 or higher with existing comorbidities such as diabetes or hypertension.
  •  

  • Potential candidates generally need prior authorization, confirming the medication's necessity and expected benefits.
  •  

  • It is crucial for patients to contact their insurance provider directly to verify specific coverage details and any out-of-pocket costs they might incur.

 

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

 

Eligibility Criteria for Orlistat Coverage

 

  • Body Mass Index (BMI): Members must have a BMI of 30 kg/m² or greater. Alternatively, they may qualify if their BMI is 27 kg/m² or greater when associated with at least one weight-related comorbidity, such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Previous Weight Loss Attempts: Documentation must be provided showing that the member has been unsuccessful in achieving or maintaining a clinically meaningful weight loss through diet and exercise alone. This should include at least a six-month trial of a physician-supervised weight loss program.
  •  

  • Age: Coverage is typically available for members who are 18 years of age or older.
  •  

 

Prescribing Physician Requirements

 

  • The prescribing physician must be a specialist in treating obesity or a primary care provider who has experience managing obesity treatment plans.
  •  

  • The physician must provide documentation of ongoing monitoring of the member’s weight loss and health status, generally on a monthly basis.
  •  

 

Duration and Monitoring

 

  • Initial authorization for Orlistat is typically for a three-month period, during which time the member must demonstrate weight loss. After the initial period, further authorization for continued coverage requires evidence of adherence to the medication and a clinically significant weight loss of at least 5% of body weight.
  •  

  • Regular follow-up appointments with the prescribing physician must be documented. These appointments should include assessments of weight loss and evaluation of potential side effects of the medication.
  •  

 

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

 

Situations Where Coverage is Denied

 

  • Prescription does not meet the medical necessity criteria specified by Blue Cross Blue Shield of North Carolina for weight loss treatment.
  •  

  • Orlistat (Xenical, Alli) is requested for a patient without a documented Body Mass Index (BMI) of 30 kg/m² or higher.
  •  

  • Patient has not attempted and documented failure of a physician-supervised weight loss program including dietary changes, physical activity, and behavior modification.
  •  

  • Orlistat is intended for cosmetic weight loss rather than for treatment of obesity-related health conditions.
  •  

  • The patient has a history of malabsorption syndromes or cholestasis, which contraindicates the use of Orlistat.
  •  

  • The prescription does not align with FDA-approved indications or dosing guidelines for Orlistat.
  •  

  • Orlistat is being requested in combination with other medications specifically for off-label, unapproved weight management purposes.
  •  

  • Patient has not undergone requisite laboratory tests to rule out secondary causes of obesity, as per insurer criteria.

 

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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 North Carolina

 

Verify Coverage in Your Plan

 

  • Log in to your Blue Cross Blue Shield of North Carolina account through their website or mobile app to access your plan details.
  •  

  • Review your benefits to check if prescription drug coverage includes Orlistat. Look at any specific sections for weight management or diet medications.
  •  

  • Contact Blue Cross Blue Shield customer service directly for detailed inquiries about Orlistat coverage. They can provide specifics based on your plan.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Orlistat.
  •  

  • Your doctor should provide medical documentation or a prescription that justifies the use of Orlistat based on your health status.
  •  

  • Ask your doctor to write a letter of medical necessity if your insurance provider requires additional documentation for coverage.

 

Submit a Prior Authorization Request

 

  • If Orlistat requires prior authorization under your plan, your healthcare provider's office will usually handle this process.
  •  

  • Ensure all required forms and documentation are completed and submitted. This typically includes your prescription and any supporting medical information justifying the medication's necessity.
  •  

  • Follow up with your healthcare provider or insurance company to confirm the submission status and verify if any further information is needed.

 

Explore Generic or Alternative Options

 

  • If Orlistat is not covered under your specific plan, inquire about generic alternatives that might be covered.
  •  

  • Discuss possible over-the-counter alternatives like Alli with your healthcare provider, as these might not require prescription coverage.
  •  

  • Consider asking your healthcare provider for assistance in exploring patient assistance programs or discounts that may offset costs if coverage is denied.

 

Appeal a Denied Claim

 

  • Should your insurance company deny the coverage claim, review the denial letter thoroughly to understand the reason.
  •  

  • Gather any additional documentation or evidence required to support your case for needing Orlistat.
  •  

  • Submit an appeal through the formal process outlined in the denial letter, including all necessary documentation and support from your healthcare provider.
  •  

  • Follow up on the appeal process and consult with a healthcare advocate or legal advisor if additional support is needed.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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.

 

Have questions left?

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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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