Does Blue Cross Blue Shield of North Carolina Cover Phentermine (Adipex-P, Lomaira)

Explore if Blue Cross NC covers Phentermine, reasons for denial, how to secure coverage, costs without insurance, and FAQ insights.
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Coverage Overview

 

  • Blue Cross Blue Shield of North Carolina may cover Phentermine (Adipex-P, Lomaira) for weight loss when medically necessary.

 

Eligibility Criteria

 

  • Coverage usually requires that the patient has a body mass index (BMI) above a certain threshold, often 27 with comorbidities or 30 without.
  • The prescription must often follow a physician-supervised weight loss program.

 

Prior Authorization

 

  • Requiring prior authorization means your physician must provide the medical necessity for the use of Phentermine.
  • The request is subject to evaluation to ensure criteria are met, including attempted lifestyle changes.

 

Additional Considerations

 

  • Duration of the prescription might be limited due to its classification as a short-term weight management solution.
  • Phentermine is typically not covered for cosmetic weight loss purposes.

 

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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 Phentermine (Adipex-P, Lomaira) Coverage with Blue Cross Blue Shield of North Carolina

 

Verify Phentermine Coverage

 

  • Consult the Blue Cross Blue Shield of North Carolina (BCBSNC) formulary list to check if Phentermine (Adipex-P, Lomaira) is covered under your specific plan. Formulary lists are often available on the BCBSNC website or through contacting customer service.
  •  

  • Understand that coverage can vary based on your specific plan and whether your plan includes coverage for weight loss medications.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Phentermine. Ensure they understand any related health conditions well, as this can influence insurance coverage decisions.
  •  

  • Request that your healthcare provider evaluates and documents your clinical need for Phentermine. This can help strengthen your case when seeking approval from your insurance provider.

 

Request Prior Authorization

 

  • Ask your healthcare provider to submit a prior authorization request for Phentermine to BCBSNC. This process involves verifying that Phentermine is necessary and appropriate based on your health needs.
  •  

  • Provide any additional documentation requested by BCBSNC, such as your provider's clinical notes or any previous treatments and their outcomes.

 

Contact BCBSNC Customer Service

 

  • Reach out to BCBSNC customer service to inquire about the status of your prior authorization request. This can ensure you're informed about the decision process and any additional steps you might need to take.
  •  

  • Ask for clarification on any denied request. If necessary, understand the appeal process through which you can challenge a denial decision.

 

Evaluate Alternative Options

 

  • If Phentermine is not covered, discuss with your healthcare provider possible alternative medications or treatments that might have coverage under your BCBSNC plan.
  •  

  • Explore possible patient assistance programs that might help with the cost of Phentermine outside of your insurance benefits.
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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Phentermine (Adipex-P, Lomaira)

Explore if Blue Cross NC covers Phentermine, reasons for denial, how to secure coverage, costs without insurance, and FAQ insights.
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Is Phentermine (Adipex-P, Lomaira) Covered by Blue Cross Blue Shield of North Carolina

 

Coverage Overview

 

  • Blue Cross Blue Shield of North Carolina may cover Phentermine (Adipex-P, Lomaira) for weight loss when medically necessary.

 

Eligibility Criteria

 

  • Coverage usually requires that the patient has a body mass index (BMI) above a certain threshold, often 27 with comorbidities or 30 without.
  • The prescription must often follow a physician-supervised weight loss program.

 

Prior Authorization

 

  • Requiring prior authorization means your physician must provide the medical necessity for the use of Phentermine.
  • The request is subject to evaluation to ensure criteria are met, including attempted lifestyle changes.

 

Additional Considerations

 

  • Duration of the prescription might be limited due to its classification as a short-term weight management solution.
  • Phentermine is typically not covered for cosmetic weight loss purposes.

 

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Blue Cross Blue Shield of North Carolina's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Eligibility Requirements for Phentermine Coverage

 

  • Applicants must have a body mass index (BMI) of 30 kg/m² or greater (obesity).
  •  

  • For applicants with a BMI of 27-29.9 kg/m², at least one weight-related comorbidity must be present, such as hypertension, type 2 diabetes, or dyslipidemia.

