Does Blue Cross Blue Shield of Texas Cover Contrave

Explore Contrave coverage by Blue Cross Blue Shield of Texas. Learn why it might be denied, how to secure coverage, costs without insurance, and FAQs.
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Does Blue Cross Blue Shield of Texas Cover Contrave?

 

  • Coverage for Contrave, a weight management medication, may vary based on the specific health plan you are enrolled in with Blue Cross Blue Shield of Texas (BCBSTX).
  •  

  • It is important to verify whether your individual policy includes prescription drug benefits for weight management medications like Contrave.
  •  

  • Approval often requires documentation showing a medical necessity, such as a body mass index (BMI) over 30, or over 27 with related obesity conditions like hypertension or diabetes.
  •  

  • Prior authorization might be needed, meaning BCBSTX must approve the medication before the prescription is filled.
  •  

  • Contacting BCBSTX customer service or reviewing your policy documentation is advisable for precise details on coverage, as they can provide specific information regarding any copayments, limitations, or prerequisites.

 

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Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Contrave Coverage with Blue Cross Blue Shield of Texas

 

Verify Your Coverage

 

  • Contact Blue Cross Blue Shield of Texas (BCBSTX) member services by calling the number on the back of your insurance card. Inquire about your specific plan's coverage for prescription medications and specifically ask about Contrave.
  •  

  • Review your benefits package documents or the BCBSTX website to understand your prescription drug plan and any requirements for medications like Contrave.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your weight management goals and the suitability of Contrave for your situation.
  •  

  • Ensure your healthcare provider is familiar with BCBSTX protocols for prescribing Contrave, including any necessary documentation or prior authorization requirements.

 

Prior Authorization Request

 

  • Have your healthcare provider initiate a prior authorization request if required. This involves submitting medical justification for prescribing Contrave to BCBSTX for approval.
  •  

  • Ensure all forms and necessary documentation, including your medical history and treatment plan, are complete and accurate to facilitate the approval process.

 

Monitor the Approval Process

 

  • Contact BCBSTX to follow up on the prior authorization request. Ask about the status and estimated time of the decision, and make a note of any reference numbers for future calls.
  •  

  • Stay in communication with your healthcare provider to address any additional information or documentation needed for BCBSTX.

 

Fill Your Prescription

 

  • Upon approval, take your prescription for Contrave to a pharmacy participating in the BCBSTX network.
  •  

  • Inquire about any co-payments and ensure the prescription is processed under your plan. Use your insurance card during the transaction to receive the benefits.

 

Appeal If Necessary

 

  • If your initial request is denied, work with your healthcare provider to appeal the decision. Collect all pertinent medical information and a detailed rationale for why Contrave is necessary for your treatment.
  •  

  • Submit the appeal to BCBSTX and monitor the process closely, maintaining contact until a resolution is reached.

 

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FAQs

Does Blue Cross Blue Shield of Texas Cover Contrave

Explore Contrave coverage by Blue Cross Blue Shield of Texas. Learn why it might be denied, how to secure coverage, costs without insurance, and FAQs.
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Is Contrave Covered by Blue Cross Blue Shield of Texas

 

Does Blue Cross Blue Shield of Texas Cover Contrave?

 

  • Coverage for Contrave, a weight management medication, may vary based on the specific health plan you are enrolled in with Blue Cross Blue Shield of Texas (BCBSTX).
  •  

  • It is important to verify whether your individual policy includes prescription drug benefits for weight management medications like Contrave.
  •  

  • Approval often requires documentation showing a medical necessity, such as a body mass index (BMI) over 30, or over 27 with related obesity conditions like hypertension or diabetes.
  •  

  • Prior authorization might be needed, meaning BCBSTX must approve the medication before the prescription is filled.
  •  

  • Contacting BCBSTX customer service or reviewing your policy documentation is advisable for precise details on coverage, as they can provide specific information regarding any copayments, limitations, or prerequisites.

 

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Blue Cross Blue Shield of Texas's Approved Criteria for Contrave Coverage

 

Eligibility Criteria for Contrave Coverage

 

  • Members must have a documented diagnosis of obesity with 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 mellitus, or dyslipidemia.
  •  

  • The individual should have tried and failed to achieve or maintain weight loss through a dedicated exercise and diet program for at least six months.
  •  

  • A healthcare provider must submit a weight management plan in which the use of Contrave is a part of a comprehensive weight loss plan.

