Does Blue Cross of Idaho Cover Orlistat (Xenical, Alli)

Discover if Blue Cross of Idaho covers Orlistat. Learn reasons for denial, ways to secure coverage, costs without insurance, and more in this comprehensive guide.
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Coverage for Orlistat (Xenical, Alli) under Blue Cross of Idaho

 

  • Blue Cross of Idaho may cover Orlistat prescriptions under specific health plans. Contact customer service or review your plan's formulary for details.
  •  

  • Typically, Orlistat coverage is available for patients with obesity or those at high risk due to related conditions, such as hypertension or diabetes.
  •  

  • Coverage may require prior authorization. This involves a healthcare provider demonstrating medical necessity based on specific criteria like BMI or comorbid conditions.
  •  

  • Patients should check if Orlistat is considered a preferred medication tier, which might impact copayment amounts.
  •  

  • Blue Cross of Idaho might have stipulations on where the prescription can be filled or if they prefer generic versions over brand names like Xenical or Alli.
  •  

 

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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.

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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 of Idaho

 

Verify Your Insurance Plan

 

  • Contact Blue Cross of Idaho customer service. Use the number on your insurance card to speak with a representative about your specific health plan benefits.
  • Inquire if Orlistat (Xenical, Alli) is covered under your current prescription drug plan. Be sure to ask if any requirements such as prior authorization or step therapy need to be fulfilled.
  • Request a copy of your insurance plan's drug formulary, which lists all medications covered under your plan, and review any specific information regarding Orlistat.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the use of Orlistat for weight management. Your doctor should evaluate whether this medication is appropriate for your health needs.
  • Ask your doctor to provide any necessary documentation or certificates that may support your prescription, such as a letter of medical necessity.

 

Prescription and Pharmacy Coordination

 

  • Ask your doctor to send the prescription for Orlistat to a participating pharmacy within Blue Cross of Idaho’s network to ensure coverage.
  • Before filling the prescription, check with the pharmacy to confirm your insurance will cover Orlistat and inquire about your copayment or coinsurance responsibilities.
  • If your insurance requires prior authorization, the pharmacy or your healthcare provider will need to initiate and complete the authorization request.

 

Submitting Claims and Appeals (if necessary)

 

  • If your insurance denies coverage, review the denial letter or Explanation of Benefits (EOB) to understand the reasons.
  • Work with your healthcare provider to gather any additional documentation necessary to appeal the decision, such as detailed medical records or letters from specialists.
  • Submit an appeal to Blue Cross of Idaho following their specified process for reconsideration. Include all supporting documents and ensure all forms are filled out correctly.
  • Keep records of all communications, documents submitted, and any decisions made by your insurance during this process.

 

Utilize Additional Resources

 

  • If you encounter challenges, consider contacting a patient advocate or consulting with other resources such as the State Insurance Department for further assistance.
  • Explore any generic versions or alternative weight management medications that may have fewer restrictions if Orlistat is ultimately unavailable through your plan.

 

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FAQs

Does Blue Cross of Idaho Cover Orlistat (Xenical, Alli)

Discover if Blue Cross of Idaho covers Orlistat. Learn reasons for denial, ways to secure coverage, costs without insurance, and more in this comprehensive guide.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Blue Cross of Idaho

 

Coverage for Orlistat (Xenical, Alli) under Blue Cross of Idaho

 

  • Blue Cross of Idaho may cover Orlistat prescriptions under specific health plans. Contact customer service or review your plan's formulary for details.
  •  

  • Typically, Orlistat coverage is available for patients with obesity or those at high risk due to related conditions, such as hypertension or diabetes.
  •  

  • Coverage may require prior authorization. This involves a healthcare provider demonstrating medical necessity based on specific criteria like BMI or comorbid conditions.
  •  

  • Patients should check if Orlistat is considered a preferred medication tier, which might impact copayment amounts.
  •  

  • Blue Cross of Idaho might have stipulations on where the prescription can be filled or if they prefer generic versions over brand names like Xenical or Alli.
  •  

 

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Start with Curex

Blue Cross of Idaho's Approved Criteria for Orlistat (Xenical, Alli) Coverage

 

Blue Cross of Idaho's Coverage Criteria for Orlistat (Xenical, Alli)

 

  • Orlistat is covered for individuals who are clinically obese, denoted by a Body Mass Index (BMI) of 30 kg/m² or higher.
  •  

