Does Blue Cross of Idaho Cover Saxenda

Explore Saxenda coverage details with Blue Cross of Idaho, tips for approval, costs without insurance, and answers to common questions.
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Coverage for Saxenda

 

  • Blue Cross of Idaho may cover Saxenda for weight management in specific cases, primarily when prescribed for obesity-related conditions.
  •  

  • Coverage often requires prior authorization, meaning the healthcare provider must request approval before the medication is dispensed.

 

Criteria for Coverage

 

  • Patients typically must meet certain criteria, such as having a BMI over a specified level, often 30 or above, or 27 with associated comorbidities like Type 2 diabetes or hypertension.
  •  

  • Documentation of previous weight loss attempts may be necessary to demonstrate the need for pharmaceutical intervention.

 

General Rules

 

  • Policyholders should consult their plan’s specific details, as coverage can vary based on the plan and individual factors.
  •  

  • It’s important to work closely with a healthcare provider to ensure all documentation is complete and meets Blue Cross of Idaho’s requirements for Saxenda coverage.

 

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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.

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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 Saxenda Coverage with Blue Cross of Idaho

 

Contact Blue Cross of Idaho

 

  • Call the customer service number on your insurance card to inquire about coverage for Saxenda. Ask specific questions regarding their policy on weight loss medications.
  •  

  • Log into your Blue Cross of Idaho online account to search for details about your prescription drug benefits, including any information on Saxenda.

 

Verify Plan Coverage

 

  • Check if Saxenda is covered under your current medical policy plan. Determine if it falls under the formulary list of covered medications.
  •  

  • Review your plan's benefits and any potential copayment or coinsurance responsibilities for prescription drugs.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of Saxenda for weight management and ask them to provide documentation supporting your need for the medication.
  •  

  • Ensure your healthcare provider is informed of any requirements from Blue Cross of Idaho for prior authorization before prescribing Saxenda.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to obtain prior authorization. This typically involves completing and submitting a formal request form to Blue Cross of Idaho.
  •  

  • Include all necessary documentation provided by your doctor to justify the medical necessity of Saxenda.

 

Check On the Authorization Status

 

  • After submission, regularly check the status of your prior authorization request by contacting Blue Cross of Idaho.
  •  

  • It might take several business days for a decision to be made, but following up helps ensure nothing falls through the cracks.

 

Appeal a Denial if Necessary

 

  • If the request for Saxenda coverage is denied, ask Blue Cross of Idaho for the reasons behind the decision and understand the appeals process.
  •  

  • Work with your healthcare provider to provide any additional information that might support your appeal, and resubmit the request.

 

Fill Your Prescription

 

  • Once the authorization is approved, proceed to fill your Saxenda prescription at a pharmacy that accepts Blue Cross of Idaho.
  •  

  • Pay attention to the cost-sharing obligations such as copays or coinsurance, and utilize any available pharmacy benefits or discounts.

 

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FAQs

Does Blue Cross of Idaho Cover Saxenda

Explore Saxenda coverage details with Blue Cross of Idaho, tips for approval, costs without insurance, and answers to common questions.
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Is Saxenda Covered by Blue Cross of Idaho

 

Coverage for Saxenda

 

  • Blue Cross of Idaho may cover Saxenda for weight management in specific cases, primarily when prescribed for obesity-related conditions.
  •  

  • Coverage often requires prior authorization, meaning the healthcare provider must request approval before the medication is dispensed.

 

Criteria for Coverage

 

  • Patients typically must meet certain criteria, such as having a BMI over a specified level, often 30 or above, or 27 with associated comorbidities like Type 2 diabetes or hypertension.
  •  

  • Documentation of previous weight loss attempts may be necessary to demonstrate the need for pharmaceutical intervention.

 

General Rules

 

  • Policyholders should consult their plan’s specific details, as coverage can vary based on the plan and individual factors.
  •  

  • It’s important to work closely with a healthcare provider to ensure all documentation is complete and meets Blue Cross of Idaho’s requirements for Saxenda coverage.