 

Prescription Requirements

 

  • The prescription for Contrave must be written by a healthcare provider specializing in obesity management or with specific expertise in weight management.
  •  

  • A comprehensive assessment of the individual's medical history and current medications must be performed to ensure there are no contraindications with Contrave usage.
  •  

  • The healthcare provider must provide documentation supporting the medical necessity of Contrave as part of the treatment plan.

 

Monitoring and Evaluation

 

  • Continued coverage of Contrave is subject to periodic evaluation of the treatment's effectiveness, defined as a weight loss of at least 5% of baseline body weight within 12 weeks of medication initiation.
  •  

  • Ongoing documentation is required to assess weight loss progress and any adverse effects associated with Contrave therapy.
  •  

  • Treatment will be re-evaluated if the member experiences significant side effects or shows an inadequate response to the medication.

 

Renewal Criteria

 

  • Renewal requests for Contrave coverage must include clinical documentation demonstrating sustained weight loss benefits and adherence to a comprehensive weight management program.
  •  

  • The member should continue to meet the initial eligibility criteria for weight-related comorbid conditions, if applicable.
  •  

  • There should be evidence of regular follow-up visits with a healthcare provider to monitor progress and adjust treatment as necessary.

 

Why Blue Cross Blue Shield of Texas Might Deny Contrave Coverage

 

Reasons for Contrave Coverage Denial by Blue Cross Blue Shield of Texas

 

  • Contrave is not covered if it does not align with the medical policy criteria set by the insurer, such as lacking either a diagnosis or medical necessity for weight loss treatment.
  •  

  • If the prescription for Contrave does not comply with the Blue Cross Blue Shield of Texas formulary guidelines, such as not being on the preferred drug list, it may be denied.
  •  

  • Coverage could be denied if there is a lack of documented prior use and failure of other weight management therapies, which might be required before covering a medication like Contrave.
  •  

  • The medication might not be covered if it is prescribed outside of FDA-approved indications or dosage parameters, which are strict about specific health conditions and usage.
  •  

  • If the patient's plan includes a specific exclusion for weight-loss medications, Contrave will not be covered despite its potential benefits.
  •  

  • Denial may occur if the patient fails to provide necessary documentation or details required for coverage determination, such as physician notes or test results supporting the use of Contrave.
  •  

  • Blue Cross Blue Shield of Texas might deny coverage if they determine that the cost of Contrave is too high in comparison to alternative medications or treatment options available within the plan.

 

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing costs.

 

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Contrave Coverage with Blue Cross Blue Shield of Texas

 

Verify Your Coverage

 

  • Contact Blue Cross Blue Shield of Texas (BCBSTX) member services by calling the number on the back of your insurance card. Inquire about your specific plan's coverage for prescription medications and specifically ask about Contrave.
  •  

  • Review your benefits package documents or the BCBSTX website to understand your prescription drug plan and any requirements for medications like Contrave.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your weight management goals and the suitability of Contrave for your situation.
  •  

  • Ensure your healthcare provider is familiar with BCBSTX protocols for prescribing Contrave, including any necessary documentation or prior authorization requirements.

 

Prior Authorization Request

 

  • Have your healthcare provider initiate a prior authorization request if required. This involves submitting medical justification for prescribing Contrave to BCBSTX for approval.
  •  

  • Ensure all forms and necessary documentation, including your medical history and treatment plan, are complete and accurate to facilitate the approval process.

 

Monitor the Approval Process

 

  • Contact BCBSTX to follow up on the prior authorization request. Ask about the status and estimated time of the decision, and make a note of any reference numbers for future calls.
  •  

  • Stay in communication with your healthcare provider to address any additional information or documentation needed for BCBSTX.

 

Fill Your Prescription

 

  • Upon approval, take your prescription for Contrave to a pharmacy participating in the BCBSTX network.
  •  

  • Inquire about any co-payments and ensure the prescription is processed under your plan. Use your insurance card during the transaction to receive the benefits.

 

Appeal If Necessary

 

  • If your initial request is denied, work with your healthcare provider to appeal the decision. Collect all pertinent medical information and a detailed rationale for why Contrave is necessary for your treatment.
  •  

  • Submit the appeal to BCBSTX and monitor the process closely, maintaining contact until a resolution is reached.

 

Premium Medication you can trust

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

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

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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Everything you need is included:

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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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