Does Blue Cross Blue Shield of North Carolina Cover Phendimetrazine

Explore BCBS North Carolina's coverage for Phendimetrazine, reasons for denial, how to secure coverage, cost without insurance, and answers to FAQs.
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Coverage for Phendimetrazine

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) may cover Phendimetrazine if it's deemed medically necessary. Coverage often applies when prescribed for short-term management of obesity combined with a weight reduction plan, including exercise and caloric restriction.
  •  

  • Phendimetrazine is considered for use in patients with a Body Mass Index (BMI) of 30 or greater, or 27 or greater with risk factors such as hypertension, diabetes, or hyperlipidemia.

 

Basic Criteria for Coverage

 

  • Prescription by a healthcare professional who confirms the necessity through patient evaluation.
  •  

  • Documented failure of traditional weight loss programs to achieve desired weight loss.
  •  

  • Compliance with pre-authorization requirements ensuring that all criteria for coverage are met.

 

Additional Considerations

 

  • Phendimetrazine is typically covered under the pharmacy benefits plan, subject to the specific terms and policies, including any co-pays or deductibles that apply.
  •  

  • Patients should consult their specific plan details or contact BCBSNC customer service for personalized coverage information.

 

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Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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 Phendimetrazine Coverage with Blue Cross Blue Shield of North Carolina

 

Check Your Insurance Plan Details

 

  • Log into your Blue Cross Blue Shield of North Carolina (BCBSNC) member account or review your insurance documentation to understand the details of your coverage plan.
  •  

  • Check if prescription drug coverage is included in your plan and if there are any specific tiers or formularies for medications like Phendimetrazine.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss if Phendimetrazine is appropriate for you as part of your treatment plan.
  •  

  • Request that your healthcare provider provides the necessary documentation or prescription that may be required by BCBSNC for medication approval.

 

Verify Medication Coverage

 

  • Contact the BCBSNC customer service directly to verify if Phendimetrazine is covered under your current plan. You can find the contact information on your insurance card or their official website.
  •  

  • Ask whether prior authorization is needed for Phendimetrazine and clarify any out-of-pocket costs associated with this prescription.

 

Complete Prior Authorization (If Required)

 

  • If prior authorization is necessary, work with your healthcare provider to submit the required forms. This typically involves providing medical history and justifying the need for Phendimetrazine.
  •  

  • Ensure all documentation is accurate and complete to prevent delays in the approval process.

 

Wait for Approval

 

  • After submission, monitor the status of your prior authorization request through your BCBSNC member portal or by contacting their customer service.
  •  

  • Be prepared to respond quickly if additional information is requested by BCBSNC to support your medication coverage request.

 

Review Coverage Decisions

 

  • Once a decision is made, review the approval or denial notice carefully. If approved, confirm any copayments, deductibles, or coverage limits that apply to Phendimetrazine.
  •  

  • If denied, you can file an appeal according to the guidelines provided in the denial notice or seek assistance from your healthcare provider to support your case.

 

Obtain Your Prescription

 

  • Fill your Phendimetrazine prescription at a pharmacy that accepts BCBSNC coverage once approved.
  •  

  • Regularly check your insurance and pharmacy statements for any discrepancies in billing related to your prescription coverage.

 

Maintain Regular Reviews

 

  • Continually review your prescription needs and insurance coverage, especially when your medical condition or insurance policy changes.
  •  

  • Stay informed about any updates in your BCBSNC plan that might affect your access to medications like Phendimetrazine.

 

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Phendimetrazine

Explore BCBS North Carolina's coverage for Phendimetrazine, reasons for denial, how to secure coverage, cost without insurance, and answers to FAQs.
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Is Phendimetrazine Covered by Blue Cross Blue Shield of North Carolina

 

Coverage for Phendimetrazine

 

  • Blue Cross Blue Shield of North Carolina (BCBSNC) may cover Phendimetrazine if it's deemed medically necessary. Coverage often applies when prescribed for short-term management of obesity combined with a weight reduction plan, including exercise and caloric restriction.
  •  

  • Phendimetrazine is considered for use in patients with a Body Mass Index (BMI) of 30 or greater, or 27 or greater with risk factors such as hypertension, diabetes, or hyperlipidemia.

 

Basic Criteria for Coverage

 

  • Prescription by a healthcare professional who confirms the necessity through patient evaluation.
  •  

  • Documented failure of traditional weight loss programs to achieve desired weight loss.
  •  

  • Compliance with pre-authorization requirements ensuring that all criteria for coverage are met.

 

Additional Considerations

 

  • Phendimetrazine is typically covered under the pharmacy benefits plan, subject to the specific terms and policies, including any co-pays or deductibles that apply.
  •  

  • Patients should consult their specific plan details or contact BCBSNC customer service for personalized coverage information.