 

Age Restrictions

 

  • Coverage applies to individuals 18 years of age or older.

 

Previous Weight Management Attempts

 

  • Documentation of failure in previous weight management programs including diet and exercise is required.
  •  

  • Provider must attest to ongoing lifestyle modification efforts such as dietary changes and regular physical activity.

 

Treatment Plan Documentation

 

  • A comprehensive treatment plan developed by a healthcare provider must be documented.
  •  

  • The plan should include monitoring of any comorbid conditions and regular follow-ups.

 

Physician Involvement

 

  • Prescription must be written by or in consultation with a healthcare provider specializing in weight management.

 

Treatment Duration and Reauthorization

 

  • Initial coverage is typically granted for a specified short-term period, such as 12 weeks.
  •  

  • For reauthorization, documentation of positive response to therapy, including weight loss and improvement in obesity-related conditions, is required.

 

Exclusion of Contraindications

 

  • Patient evaluation must ensure absence of contraindications like uncontrolled hypertension, history of cardiovascular disease, or hyperthyroidism.

 

Acceptable Combination Therapies

 

  • Phentermine may be covered in combination with other specific agents if medically necessary, based on current clinical guidelines.

 

Why Blue Cross Blue Shield of North Carolina Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Situations Where Phentermine is Not Covered

 

  • Phentermine is prescribed without a diagnosis of obesity as per medical guidelines. Patients must have a BMI (Body Mass Index) that meets the defined medical threshold for obesity, typically greater than 30, or 27 with associated health conditions.
  •  

  • The prescription is intended for cosmetic weight loss or non-medically necessary purposes. Coverage is not extended for lifestyle or aesthetic weight loss goals.
  •  

  • Therapy exceeds the recommended duration. Phentermine is generally prescribed for short-term use, often up to 12 weeks. Usage beyond this period without demonstrable clinical necessity is not covered.
  •  

  • The patient has a history of drug abuse or is using the medication in a manner inconsistent with prescribed guidelines. Misuse concerns may lead to denial of coverage.
  •  

  • The medication is not prescribed by a healthcare provider within the BCBSNC network or without proper pre-authorization. Prescriptions must align with the plan's network and authorization protocols.
  •  

  • No documentation of failed prior weight loss interventions such as dietary adjustments or exercise programs. Proof of prior unsuccessful attempts at weight loss with conventional methods may be required.

 

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How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 Phentermine (Adipex-P, Lomaira) Coverage with Blue Cross Blue Shield of North Carolina

 

Verify Phentermine Coverage

 

  • Consult the Blue Cross Blue Shield of North Carolina (BCBSNC) formulary list to check if Phentermine (Adipex-P, Lomaira) is covered under your specific plan. Formulary lists are often available on the BCBSNC website or through contacting customer service.
  •  

  • Understand that coverage can vary based on your specific plan and whether your plan includes coverage for weight loss medications.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Phentermine. Ensure they understand any related health conditions well, as this can influence insurance coverage decisions.
  •  

  • Request that your healthcare provider evaluates and documents your clinical need for Phentermine. This can help strengthen your case when seeking approval from your insurance provider.

 

Request Prior Authorization

 

  • Ask your healthcare provider to submit a prior authorization request for Phentermine to BCBSNC. This process involves verifying that Phentermine is necessary and appropriate based on your health needs.
  •  

  • Provide any additional documentation requested by BCBSNC, such as your provider's clinical notes or any previous treatments and their outcomes.

 

Contact BCBSNC Customer Service

 

  • Reach out to BCBSNC customer service to inquire about the status of your prior authorization request. This can ensure you're informed about the decision process and any additional steps you might need to take.
  •  

  • Ask for clarification on any denied request. If necessary, understand the appeal process through which you can challenge a denial decision.

 

Evaluate Alternative Options

 

  • If Phentermine is not covered, discuss with your healthcare provider possible alternative medications or treatments that might have coverage under your BCBSNC plan.
  •  

  • Explore possible patient assistance programs that might help with the cost of Phentermine outside of your insurance benefits.

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Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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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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