 

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Blue Cross of Idaho's Approved Criteria for Saxenda Coverage

 

Eligibility Criteria for Saxenda Coverage

 

  • The patient must have a Body Mass Index (BMI) of 30 kg/m² or greater, classified as obesity, 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 qualify for Saxenda therapy.
  •  

  • Prior to initiating Saxenda treatment, it is required that the patient has attempted weight management through lifestyle modifications, including a reduced-calorie diet and increased physical activity, without achieving significant weight loss.
  •  

  • Saxenda treatment must be prescribed by a healthcare professional experienced in the treatment of obesity and associated comorbidities.
  •  

  • The patient must demonstrate a significant clinical response to Saxenda therapy, typically defined as at least a 4% reduction in baseline body weight within 16 weeks of treatment initiation.

 

Continued Coverage Requirements

 

  • Patients must undergo regular follow-ups with their healthcare provider to ensure the continued effectiveness and safety of Saxenda therapy.
  •  

  • Weight loss progress must be documented by the healthcare provider, with ongoing treatment contingent upon continued clinical benefit, typically evidenced by further weight reduction or maintenance of initial weight loss.
  •  

  • The continued use of Saxenda should be accompanied by lifestyle interventions, focusing on dietary management and physical activity adjustments.
  •  

  • Healthcare providers must reassess the patient’s overall health status and the appropriateness of continued Saxenda therapy at regular intervals.

 

Why Blue Cross of Idaho Might Deny Saxenda Coverage

 

Situations Where Coverage is Denied

 

  • Saxenda is not covered when it is prescribed solely for cosmetic weight loss, as opposed to medical necessity related to comorbid health conditions such as diabetes or heart disease.
  •  

  • Denial occurs if Saxenda is not approved by the Food and Drug Administration (FDA) for the specific condition or population it is being prescribed for.
  •  

  • Coverage is not provided if the patient has not met the predefined clinical criteria or guidelines laid out by Blue Cross of Idaho for weight management medications.
  •  

  • Blue Cross of Idaho might deny coverage if there is a lack of documentation showing the failure of other weight loss methods or medications before Saxenda was prescribed.
  •  

  • Insurance does not cover Saxenda when prescribed off-label for conditions not explicitly approved by Blue Cross of Idaho policies.
  •  

  • Claims for Saxenda might be denied if the prescription does not align with the patient's benefit plan terms or falls outside of their enrolled plan coverage.
  •  

  • Coverage may be refused if the prescriber is not part of the Blue Cross of Idaho network or if proper referral processes are not followed.
  •  

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket 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 Saxenda Coverage with Blue Cross of Idaho

 

Contact Blue Cross of Idaho

 

  • Call the customer service number on your insurance card to inquire about coverage for Saxenda. Ask specific questions regarding their policy on weight loss medications.
  •  

  • Log into your Blue Cross of Idaho online account to search for details about your prescription drug benefits, including any information on Saxenda.

 

Verify Plan Coverage

 

  • Check if Saxenda is covered under your current medical policy plan. Determine if it falls under the formulary list of covered medications.
  •  

  • Review your plan's benefits and any potential copayment or coinsurance responsibilities for prescription drugs.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of Saxenda for weight management and ask them to provide documentation supporting your need for the medication.
  •  

  • Ensure your healthcare provider is informed of any requirements from Blue Cross of Idaho for prior authorization before prescribing Saxenda.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to obtain prior authorization. This typically involves completing and submitting a formal request form to Blue Cross of Idaho.
  •  

  • Include all necessary documentation provided by your doctor to justify the medical necessity of Saxenda.

 

Check On the Authorization Status

 

  • After submission, regularly check the status of your prior authorization request by contacting Blue Cross of Idaho.
  •  

  • It might take several business days for a decision to be made, but following up helps ensure nothing falls through the cracks.

 

Appeal a Denial if Necessary

 

  • If the request for Saxenda coverage is denied, ask Blue Cross of Idaho for the reasons behind the decision and understand the appeals process.
  •  

  • Work with your healthcare provider to provide any additional information that might support your appeal, and resubmit the request.

 

Fill Your Prescription

 

  • Once the authorization is approved, proceed to fill your Saxenda prescription at a pharmacy that accepts Blue Cross of Idaho.
  •  

  • Pay attention to the cost-sharing obligations such as copays or coinsurance, and utilize any available pharmacy benefits or discounts.

 

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

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Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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.

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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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