 

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

 

Criteria for Coverage of Phendimetrazine

 

  • Phendimetrazine is considered for coverage only when prescribed as part of a comprehensive weight management program, which includes a medically-supervised diet and exercise plan.
  •  

  • Patients 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 comorbid condition, such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient must be 18 years of age or older to receive coverage.
  •  

  • Before approval, documentation from the healthcare provider is required to establish that the patient has shown an inadequate weight response to lifestyle modification alone, without pharmaceutical intervention.
  •  

  • A healthcare provider must monitor the patient's progress and effectiveness of treatment regularly, typically suggested every 12 weeks, to ensure continuation of coverage.
  •  

  • Phendimetrazine coverage requires documentation that it is being used for short-term management of obesity as part of a treatment plan under direct medical supervision.
  •  

  • Prescription requests must specify that the drug is being used as an adjunct to diet and exercise and not as a standalone therapy.

 

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

 

Criteria for Non-Coverage of Phendimetrazine by Blue Cross Blue Shield of North Carolina

 

  • **Non-Medically Necessary Use**: Phendimetrazine may not be covered if it's determined that the use of the drug is not medically necessary as part of a weight-loss treatment plan.
  •  

  • **Exceeding Maximum Dosage Limitations**: Coverage might be denied if prescribed dosages exceed the established guidelines or maximum daily dosages recommended by medical standards or Blue Cross Blue Shield's specific dosage policies.
  •  

  • **Lack of Proper Authorization**: If prior authorization requirements are not fulfilled or documented appropriately, coverage may be denied. This could include not providing sufficient documentation from the prescribing physician.
  •  

  • **Off-Label Use**: Phendimetrazine prescribed for uses that are not FDA-approved or are outside the accepted medical guidelines might not be covered.
  •  

  • **Non-Eligible Diagnoses**: If the patient’s condition does not align with the diagnoses classified as eligible for Phendimetrazine treatment under the insurer’s guidelines, the drug may not be covered.
  •  

  • **Failure to Meet Medical Criteria for Obesity**: In cases where the patient does not meet the specific medical criteria for obesity or overweight conditions as defined by Blue Cross Blue Shield of North Carolina, coverage might be denied.
  •  

  • **Inadequate Trial of Lifestyle Interventions**: If there's evidence of insufficient engagement in prescribed lifestyle changes like diet and exercise prior to medication therapy, coverage for Phendimetrazine might be refused.
  •  

 

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How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

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 Phendimetrazine Coverage with Blue Cross Blue Shield of North Carolina

 

Check Your Insurance Plan Details

 

  • Log into your Blue Cross Blue Shield of North Carolina (BCBSNC) member account or review your insurance documentation to understand the details of your coverage plan.
  •  

  • Check if prescription drug coverage is included in your plan and if there are any specific tiers or formularies for medications like Phendimetrazine.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss if Phendimetrazine is appropriate for you as part of your treatment plan.
  •  

  • Request that your healthcare provider provides the necessary documentation or prescription that may be required by BCBSNC for medication approval.

 

Verify Medication Coverage

 

  • Contact the BCBSNC customer service directly to verify if Phendimetrazine is covered under your current plan. You can find the contact information on your insurance card or their official website.
  •  

  • Ask whether prior authorization is needed for Phendimetrazine and clarify any out-of-pocket costs associated with this prescription.

 

Complete Prior Authorization (If Required)

 

  • If prior authorization is necessary, work with your healthcare provider to submit the required forms. This typically involves providing medical history and justifying the need for Phendimetrazine.
  •  

  • Ensure all documentation is accurate and complete to prevent delays in the approval process.

 

Wait for Approval

 

  • After submission, monitor the status of your prior authorization request through your BCBSNC member portal or by contacting their customer service.
  •  

  • Be prepared to respond quickly if additional information is requested by BCBSNC to support your medication coverage request.

 

Review Coverage Decisions

 

  • Once a decision is made, review the approval or denial notice carefully. If approved, confirm any copayments, deductibles, or coverage limits that apply to Phendimetrazine.
  •  

  • If denied, you can file an appeal according to the guidelines provided in the denial notice or seek assistance from your healthcare provider to support your case.

 

Obtain Your Prescription

 

  • Fill your Phendimetrazine prescription at a pharmacy that accepts BCBSNC coverage once approved.
  •  

  • Regularly check your insurance and pharmacy statements for any discrepancies in billing related to your prescription coverage.

 

Maintain Regular Reviews

 

  • Continually review your prescription needs and insurance coverage, especially when your medical condition or insurance policy changes.
  •  

  • Stay informed about any updates in your BCBSNC plan that might affect your access to medications like Phendimetrazine.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

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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.

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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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