  • Coverage is also extended to individuals with a BMI of 27 kg/m² or higher if they have comorbid conditions such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • A comprehensive weight management plan, which includes a reduced-calorie diet, increased physical activity, and behavioral modifications, is required for coverage eligibility.
  •  

  • The individual must have documented unsuccessful weight loss attempts through traditional methods, including lifestyle changes and dietary adjustments, prior to seeking pharmaceutical assistance with Orlistat.
  •  

  • Regular follow-up consultations with a healthcare professional to track progress and assess the continued need for Orlistat are required as part of the coverage criteria.
  •  

  • Approval for coverage necessitates a prescription from a licensed healthcare provider who can confirm the suitability and need for Orlistat as part of the individual's weight management strategy.
  •  

  • Documentation of adherence to the prescribed dietary plan and lifestyle modifications must be maintained and submitted periodically to ensure ongoing coverage.

 

Why Blue Cross of Idaho Might Deny Orlistat (Xenical, Alli) Coverage

 

Reasons for Denial of Orlistat Coverage

 

  • Blue Cross of Idaho may deny coverage for Orlistat if it is deemed not medically necessary. The determination of medical necessity often depends on various factors such as the member's specific medical conditions and the prescribed use of the medication.
  •  

  • Coverage may be denied if the prescribed medication does not meet the insurer's specific criteria for prior authorization. This can include failing to demonstrate that alternative, less expensive treatments have been tried and found ineffective.
  •  

  • Orlistat coverage can also be denied if there is a lack of documentation supporting a long-term use requirement. Insurers may need evidence indicating that the medication is necessary over an extended period for managing the member's condition.
  •  

  • If Orlistat is being used for a non-FDA approved indication or in a dosage that is not recognized as standard treatment, Blue Cross of Idaho might not cover the prescription. Off-label uses often fall outside the scope of coverage.
  •  

  • Insurance may not cover the prescription if the member's plan excludes weight-loss drugs. Some health insurance policies have specific exclusions for medications primarily intended for weight management.
  •  

  • Coverage for Orlistat may be denied if the member has not met certain BMI (Body Mass Index) or other health criteria specified by the insurer. Insurers often have thresholds to determine eligibility for obesity medications based on health risk factors.
  •  

  • Denial can occur if the member fails to comply with required health programs or associated lifestyle changes outlined by Blue Cross of Idaho as part of the treatment protocol.

 

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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 of Idaho

 

Verify Your Insurance Plan

 

  • Contact Blue Cross of Idaho customer service. Use the number on your insurance card to speak with a representative about your specific health plan benefits.
  • Inquire if Orlistat (Xenical, Alli) is covered under your current prescription drug plan. Be sure to ask if any requirements such as prior authorization or step therapy need to be fulfilled.
  • Request a copy of your insurance plan's drug formulary, which lists all medications covered under your plan, and review any specific information regarding Orlistat.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the use of Orlistat for weight management. Your doctor should evaluate whether this medication is appropriate for your health needs.
  • Ask your doctor to provide any necessary documentation or certificates that may support your prescription, such as a letter of medical necessity.

 

Prescription and Pharmacy Coordination

 

  • Ask your doctor to send the prescription for Orlistat to a participating pharmacy within Blue Cross of Idaho’s network to ensure coverage.
  • Before filling the prescription, check with the pharmacy to confirm your insurance will cover Orlistat and inquire about your copayment or coinsurance responsibilities.
  • If your insurance requires prior authorization, the pharmacy or your healthcare provider will need to initiate and complete the authorization request.

 

Submitting Claims and Appeals (if necessary)

 

  • If your insurance denies coverage, review the denial letter or Explanation of Benefits (EOB) to understand the reasons.
  • Work with your healthcare provider to gather any additional documentation necessary to appeal the decision, such as detailed medical records or letters from specialists.
  • Submit an appeal to Blue Cross of Idaho following their specified process for reconsideration. Include all supporting documents and ensure all forms are filled out correctly.
  • Keep records of all communications, documents submitted, and any decisions made by your insurance during this process.

 

Utilize Additional Resources

 

  • If you encounter challenges, consider contacting a patient advocate or consulting with other resources such as the State Insurance Department for further assistance.
  • Explore any generic versions or alternative weight management medications that may have fewer restrictions if Orlistat is ultimately unavailable through your plan.

 

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.

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.

 

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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